河北医科大学学报

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乌司他丁对百草枯中毒治疗效果的Meta分析

  

  1. 1.广西医科大学第一附属医院急诊科，广西 南宁 530000；2.广西卫生职业技术学院，广西 南宁 530000
  • 出版日期:2018-02-25 发布日期:2018-02-06
  • 作者简介:卢欣颖（1994-），女，陕西咸阳人，广西医科大学第一附属医院医学硕士研究生，从事危重病诊治研究
  • 基金资助:
    国家自然科学基金资助项目（81470230）

A Metaanalysis about the efficacy of ulinastatin on patients of paraquat poisoning

  1. 1.Dapartment  of Emergency, the First Affiliated Hospital of Guangxi Medical University, Nanning
    530000, China; 2. Guangxi Medical College, Nanning,530000, China
  • Online:2018-02-25 Published:2018-02-06

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摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗因乌司他丁对百草枯中毒治疗效果的不确切性，故对乌司他丁治疗百草枯中毒的疗效进行Meta分析。
〖HTH〗方法〖HTSS〗〖KG*2〗检索中国知网、万方数据库、维普网、Pubmed、Embase、The Cochrane Library中关于百草中毒和乌司他丁的相关文献，并剔除不符合纳入标准的文献。用Revman 5.3中包含的偏倚风险评估工具评估纳入文献的随机对照试验（randomized controlled trial,RCT)的证据等级，用Newcastle Ottawa Scale评估非随机对照试验(nonRCT）的证据等级。通过随机效应模型或者固定效应模型计算纳入文献的比值比（Odd Ratios，OR)、标准化均数差（standard mean difference，SMD）、95%可信区间(confidence intervals,CI)，并且通过Revman 5.3软件绘制森林图和漏斗图。评价结果包括乌司他丁组与对照组之间病死率和急性肺损伤/急性呼吸窘迫综合征(acute lung injury/acute respiration distress syndrome,ALI/ARDS）、肺纤维化、呼吸衰竭、多器官功能障碍综合征(multiple organs dysfunctional syndrome,MODS)发生率的变化，以及炎症因子白细胞介素6（interleukin 6，IL6）的变化。
〖HTH〗结果〖HTSS〗〖KG*2〗根据纳入与排除标准，本Meta分析共纳入9篇RCT文献及6篇nonRCT文献，包括1 133例百草枯中毒患者，其中乌司他丁组589例，对照组544例。主要评价指标结果如下：乌司他丁组病死率低于对照组（OR=0.41，95%CI=0.31~0.55,P＜0.01），MODS发生例数少于对照组（OR=0.52，95%CI=0.37~0.72,P＜0.01），炎症因子IL6的下降范围大于对照组（SMD =1.32，95%CI=0.94~1.71,P＜0.01）。
〖HTH〗结论〖HTSS〗〖KG*2〗乌司他丁治疗百草枯中毒，与单纯使用糖皮质激素相比，可有效增加IL6的下降范围，减少MODS的发生，降低病死率。

关键词: 百草枯, 中毒, 乌司他丁, Meta分析

Abstract: ［Abstract］ Objective〖HTSS〗〓Owing to the curative effect of ulinastatin to paraquat poisoning is uncertain, we conducted the Metaanalysis about the effection of ulinastatin on patients of paraquat poisoning.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The studies about paraquat poisoning and ulinastatin were searched by the PubMed, Embase, The Cochrane Library, CNKI, VIP and the WANFANG data base，and the studies that are inconsistent with the included standards were deleted. Subsequently, we made the bias risk assessment, included in the Revman 5.3, to assess the evidence of randomized controlled trial(RCT). And the Newcastle Ottawa Scale is used to evaluate the evidence of nonRCT. Afterwards, we calculated the Odd Ratios(OR), standardized mean difference(SMD) and 95% confidence intervals(CI) by random or fixed effects model. And we mapped the forest graphs, Funnel Graphs with the Revman 5.3 software. The evaluation results include the effects between statin group and control group and the mortality rate of acute lung injury/acute respiration distress syndrome(ALI/ARDS), pulmonary fibrosis, respiratory failure, multiple organ dysfunction syndrome(MODS) the incidence rate of change, and inflammatory cytokines interleukin 6(IL6) changes.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Nine RCT and 6 nonRCT studies were chosen in the meta analysis, which involved 1 133 paraquat poisoning patients. There are 589 patients about ulinastatin group and 544 patients about control group in the meta analysis. And the results of the meta analysis were as followings: the main outcome is mortality/the incidence of inefficiency, and the incidence is less than the control group(OR=0.41，95%CI=0.31~0.55), P＜001). The incidence of MODS is less than control group(OR=0.52， 95%CI=0.37~0.72, P＜001). The change of inflammation cytokine IL6 is more  obvious than control group(SMD=1.32， 95%CI=0.94~1.71, P＜001).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Ulinastatin, which has effective affects in increasing the descent range of  the inflammation cytokine IL6, decreasing the mortality and reducing the incidence of MODS, is more beneficial than the glucocorticoid alone.

Key words: paraquat, poisoning； ulinastatin； Metaanalysis

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