血必净注射液联合血液净化治疗全身炎症反应综合征的Meta分析

Meta analysis of Xuebijing combined with blood purification in the treatment of systemic inflammatory response syndrome

目的系统评价血必净注射液联合血液净化治疗全身炎症反应综合征(SIRS)的疗效及安全性,为SIRS提供临床用药循证参考。方法计算机检索WanFang、VIP、CNKI、CBM、PubMed、Embase及Cochrane数据库,收集血必净注射液联合血液净化治疗SIRS的随机对照试验,检索时间为数据库建立至2021年12月22日。进行纳入及排除标准的文献筛选,根据Cochrane国际协作网规程,进行质量控评和偏倚评估,Meta分析运用Revman 5.3进行。结果共检索275篇文献,最终纳入29项临床随机对照试验,共计2152例患者。荟萃分析显示,血必净注射液可提高血液净化疗法的总有效率[加权均数差(WMD)=0.24,95%可信区间(CI)(0.18,0.30),P<0.00001],缩短患者ICU住院时间[WMD=-3.74,95%CI(-5.74,-1.59),P=0.0002],降低急性生理学与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分[WMD=-4.49,95%CI(-5.42,-3.55),P≤0.00001],有效改善肿瘤坏死因子-α(TNF-α)[WMD=-28.28,95%CI(-33.88,-22.68),P≤0.00001]、白细胞介素-6(IL-6)[WMD=-37.44,95%CI(-52.10,-22.79),P≤0.00001]炎症因子水平,不增加不良反应[WMD=-55,95%CI(0.27,1.13),P=0.1]。结论血必净注射液可以提高血液净化疗法SIRS患者的疗效,抑制炎症反应,且不增加不良反应。这一结论也为新型冠状病毒肺炎继发SIRS的治疗提供一定的依据。

Objective To systematically evaluate the efficacy and safety of Xuebijing combined with blood purification in the treatment of systemic inflammatory response syndrome(SIRS),and to provide evidence-based reference for clinical medication of SIRS.Methods The databases of WanFang,VIP,CNKI,CBM,PubMed,Embase and Cochrane were searched by computer,and the randomized controlled trials of Xuebijing combined with blood purification in the treatment of SIRS were collected.The search time was from the databases establishment to December 22,2021.The literatures were selected by inclusion and exclusion criteria and the quality control evaluation and bias evaluation were carried out according to the procedures of Cochrane international collaboration network.Revman 5.3 was used for Meta analysis.Results A total of 275 literatures were searched,and 29 clinical randomized controlled trials were finally included,with a total of 2152 patients.Meta analysis showed that Xuebijing could improve the total effective rate of blood purification therapy[weighted mean difference(WMD)=0.24,95%confidence interval(CI)(0.18,0.30),P<0.00001],shorten the length of stay in ICU[WMD=-3.74,95%CI(-5.74,-1.59),P=0.0002],and reduce the acute physiology and chronic health evaluationⅡ(APACHEⅡ)[WMD=-4.49,95%CI(-5.42,-3.55),P≤0.00001],which can effectively reduce tumor necrosis factor-α(TNF-α)[WMD=-28.28,95%CI(-33.88,-22.68),P≤0.00001],interleukin-6(IL-6)[WMD=-37.44,95%CI(-52.10,-22.79),P≤0.00001]levels,and did not increase adverse reactions[WMD=-55,95%CI(0.27,1.13),P=0.1].Conclusions Xuebijing can improve the efficacy of blood purification therapy,inhibit inflammatory reaction,and does not increase adverse reactions.This conclusion also provides a basis for the treatment of SIRS secondary to new coronavirus pneumonia.