康复者恢复期血浆治疗新型冠状病毒疾病临床疗效的系统评价

目的系统评价新型冠状病毒疾病(COVID-19)康复者恢复期血浆(CP)治疗COVID-19的临床疗效。方法计算机检索PubMed、EMbase、The Cochrane Library、VIP、WanFang Data和CNKI数据库,搜集有关CP治疗COVID-19疗效的随机对照试验(RCT),检索时限均从建库至2021年9月15日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4.1软件进行Meta分析。结果共纳入16个RCT,包括15301例患者。Meta分析结果显示:CP治疗组与空白对照组RR=0.99,95%CI(0.93,1.05),P=0.63]或生理盐水组RR=1.06,95%CI(0.60,1.86),P=0.84]相比,病死率差异无统计学意义。但与标准血浆相比,CP组病死率更低RR=0.59,95%CI(0.37,0.95),P=0.03]。此外,与空白对照或生理盐水相比,CP治疗不能改善28~30天临床病情;疾病早期和随机化分组时不需有创机械通气的患者给予CP治疗不能降低病死率。结论当前证据显示,与空白对照或生理盐水相比,CP治疗COVID-19患者不能降低病死率。但当病情发展到需要使用标准血浆时,CP治疗可能会降低患者的病死率。另外,疾病早期或非危重COVID-19患者使用CP不能降低病死率及改善临床症状。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Efficacy of convalescent plasma in the treatment of coronavirus disease 2019:a systematic review

Objective To systematically review the efficacy of convalescent plasma(CP)in the treatment of coronavirus disease 2019(COVID-19).Methods PubMed,EMbase,The Cochrane Library,VIP,WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials(RCTs)on the efficacy of CP in the treatment of COVID-19 from inception to September 15 th,2021.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies;then,meta-analysis was performed using RevMan 5.4.1 software.Results A total of 16 RCTs involving 15301 patients were included.The results of meta-analysis showed that CP treatment did not reduce mortality compared with no-placebo(RR=0.99,95%CI 0.93 to 1.05,P=0.63)or normal saline(RR=1.06,95%CI 0.60 to 1.86,P=0.84).However,compared with standard plasma,the mortality of CP group was lower(RR=0.59,95%CI 0.37 to 0.95,P=0.03).In addition,compared with no-placebo or normal saline,CP treatment could not improve the clinical condition at 28-30 days,reduce mortality at early treatment and in patients without invasive mechanical ventilation when randomized.Conclusion Current evidence shows that compared with no-placebo or normal saline,CP does not reduce mortality in patients with COVID-19.However,when the disease progresses to the point where standard plasma is required,CP may reduce mortality.In addition,use of CP in patients with early or noncritical COVID-19 failed to reduce mortality.Due to limited quality and quantity of the included studies,more high-quality studies are required to verify the above conclusion.