乌司他丁联合胸腺肽α1治疗对脓毒症患者疗效的荟萃分析  

Evaluation of efficacy of ulinastatin combined with thymosin α1 in treatment of sepsis： a systematic review

作　　者：陈子盛[1] 傅应云[1] 林少雄[4] 刘盛国[1] 何正强[1] 涂惠英[2] 李伟[3] 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院呼吸科,广东深圳518000 [2]暨南大学第二临床医学院深圳市人民医院新生儿科,广东深圳518000 [3]暨南大学第二临床医学院深圳市人民医院骨关节科,广东深圳518000 [4]南方医科大学附属南方医院耳鼻喉科,广东广州510400

出　　处：《中国中西医结合急救杂志》2012年第1期16-20,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的评价乌司他丁（UTI）联合胸腺肽仅，对脓毒症患者免疫状态和疗效、预后的影响。方法通过关键词、主题词、引文追溯等途径检索PubMed、Elsevier-SDOL、Embase、Cochrane Library、万方医学期刊库和中国学术期刊全文数据库，检索2000年至2011年关于UTI联合胸腺肽d，治疗对脓毒症患者疗效的随机对照研究（RCT），提取入选文献资料并总结分析。结果最终纳入10个RCT，共1131例患者，Meta分析表明，与常规重症监护病房（ICU）治疗比较，UTI联合胸腺肽d．能显著降低患者28d急性生理学与慢性健康状况评分系统II（APACHEII）评分[加权均数差值（WMD）=-3．72，95％可信区间（95％CI）-5．52- -1．92，P〈0．0001）]，提高28d人白细胞DR抗原／CD14＋（HLA—DR／CD14＋）表达率（WMD=14．02，95％C／11．05。16．99，P〈0．00001），降低28d白细胞介素-6（IL-6）水平（WMD=-10．83，95％CI-14．14～-7．51，P〈0．00001），而28dIL-10水平无差异（WMD=1．25，95％CI-1．08～3．59，P=0．29），同时缩短ICU住院期间机械通气时间（WMD=-4．00．95％CI-4．65- -3．34，P〈0．00001）及28d病死率（合并优势比（0四）=0．48，95％CI0．36～0．63，P〈0．00001），而ICU住院时间无差异（WMD=-1．10，95％CI-2．81～0．60，P=0．21]。结论UTI联合胸腺肽仅．治疗能改善脓毒症患者免疫状态，修复促炎／抗炎失衡，降低APACHE1I评分，缩短ICU住院期间机械通气时间，降低28d病死率。Objective To assess the therapeutic effects of ulinastatin （ UTI ） combined with thymosin ot on the improvement of immunity and prognosis of sepsis. Methods The key words, subject terms and references were used to search the effects of UTI combined with thymosin α1 on sepsis in randomized and controlled trials （RCT） between 2000 to 2011 in the database of PubMed, Elsevier-SDOL, Embase, Cochrane Library, Wanfang Database, China National Knowledge Internet （CNKI）. Study selection and assessment, data collection and analyses were undertaken. Results Ten clinical RCTs （ 1131 patients） were included. Meta-analysis showed that compared to the conventional treatment in intensive care unit （ICU）, UTI combined with thymosinα1 could significantly decrease the 28-day acute physiology and chronic health evaluation II （APACHEII）scores [weighted mean difference （WMD）= -3.72, 95% confidence interval （95%CI） ： -5.52 --1.92, P〈0.0001~, enhance the 28-day rate of human leukoyte antigen DR （HLA-DR）/CD14＋ expression （WMD = 14.02, 95%CI： 11.05 - 16.99, P〈0.000 01 ）, reduce 28-day interleukin （IL） -6 level （WMD = -10.83, 95% CI： -14.14 --7.51, P〈0.000 01）, however, there was no difference in 28-day IL-10 level （WMD = 1.25, 95% CI： -1.08 - 3.59, P = 0.29） ; in the mean time, the duration of mechanical ventilation in ICU was shortened （WMD = -4.00, 95%CI： -4.65 - -3.34, P〈0.000 01） and 28-day death rate was decreased [the combined odds risk （OR） =0.48, 95%CI： 0.36 - 0.63, P〈0.000 01], but there was no difference in the duration of ICU stay （WMD=-1.10, 95%CI： -2.81 - 0.60, P = 0.21）. Conclusion The current evidences show that UTI combined with thymosinotI can improve the septic patients＇ immune status, repair the imbalance between proinflammation and anti-inflammation, decrease the APACHE II score, shorten the duration of mechanical ventilation and ICU stay and decrease the 28-day death rate.

关 键 词：乌司他丁 胸腺肽 脓毒症 META分析 

分 类 号：R285.6[医药卫生—中药学] R631.3[医药卫生—中医学]