多黏菌素B血液灌流对严重感染患者预后影响的荟萃分析  

A meta-analysis of the effects of direct hemoperfusion with polymyxin B-immobilized fiber on prognosis in severe sepsis

作　　者：邱晓华[1] 刘松桥[1] 郭凤梅[1] 杨毅[1] 邱海波[1] 

机构地区：[1]东南大学医学院附属中大医院重症医学科,南京210009

出　　处：《中华内科杂志》2011年第4期316-321,共6页Chinese Journal of Internal Medicine

基　　金：江苏省“科教兴卫工程”医学领军人才基金（2007）;江苏省“科教兴卫工程”医学重点人才基金（2007,RC2007011）

摘　　要：目的探讨多黏菌素B血液灌流对严重感染患者预后的影响。方法通过计算机和手工全面检索Pubmed、Embase、WebofScience数据库，收集1995年1月1日至2010年5月30日关于多黏菌素B血液灌流治疗严重感染的随机对照研究，按Cochrane协作网推荐的方法对多黏菌素B血液灌流治疗重症感染患者的病死率、血内毒素水平变化作荟萃（Meta）分析。结果共纳入11篇随机对照研究，其中研究结果包括严重感染患者病死率的文献共8篇，共纳入多黏菌素B血液灌流组211例，对照组178例，治疗组和对照组患者的病死率分别为37．4％（79／211）和68．5％（122／178），多黏菌素B血液灌流能够降低患者病死率（OR=0．24，95％C10．16—0．38，P〈0．00001）。对革兰阴性菌感染导致的严重感染患者的病死率、随访时间≤30d的严重感染患者早期病死率行亚组分析，结果同样提示患者病死率明显降低（OR=0．27，95％C10．17—0．45，P〈0．0000l；OR=0．29，95％C10．17-0．48，P〈0．00001）。对纳入的6篇研究中的血内毒素水平变化进行荟萃分析，多黏菌素B血液灌流能够使重症感染患者的血内毒素水平下降31ng／L（95％CI22．46～39．55），与治疗前相比，治疗后血毒素水平降低，差异有统计学意义（P〈0．00001）。而对照组内毒素水平无明显变化（P=0．94）。结论多黏菌素B血液灌流能够显著改善严重感染患者的预后，降低患者血内毒素水平。但由于随机对照研究数量较少、质量较低（缺少盲法），需高质量的大规模随机对照研究进一步证实。Objective To investigate the effects of direct hemoperfusion with polymixin B-immobilized fiber （DHP-PMX） in patients with sepsis. Methods We searched Pubmed, Embase,Web of Science databases and identified relevant randomized controlled trials （RCT） from January 1995 to May 2010. Meta-analysis of DHP-PMX on mortality and levels of endotoxin in patients with sepsis were conducted using the methods recommended by the Cochrane Collaboration. Results Eleven RCTs were included. Eight of them included the mortality of patients （sample size： 211 DHP-PMX and 178 conventional medical therapy）. In total, the mortalities of patients with sepsis in DHP-PMX group and conventional group were 37.4% （79/211） and 68. 5% （122/178） respectively. Compared with the conventional medical therapy, DHP-PMX appeared to significantly reduce mortality （OR =0. 24,95% CI O. 16-0. 38 ,P 〈 0. 000 01 ）. The results were similar when two RCTs enrolling patients with methicillin resistant staphylococcus aureus （MRSA） infections were excluded（ OR =0. 27,95% C10. 17-0. 45, P 〈0. 000 01 ）. When the analysis was limited to the nine studies that reported 28- to 30-day mortality, results were unchanged（ OR = 0. 29,95% C1 0. 17-0. 48 ,P 〈 0. 000 01 ）. Six RCTs had the available data of endotoxin. The level of endotoxin decreased 31 ng/L（95% CI 22.46-39.55） after DHP-PMX therapy, and the decreasing was statistically significant （ P 〈 0. 000 01 ）, while the level of endotoxin in patients of conventional group did not change （ P= 0. 94 ）. Conclusions This study suggests a favorable effects of DHP-PMX on mortality and endotoxin decreasing in patients with sepsis. However, lack of enough cases and blinding need to be considered. Furtherinvestigation with large sample of high quality RCTs is needed.

关 键 词：多黏菌素B 血液灌注 感染 死亡率 META分析 

分 类 号：R459.7[医药卫生—急诊医学]