糖皮质激素治疗重症急性胰腺炎的疗效及其并发症临床荟萃分析

目的采用荟萃分析法评价糖皮质激素(GC)治疗重症急性胰腺炎(SAP)的疗效及安全性。方法检索Cochrane Library、Pub Med、Embase、中国生物医学数据库、CNKI、万方数据库、维普中文科技期刊数据库,查找2005年1月1日到2016年7月1日有关GC治疗SAP的临床随机对照试验,通过纳入和排除标准筛选文献,对纳入的研究进行分析并提取试验数据。采用R软件进行数据分析。结果研究共纳入18篇符合要求的文献,纳入的病例总数为1 601例,其中实验组773例,对照组828例。Meta分析的结果表明:实验组患者腹痛缓解时间及血淀粉酶恢复时间明显低于对照组,合并标准均数差(SMD)分别为-2.59(95%CI:-3.28~1.90)和-1.45(95%CI:-1.80~-1.10);实验组并发症的发生率、中转手术治疗率及病死率均显著低于对照组,OR值分别为0.15(95%CI:0.09~0.26)、0.30(95%CI:0.13~0.74)和0.15(95%CI:0.08~0.28)。结论 SAP的患者早期、短程使用GC是获益的,但仍需大样本、多中心、前瞻性随机对照研究来进一步证实。

Meta-analysis of the efficacy and complications of glucocorticoids in patients with severe acute pancreatitis

Objective To systematically evaluate the efficacy and complications of glucocorticoid mono-therapy in severe acute pancreatitis (SAP). Methods From Jan.1st 2005 to Jul.31st 2016, literature about GC in patients with SAP were retrieved from Cochrane Library, PubMed, Embase, CBM, CNKI database, Wangfang and VIP database, then the data were extracted and analyzed by the R software. Results Eighteen RCTs pa-pers were enrolled in this Meta-analysis, 1601 patients were analyzed. GC was used in 773 patients, other 828 patients in the control group. Meta-analysis showed that GC therapy for SAP was associated with reductions in the length of abdominal pain, the blood amylase recovery time, the standard mean differences (SMD) was-2.59(95%CI: -3.28~-1.90) and -1.45(95%CI: -1.80~-1.10), respectively. The complication incidence rates, the rate of surgical intervention, and the mortality rate in experimental group were significantly lower than those in control group, the odds ratios (ORs) was 0.15(95%CI: 0.09~0.26), 0.30(95%CI: 0.13~0.74) and 0.15(95%CI:0.08~0.28), respectively. Conclusion Early and short-term use of GC may improve outcomes in patients with SAP; however, large, multicenter prospective randomized controlled trials are still needed to confirm the find-ings of this meta-analysis.