生长激素治疗严重烧伤的Meta分析

Effectiveness of growth hormone on severe burn:a Meta analysis

目的：系统评价生长激素治疗严重烧伤的有效性及安全性。方法以“生长激素”和“烧伤”为检索词，检索万方科技期刊全文数据库、维普中文期刊全文数据库、中文科技期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM），收集2005～2016年所有相关对照试验，筛选所需的研究，进行方法学质量评估并进行资料提取后，采用 RevMan（review mannage）5.3软件进行 Meta 分析。结果本文共纳入8个随机对照试验（RCT）研究，共包括519例患者。Meta分析的结果显示，应用生长激素2周后试验组的总蛋白水平[加权均数差值（WMD）14.89，95% CI （10.19，19.59），P＜0.00001]、白蛋白水平[WMD 5.17，95% CI（4.05，6.29），P＜0.00001]、血红蛋白水平[WMD 37.72，95% CI（29.06，46.39），P＜0.00001]明显高于对照组；同时供皮区创面愈合时间[WMD －3.48，95% CI（－4.30，－2.65），P＜0.00001]、深二度创面愈合时间[WMD－9.46，95% CI（－10.91，－8.01），P＜0.00001]、植皮区创面愈合时间[WMD －13.02，95% CI （－18.01，－8.03），P＜0.00001]及住院时间[WMD －20.42，95% CI（－25.08，－15.77），P＜0.00001]相比对照组明显缩短；体内的肿瘤坏死因子α（TNF-α）[WMD －8.12，95% CI（－9.44，－6.81）， P＜0.00001]及白细胞介素-6（IL-6）[WMD 2.05，95% CI（1.06，3.04），P＜0.00001]水平明显低于对照组；另外本研究显示治疗组的血糖[WMD 2.05，95% CI（1.06，3.04），P＜0.00001]高于对照组。结论严重烧伤患者在检测和控制好血糖水平的前提下使用生长激素能够加速创面愈合，减轻高代谢反应，改善其免疫功能，是安全有效的。

Objective Though clinical growth hormone treatment of severe burn has gained wide acceptance, unfortunately, systematical evaluation of current domestic growth hormone for severe burns in adults is absence. To systematically evaluate the effectiveness and safety of rhGH on the healing of burn wounds. Methods Randomized controlled trials (RCTs) with key words of 'growth hormone'and 'burns' were searched in Wanfang database, VIP, CNKI, and CBM from 2005 up to 2016. After manually screening and assessing the methodological quality of the included literatures, qualified data were retrieved and then a Meta-analysis was performed using RevMan 5.3. Results A total of eight research involving 519 patients were eligibly enrolled. Result of the Meta-analysis suggested that: after a two-week application of growth hormone, the total protein level [WMD 14.89, 95% CI, (10.19, 19.59), P<0.000 01], albumin level [WMD 5.17, 95% CI (4.05, 6.29), P<0.000 01], and hemoglobin level [WMD 37.72, 95% CI (29.06, 46.39), P<0.000 01] in the experimental group were significantly higher than the control group;Meanwhile, we found the donor site healing time [WMD -3.48, 95% CI (-4.30, -2.65), P<0.000 01], deep second degree burn wounds healing time [WMD -9.46, 95% CI (-10.91, -8.01), P<0.000 01], the skin wound healing time [WMD -13.02, 95% CI (-18.01, -8.03), P<0.000 01] and the hospitalization time [WMD -20.42, 95% CI (-25.08, -15.77), P<0.000 01] in the experimental group were obviously shortened than the control group; In addition, the level of TNF-α [WMD -8.12, 95% CI (-9.44, -6.81), P<0.000 01] and IL-6 [WMD 2.05, 95% CI (1.06, 3.04), P<0.000 01] notably decreased; However, our study indicated&nbsp;that the blood sugar levels [WMD 2.05, 95% CI (1.06, 3.04), P<0.000 01] in the experimental group were higher than the control group. Conclusion Growth hormone safely and effectively promotes the healing of burn wounds, reduces hypermetabolic reaction and improves the immune function on the premise that the blood glucose level is well managed.