生长抑素联合中药在治疗重症急性胰腺炎中的系统评价

目的评价生长抑素联合中药在治疗重症急性胰腺炎中的有效性。方法应用国际Cochrane协作网系统评价方法对生长抑素联合中药治疗重症急性胰腺炎的随机对照试验（RCT）进行系统评价。计算机检索MEDLINE（Ovid）、PubMed数据库、中文科技期全文数据库（VIP）、万方数据库、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）。检索时间均为建库至2009年9月。文献检索语种为英语和中文。结果共纳入8个RCT,436例患者,所有纳入试验在治疗末均未进行随访。Meta分析结果显示,生长抑素联合中药治疗组（治疗组）的病死率（13/188,6.9%）明显低于单纯生长抑素治疗组（对照组）（24/174,13.7%）,差异有统计学意义Peto OR=0.46,95%CI（0.22,0.94）,P〈0.05]。治疗组平均住院日低于对照组WMD=-7.01,95%CI（-7.89,-6.13）,P〈0.000 01]。治疗组腹痛缓解时间明显低于对照组,其差异有统计学意义WMD=-0.77,95%CI（-0.82,-0.72）,P〈0.000 01]。治疗组与对照组治疗第7天APACHEⅡ评分均下降,治疗组下降幅度大于对照组,两组比较差异有统计学意义（P〈0.05）。治疗组并发症发生率（26/91,28.6%）与对照组（35/88,39.8%）相比,其差异无统计学意义Peto OR=0.61,95%CI（0.32,1.13）,P=0.12]。结论生长抑素联合中药治疗在改善重症急性胰腺炎的病死率、平均住院时间、腹痛缓解时间、APACHEⅡ评分下降幅度优于单纯生长抑素治疗

Somatostatin with Traditional Chinese Medicine for Acute Pancreatitis:A Systematic Review

Objective To assess the therapeutic effect of somatostatin with traditional Chinese medicine on severe acute pancreatitis（SAP）.Methods A systematic review of randomized controlled trials（RCT） of ulinastatin for SAP was performed.The retrieval was carried out in the databases including MEDLINE（Ovid）,PubMed,VIP（1989 to Sep 2009）,Wanfang,CNKI,CBM from the begging of their establishment to September 2009.The retrieval languages were Chinese and English.Results Eight RCT including 436 patients were enrolled.The meta-analysis of five RCT showed that the mortality rate（13/188,6.9%） in somatostatin combined with traditional Chinese medicine treatment group（Group T） was lower than that in the simple somatostatin treatment group（Group C）（24/174,13.7%）,the difference was statistically significant Peto OR=0.46,95% CI（0.22,0.94）,P〈0.05].The average length of stay in Group T was shorter than that in Group C WMD=-7.01,95% CI（-7.89,-6.13）,P〈0.000 01].The relieved time of abdominal pain in Group T was significantly shorter than that in Group C WMD=-0.77,95% CI（-0.82,-0.72）,P〈0.000 01].The APCHE Ⅱ scores on the seventh day declined gradually in both groups,but the decrease in Group T was larger than that in Group C（P〈0.05）.The difference in complication incidence between Group T（26/91,28.6%） and Group C（35/88,39.8%） was not statistically significant Peto OR=0.61,95% CI（0.32,1.13）,P=0.12].Conclusion Treating SAP,Somatostatin combined with traditional Chinese medicine is better than the simple somatostatin treatment in decreasing fatality rates,the average length of stay,relieved time of abdominal pain,and APACHE Ⅱ score