基于Meta分析的不同临床治疗方法对鹅膏毒肽中毒治疗效果的定量评估  

Quantitative evaluation on therapeutic effect of different treatments for amanitin poisoning based on Meta-analysis

作　　者：陈宵[1] 李斌[1] 邵兵[2] 余成敏 姚群梅 马沛滨[1] 章轶哲 孙承业[1] CHEN Xiao;LI Bin;SHAO Bing;YU Cheng-min;YAO Qun-mei;MA Pei-bin;ZHANG Yi-zhe;SUN Cheng-ye(National Institute of Occupational Health and Poison Control,Chinese Center for Disease Control and Prevention,Beijing 100050,China)

机构地区：[1]中国疾病预防控制中心职业卫生与中毒控制所,北京100050 [2]北京市疾病预防控制中心中心实验室 [3]云南省楚雄彝族自治州人民医院

出　　处：《中国工业医学杂志》2020年第3期217-222,246,共7页Chinese Journal of Industrial Medicine

基　　金：国家自然科学基金青年基金项目(No.31501814)。

摘　　要：目的对鹅膏毒肽中毒患者的不同临床治疗方法及其效果进行评估。方法检索PubMed、Embase、OVID、万方和中国知网(CNKI)数据库,收集整理数据,并对文献进行综述,根据文献对鹅膏毒肽中毒的治疗措施进行分类。同时,根据数据异质性情况,分别采取随机效应模型或固定效应模型进行Meta分析,同步进行偏倚评估和敏感性分析。结果本研究共检索到文献2 659篇,最终纳入Meta分析的文献70篇。随机效应模型分析显示,鹅膏毒肽中毒治疗后的总病死率为16.9%。在单独一种治疗方式下,鹅膏毒肽中毒治疗后总病死率为21.4%,其中单独支持治疗后的病死率(38.4%)明显高于单独解毒治疗(14.0%)和单独药物治疗(8.3%);在两种治疗方式组合使用后,总病死率为16.8%,其中支持治疗+药物治疗的病死率为15.6%,解毒治疗+药物治疗的病死率为16.2%;解毒治疗、支持治疗和药物治疗三种方式联合使用的总病死率最低(15.1%,95%CI 9.8%~22.5%)。从地区分布看,亚洲患者中毒治疗后的病死率(28.4%)明显高于北美洲(16.9%)和欧洲(12.5%)。结论治疗后鹅膏毒肽中毒病死率仍较高,且各大洲之间存在明显差异。药物+解毒+支持治疗可有效改善治疗效果。Objective To evaluate the therapeutic effect of different clinical treatment methods on amanitin poisoning.Methods PubMed,Embase,OVID,Wanfang and China national knowledge infrastructure(CNKI)were searched for qualifying study,then the data were collected and organized.The treatment methods for amanitin poisoning were classified according to the literature.Fur-thermore,a random effect model or a fixed effect model were applied for Meta-analysis based on the heterogeneity,and the bias evaluation and sensitivity analysis were performed simultaneously.Results A total of 2659 documents were retrieved in this study,and 70 were finally included in Meta-analysis.The random effect model showed that the total fatality rate of amanitin poisoning after treatment was 16.9%,the total fatality rate for single treatment method was 21.4%,among them,the fatality rate(38.4%)of sup-portive treatment was significantly higher than that of detoxification alone(14.0%)and drug therapy alone(8.3%)also.While the total fatality rate of two methods combine therapy was 16.8%,of which the fatality rate of supportive therapy combined with drug thera-py was 15.6%,the fatality rate of detoxification therapy combined with drug therapy was 16.2%.But the lowest fatality rate was the treatment of combined all the detoxification,supportive and drug therapies together:15.1%(95%CI 9.8%~22.5%).Additionally,in terms of regional distribution,the fatality rate of amanitin poisoning in Asian(28.4%)was significantly higher than that in north America(16.9%)and Europe(12.5%).Conclusion The results suggested that the fatality rate of amnitin poisoning was still high even after treatment,there were significant differences between continents,the comprehensive treatment combined drugs,detoxification and supportive therapies might effectively improve the therapeutic effect.

关 键 词：鹅膏毒肽 中毒 治疗 荟萃分析 病死率 

分 类 号：R135[医药卫生—劳动卫生] TP393.07[医药卫生—公共卫生与预防医学]