重组人表皮生长因子治疗压力性损伤疗效的系统评价

Systematic Review of Recombinant Human Epidermal Growth Factors in the Treatment of Stress Injuries

目的 采用Meta分析及描述性分析评价重组人表皮生长因子(rEGF)用于压力性损伤创面治疗的效果。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、知网、万方、中国生物医学文献服务系统和维普等数据库,收集有关rEGF对压力性损伤疗效影响的随机对照研究,检索时限为建库至2021年4月。通过文献筛选、资料提取及文献质量评价,采用RevMan 5.3进行Meta分析。结果 最终纳入14项随机对照研究,涉及患者896例。Meta分析结果显示,与常规治疗相比,rEGF可提高压力性损伤的创面愈合率[OR=3.82,95%CI(2.85,5.11),P<0.001]、缩短压力性损伤创面愈合时间[MD=-8.15,95%CI(-12.45,-3.86),P<0.001]。仅有1项研究涉及组织学观察指标,并显示,与常规治疗相比,rEGF可增加肉芽组织中羟脯氨酸含量并降低Ⅰ/Ⅲ型胶原蛋白比例,有利于促进创面修复。亚组分析显示,不同rEGF治疗时间组治愈率均高于对照组,差异具有统计学意义[OR=4.32,95%CI(3.10,6.03),P<0.001];其中治疗时间14~21 d组创面愈合率最高,优势明显[OR=3.21,95%CI(2.25,4.58),P<0.001]。结论 rEGF对压力性损伤具有较好的治疗作用,但仍需开展更多高质量研究予以验证。

ObjectiveTo evaluate the effect of recombinant human epidermal growth factors(rEGFs) in the treatment of stress injury wounds by Meta-analysis and descriptive analysis.MethodsRandomized controlled studies about the efficacy of rEGFs on stress injuries were retrieved in PubMed, Embase, Cochrane Library,Web of Science, CNKI, Wanfang Data, CBM and VIP from the date of database establishment to April 2021.After article screening, data extraction and article quality evaluation, a meta-analysis was performed by RevMan 5.3.ResultsFinally, 14 randomized controlled studies involving 896 patients were included. Metaanalysis showed that rEGFs increased the healing rate of stress injury wounds [OR=3.82,95%CI(2.85,5.11),P<0.001] and shortened the healing time [MD=-8.15,95%CI(-12.45,-3.86),P<0.001] compared with routine care.Only one study involved histological measures and showed that rEGFs increased hydroxyproline content and decreased the type I/III collagen ratio in granulation tissues compared with routine care, which was beneficial to promote wound repair. Subgroup analysis showed that the healing rate of rEGF treatment groups(different in of the control group [OR=4.32,95%CI(3.10,6.03),P<0.001];among them, the wound healing rate of the 14-21 d treatment group was the highest, significantly superior to that of other groups [OR=3.21, 95%CI(2.25,4.58),P<0.001].ConclusionrEGFs have good efficacy on stress injuries, but more high-quality studies are still needed for validation.