补充维生素C对脓毒症和脓毒症休克患者病死率影响的Meta分析

Effects of vitamin C supplementation on mortality in patients with sepsis and septic shock:a meta-analysis

目的 系统评价维生素C补充治疗对脓毒症和脓毒症休克患者病死率的影响。方法 计算机检索Cochrane图书馆、PubMed、Web of Science、EMbase、万方数据知识服务平台、中国知网和维普数据库从建库至2022年1月20日关于维生素C对脓毒症和脓毒症休克患者病死率影响的随机对照研究。由2名研究人员独立对文献筛选、提取数据并进行质量评价后,使用STATA 16.0软件进行Meta分析。结果 最终纳入15项随机对照试验研究,共2 077例患者,其中试验组1 041例,对照组1 036例。文献质量结果显示,7项研究为A级,8项研究为B级,提示纳入文献整体质量较好。Meta分析结果显示,与对照组比较,试验组脓毒症和脓毒症休克患者的病死率有效降低[比值比(odds ratio,OR)=0.81,95%置信区间(confidential interval,CI)0.67~0.98,P=0.027]。亚组分析结果显示,维生素C补充治疗疗程4 d以上可显著降低脓毒症患者的病死率(OR=0.67,95%CI0.49~0.90,P=0.008);采用维生素C单独治疗可显著降低脓毒症患者的病死率(OR=0.50,95%CI 0.34~0.74,P=0.001);维生素C补充治疗能有效降低脓毒症患者的短期(≤30 d)病死率(OR=0.77,95%CI 0.63~0.96,P=0.017)。漏斗图显示纳入文献基本对称,尚不能认为存在发表偏倚。结论 补充维生素C可有效降低脓毒症和脓毒症休克患者病死率。维生素C补充治疗疗程4 d以上和单独治疗能有效降低脓毒症和脓毒症休克患者的短期病死率,但不能降低患者的长期(90 d)病死率。

Objective To systematically evaluate the effect of vitamin C supplementation on the mortality of patients with sepsis and septic shock.Methods The Cochrane Library,PubMed,EMbase,Wanfang Data KnowledgeService Platform,China National Knowledge Infrastructure Database and Chinese Science and Technology PeriodicalDatabase were searched by computer for randomized controlled trials(RCTs)on the effect of vitamin C on the mortalityof patients with sepsis.The retrieval time of each database was from the establishment of the database to January 20,2022.Two researchers independently screened the literature,extracted data,and evaluated the quality,and then used STATA16.0 software for meta-analysis.Results A total of 15 RCTs were included,with a total of2077patients,including1041in the experimental group and1036in the control group.The results of literature quality showed that 7 studieswere grade A and 8 studies were grade B,indicating that the overall quality of the included literature was good.The resultsof meta-analysis showed that compared with the control group,the mortality of patients with sepsis and septic shock inthe experimental group were effectively reduced[odds ratio(OR)=0.81,95%confidential interval(CI)0.67-0.98,P=0.027].The results of subgroup analysis showed that vitamin C supplementation therapy for more than 4 days couldsignificantly reduce the mortality of the patients with sepsis(OR=0.67,95%CI0.49-0.90,P=0.008);single treatment couldsignificantly reduce the mortality rate of patients with sepsis(OR=0.50,95%CI0.34-0.74,P=0.001);vitamin C supplementation can effectively reduce the short-term(≤30 days)mortality of patients with sepsis(OR=0.77,95%CI 0.63-0.96,P=0.017).The funnel plot showed that the included literature was basically symmetrical,and publication bias could not be considered.Conclusions Vitamin C supplementation can effectively reduce the mortality rate of patients with sepsis and septic shock.Vitamin C supplementation treatment course of 4 days or less and single treatment can reduce the mortality rate of patients with sepsis and septic shock,but cannot reduce the long-term(90 days)mortality rate of patients.