系统评价血必净注射液对腹部手术患者炎症反应影响的Meta分析

Systematic evaluation of effect of Xuebijing injection on inflammatory response of patients undergoing abdominal surgery:a Meta-analysis

目的评价血必净注射液对腹部手术患者炎症反应的影响,为其临床应用提供更可靠的依据。方法应用计算机检索中国知网(CNKI)、维普数据库(VIP)、万方数据库、美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、Cochrane图书馆、Medline数据库、Sci Finder数据库,查找从建库到2021年1月关于血必净注射液治疗腹部手术患者的随机对照试验(RCT),按照纳入与排除标准进行文献筛选、资料提取和质量评价,采用RevMan 5.3软件进行Meta分析,使用Stata 14.0进行Egger检验。结果最终纳入12篇文献,包含14项RCT研究,共1225名受试者,其中试验组614例,对照组611例。Meta分析结果显示,腹部手术患者围手术期联用血必净,能使机体炎症反应较对照组明显降低,能明显降低试验组的白细胞计数〔WBC;标准化均数差(SMD)=-0.83,95%可信区间(95%CI)为-1.36~-0.29,P=0.003〕、中性粒细胞比例(NEU%;SMD=-0.50,95%CI为-0.88~-0.12,P=0.01)、C-反应蛋白(CRP;SMD=-0.49,95%CI为-0.84~-0.15,P=0.005)、白细胞介素-6(IL-6;SMD=-1.89,95%CI为-3.00~-0.78,P=0.0009)、肿瘤坏死因子-α(TNF-α;SMD=-0.98,95%CI为-1.19~-0.77,P<0.00001)和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ;SMD=-1.71,95%CI为-3.24~-0.17,P=0.03)水平,差异均有统计学意义。结论腹部手术患者围手术期联用血必净注射液,能明显降低机体的炎症反应(包括WBC、NEU%、CRP、IL-6、TNF-α水平显著降低)以及病情程度(APACHEⅡ评分)。但由于纳入研究质量有限,上述结论仍需更多高质量、大样本的RCT研究验证。

(Embase),Cochrane library,Medline and SCI Finder database were searched by a computer from the establishments to January 2021 to find the randomized controlled trials(RCT)of Xuebijing injection in the treatment of patients undergoing abdominal surgery.According to inclusion and exclusion criteria,literature screening,data extraction and quality assessment were performed.RevMan 5.3 software was used to carry out Meta-analysis,and Stata 14.0 was applied to perform Egger test.Results Finally,12 literatures were enrolled,including 14 RCT studies with totally 1225 subjects in which 614 cases were in the experimental group and 611 in the control group.Meta-analysis results showed that compared with control group,in the patients using Xuebijing injection combined with other treatment in the peri-operational period,the inflammatory responses of the organisms were reduced,and the white blood cell count[WBC;standardized mean difference(SMD)=-0.83,95%CI was-1.36 to-0.29,P=0.003],percentage of neutrophils(NEU%;SMD=-0.50,95%CI was-0.88 to-0.12,P=0.01),C-reactive protein(CRP;SMD=-0.49,95%CI was-0.84 to-0.15,P=0.005),interleukin-6(IL-6;SMD=-1.89,95%CI was-3.00 to-0.78,P=0.0009),tumor necrosis factor-α(TNF-α;SMD=-0.98,95%CI was-1.19 to-0.77,P<0.00001)and acute physiological and chronic health evaluation score(APACHEⅡ;SMD=-1.71,95%CI was-3.24 to-0.17,P=0.03)were decreased,the differences were statistically significant.Conclusions In patients undergoing abdominal surgery,the treatment combined with Xuebijing injection during peri-operative period can significantly reduce the inflammatory response(including the levels of WBC,NEU%,CRP,IL-6,TNF-α)and degree of illness(APACHEⅡscore).However,due to the limited quality of the included studies,the above conclusions still need to be verified by more high-quality,large-sample RCT studies.