双重滤过血浆置换治疗高脂血症性急性胰腺炎临床疗效的Meta分析

A systematic review and meta-analysis of the clinical efficacy of dual-filtration plasmapheresis in the treatment of hyperlipidemic acute pancreatitis

目的通过系统分析方法评价双重滤过血浆置换(DFPP)治疗高脂血症性急性胰腺炎(HLAP)的临床疗效。方法通过计算机检索美国国立医学图书馆PubMed数据库、荷兰医学文摘EMbase数据库、Cochrane图书馆数据库、科学网(Web of Science)、万方数据、维普中文科技期刊全文数据库(VIP)和中国知网(CNKI)等中英文数据库中由建库至2022年9月发表的有关DFPP治疗HLAP的临床对照试验(CCT)或随机对照试验(RCT)。对照组给予药物治疗,DFPP组在药物治疗基础上加用DFPP;主要结局指标为:住院时间、重症监护病房(ICU)住院时间、总体病死率;次要结局指标为:三酰甘油(TG)、血淀粉酶、C-反应蛋白(CRP)。由2名研究者收集数据,依据Cochrane 5.1手册评价文献质量,采用RevMan 5.3软件进行Meta分析;Meta分析结果的稳定性用敏感性分析方法检验,用漏斗图分析文章的发表偏倚。结果最终纳入16篇中英文文献,共涉及835例患者,其中DFPP组450例,对照组385例。Meta分析结果显示,与对照组相比,DFPP组住院时间缩短〔均数差(MD)=-5.28,95%可信区间(95%CI)为-7.14~-3.15,P<0.00001〕、ICU住院时间缩短(MD=-3.90,95%CI为-5.71~-2.05,P<0.0001),TG(MD=-10.75,95%CI为-15.23~-6.27,P<0.00001)、血淀粉酶(MD=-219.01,95%CI为-320.05~-117.96,P<0.0001)、CRP(MD=-34.84,95%CI为-59.11~-10.57,P=0.005)均显著降低。但两组总体病死率比较差异无统计学意义〔相对危险度(RR)=0.77,95%CI为0.20~3.03,P=0.71〕。对纳入文献数量超过10篇的TG进行漏斗图分析,结果显示,本研究文献可能存在一定发表偏倚。结论在使用药物治疗的基础上应用DFPP能提高HLAP治疗的临床效果,改善预后。

Objective To evaluate the clinical efficacy of double filtration plasmapheresis (DFPP) in thetreatment of hyperlipidemic acute pancreatitis (HLAP) by systematic analysis. Methods The National Library of Medicine database (PubMed), Dutch Medical Abstracts Database(Embase),Cochrane Library database,Web of Science,Wanfang,Weipu Chinese full-text database,and CNKI were searched by computer for controlled clinical trial(CCT)or randomized controlled trial(RCT)on the treatment of HLAP with dual filtration plasmapheresis published up to September 2022.The control group was given drug treatment,and the experimental group added DFPP to the drug treatment.The primary outcomes were:length of hospital stay,intensive care unit(ICU)length of stay,overall case fatality;secondary outcomes were:triglycerides(TG),blood amylase,C-reactive protein(CRP),and other indicators.Data were collected by two review authors to assess literature quality according to the Cochrane 5.1 handbook,using RevMan 5.3 software for meta-analysis.The stability of meta-analysis results was tested using sensitivity analysis and the publication bias was analyzed by funnel plots.Results A total of 16 Chinese and English literature involving 835 patients were included,including 450 in the experimental group and 385 in the control group.Meta-analysis showed that compared with the control group,length of hospital stay[MD=-5.28,95%confidence interval(95%CI)was-7.14 to-3.15,P<0.00001],length of ICU stay(MD=-3.90,95%CI was-5.71 to-2.05,P<0.00001)and were significantly lower than those in the control group.After treatment,TG(MD=-10.75,95%CI was-15.23 to-6.27,P<0.00001),blood amylase(MD=-219.01,95%CI was-320.05 to-117.96,P<0.0001),CRP(MD=-34.84,95%CI was-59.11 to-10.57,P=0.005)were significantly reduced.However,the overall case fatality was not statistically different[relative risk(RR)=0.77,95%CI was 0.20 to 3.03,P=0.71].Funnel chart analysis was performed on TG of more than 10 included articles,and the results showed that there was some publication bias.Conclusion DFPP can improve the clinical effect and prognosis of HLAP treatment based on drug treatment.