氢化可的松联合维生素C、维生素B_(1)治疗脓毒症疗效的Meta分析  

Effect of Hydrocortisone Combined with Vitamin C and Vitamin B_(1) in the Treatment of Sepsis:a Meta-analysis

作　　者：王建 张炎 程璐[1] 鲁俊[1] 周江[1] WANG Jian;ZHANG Yan;CHENG Lu;LU Jun;ZHOU Jiang(Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院,江苏省南京市210029

出　　处：《实用心脑肺血管病杂志》2022年第2期95-102,共8页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家自然科学基金资助项目(82074379);江苏省中医药科技发展计划项目(ZD202004,QN202004)。

摘　　要：背景维生素C与维生素B_(1)具有抗氧化作用,推测其与氢化可的松联合使用能产生协同效应,从而起到改善脓毒症或脓毒性休克患者免疫功能和减轻氧化应激的作用。有研究者基于此假设通过回顾性对照研究发现,此三联疗法能明显降低脓毒症患者病死率,但其后多篇随机对照研究对此治疗方案提出质疑。目的采用Meta分析评价氢化可的松联合维生素C、维生素B_(1)(HAT)治疗脓毒症的疗效。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、中国生物医学文献服务系统及维普网自建库至2021-08-01发表的HAT治疗脓毒症的随机对照试验。对照组采用脓毒症集束化基础治疗,试验组在对照组基础上采用HAT治疗。主要观察指标为院内病死率,次要观察指标为72 h序贯器官衰竭估计评分变化值(72 hΔSOFA)、血管活性药物使用时间、急性肾损伤(AKI)发生率。由2名研究者独立进行文献筛选、资料提取,并采用Cochrane偏倚风险评估工具对纳入文献进行方法学质量评价。应用RevMan 5.3软件评估纳入文献的偏倚风险,应用R 3.6.2软件Meta包进行Meta分析。根据疾病类型将患者分为脓毒症、脓毒症和脓毒性休克、脓毒性休克3类,进行亚组分析。应用漏斗图和Egger检验评估纳入文献的发表偏倚。结果最终纳入文献10篇,共包含1611例患者,其中试验组805例、对照组806例。在随机序列产生、分配隐藏方面,7篇文献为低偏倚风险,2篇文献为高偏倚风险,1篇文献的偏倚风险不清楚;在对受试者、试验人员施盲及对结局评估员施盲、结果数据不完整、选择性报告研究结果、其他偏倚来源方面,10篇文献均为低偏倚风险。Meta分析结果显示:试验组与对照组院内病死率〔相对危险度(RR)=1.03,95%可信区间(CI)(0.92,1.15),P=0.65〕、AKI发生率〔RR=1.04,95%CI(0.89,1.21),P=0.70〕比较,差异无统计Background Vitamin C and vitamin B_(1) have antioxidant effects,and it is speculated that they can produce synergistic effect when used in combination with hydrocortisone,which can improve immune function and reducing oxidative stress in patients with sepsis or septic shock.Based on this hypothesis,some researchers have found that this triple therapy can significantly reduce the mortality of patients with sepsis through retrospective controlled studies,but a number of prospective randomized controlled studies have questioned this treatment plan.Objective To evaluate the effect of hydrocortisone,vitamin C(ascorbic acid)and vitamin B_(1)(thiamine)(HAT)in the treatment of patients with sepsis by metaanalysis.Methods The randomized controlled trials of HAT in the treatment of sepsis published in PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang Data,Chinese Biomedical Document Service System and VIP from the establishment of database to August 1,2021 were searched.The control group was given the basic treatment of sepsis bundle,and the experimental group was given HAT treatment on the basis of the control group.Among the observed indexes,the main index was the in-hospital mortality,and the secondary indexes were the change of sequential organ failure assessment score at 72 h(72 hΔSOFA),duration of vasoactive drug use,and incidence of acute kidney injury(AKI).The literature were screened and extracted independently by two investigators,and the methodological quality of the included literature was evaluated by the Cochrane risk of bias assessment tool.RevMan 5.3 software was used to evaluate the risk of bias of the included literature,and R 3.6.2 software Meta package was used for meta-analysis.According to the type of disease,patients were divided into three categories:sepsis,sepsis and septic shock,and septic shock,and subgroup analysis was performed.The publication bias of the included literature was assessed using funnel plot and Egger test.Results Finally,10 literature were included,including 1611 patien

关 键 词：脓毒症 脓毒性休克 氢化可的松 维生素C 维生素B_(1) 治疗结果 META分析 

分 类 号：R631[医药卫生—外科学]