大黄素治疗重症急性胰腺炎并发急性肺损伤临床前研究的Meta分析

Meta-Analysis of Preclinical Studies on Emodin in the Treatment of Severe Acute Pancreatitis Complicated with Acute Lung Injury

目的:系统评价大黄素治疗重症急性胰腺炎并发急性肺损伤的疗效。方法:通过计算机检索Embase、PubMed、the Cochrane Library、中国生物医学文献数据库、中国知网、维普数据库和万方数据库7个数据库,搜索时间限制为2011年1月1日至2022年6月12日,收集大黄素与重症急性胰腺炎并发急性肺损伤(SAP-ALI)的临床前实验研究。通过筛选文献、提取数据和评估纳入研究的偏倚风险,使用SYRCLE动物实验偏倚风险评估工具进行质量评估,使用RevMan和Stata软件进行Meta分析。并且对不同语言类型、模型剂量、给药方法和治疗剂量的主要结果指标进行亚组分析。结果:共纳入11项研究,涉及257只动物,实验组(大黄素干预)136只,对照组(常规干预)121只。Meta分析结果显示,大黄素可以显著降低SAP-ALI动物模型的肿瘤坏死因子α、白细胞介素1β、白细胞介素6、NOD样受体热蛋白结构域相关蛋白3、肺组织炎症评分、胰腺炎症评分、肺部干湿重比、淀粉酶、动脉二氧化碳分压、凋亡相关斑点样蛋白、含半胱氨酸的天冬氨酸蛋白水解酶1等指标水平,显著升高动脉氧分压水平,与对照组的差异均有统计学意义(P<0.05)。经亚组分析,肺组织炎症评分的异质性受到语言类型、模型剂量、给药方式的影响(P<0.05),而血清淀粉酶并未受到亚组影响。结论:从现有证据来看,大黄素可保护胰腺和肺功能,延缓组织损伤,可作为治疗SAP-ALI的潜在治疗药物。然而,此证据质量一般且为临床前研究,仍需要更高层次的证据验证该结论。

OBJECTIVE:To systematically evaluate the efficacy of emodin in the treatment of severe acute pancreatitis complicated by acute lung injury.METHODS:Embase,PubMed,the Cochrane Library,CBM,CNKI,VIP and Wanfang Data were retrieved to collect preclinical studies on emodin in the treatment of severe acute pancreatitis complicated with acute lung injury(SAP-ALI)from Jan.1st,2011 to Jun.12th,2022.Quality assessment was performed by screening the literature,extracting data,and assessing the risk of bias in the included studies by using the SYRCLE risk of bias assessment tool for animal experiments.Meta-analysis was performed by using RevMan and Stata software.And subgroup analysis were performed on key outcome indicators for different language types,model doses,administration methods and treatment doses.RESULTS:A total of 11 studies were enrolled,including 257 animals,with 136 cases in the experimental group(emodin intervention)and 121 cases in the control group(routine intervention).Meta-analysis showed that emodin significantly reduced the levels of tumor necrosis factor-α,interleukin-1β,interleukin-6,NOD-like receptor thermoprotein structural domain-associated protein 3,lung tissue inflammation score,pancreatic inflammation score,lung wet weight/dry weight,amylase,arterial partial pressure of carbon dioxide,apoptosis-associated speck-like protein containing a CARD and cysteine-containing aspartate protein hydrolase 1,and significantly increased the levels of arterial partial pressure of oxygen,the differences with the control group were statistically significant(P<0.05).By subgroup analysis,heterogeneity of lung tissue inflammation scores was influenced by language types,model doses and administration methods(P<0.05),whereas serum amylase was not influenced by subgroup.CONCLUSIONS:The available evidence suggests that emodin protects pancreatic and pulmonary function,delays tissue damage,and may be a potential therapeutic agent for the treatment of acute lung injury complicated by severe acute pancreatitis.However,this evidence is of average quality and is a preclinical study,higher-level evidence is still needed to validate this conclusion.