连续肾脏替代治疗在重症急性胰腺炎中的疗效荟萃分析  

The efficacy of continuous renal replacement therapy in severe acute pancreatitis:a meta-analysis

作　　者：童俊翔[1] 任为正[1] 徐菁[1] 何蕾[1] Tong Junxiang;Ren Weizheng;Xu Jing;He Lei(Faculty of Hepatopancreatobiliary Surgery,The First Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肝胆胰外科医学部,北京100853

出　　处：《中国体外循环杂志》2021年第6期356-360,375,共6页Chinese Journal of Extracorporeal Circulation

摘　　要：目的评价连续肾脏替代治疗(CRRT)对重症急性胰腺炎(SAP)患者的疗效。方法检索Pubmed、The Cochrane Library、Embase、Web of Science、万方数据资源系统、维普-中文科技期刊系统数据库和中国生物医学文献数据库、中国知网等数据库,收集CRRT与常规内科治疗(CMT)对SAP疗效的随机对照研究。末次检索时间为2021年8月31日。采用R 4.1.1软件对提取的数据指标进行荟萃分析。结果共收集到文献8篇,总计348例SAP患者被纳入研究。荟萃分析结果显示,CRRT组住院期间病死率显著低于CMT组(RR=0.52,95%CI:0.34~0.79,P=0.002)。CRRT组治疗后急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分显著低于CMT组(随机效应模型MD:-2.7385,95%CI:-5.0017~-0.4753,P=0.0177)。I^(2)=92.0%(84.3%~95.9%),H=3.53(2.52~4.95),提示此研究存在异质性。Meta回归提示发表年份是主要的异质性来源(P=0.0431),年龄可能是一个次要的异质性来源(P=0.1573)。结论CRRT有助于降低SAP患者的病死率和APACHEⅡ评分,但目前尚无大规模多中心随机对照研究。Objective To evaluate the efficacy of continuous renal replacement therapy(CRRT)on patients with severe acute pancreatitis.Methods Pubmed,The Cochrane Library,Embase,Web of Science,CNKI,Wanfang Data Resource System,VIP-Chinese Science and Technology Journal System Database,Chinese Biomedical Literature Database and other databases were queried to collect randomized controlled trials(RCT)about CRRT versus conventional medical treatment(CMT)on the efficacy of severe acute pancreatitis.The last query time is August 31,2021.The R 4.1.1 software and its meta package were used to conduct a meta-analysis on the extracted data.Results A total of 8 articles,comprising 348 patients with severe acute pancreatitis were included in the study.The results of the meta-analysis showed that the mortality during hospitalization in the CRRT group was significantly lower than that in the CMT group(RR=0.52,95%CI:0.34 to 0.79,P=0.002).After treatment,the APACHEⅡscore of the CRRT group was significantly lower than that of the CMT group(random-effect model MD:-2.7385,95%CI:-5.0017~-0.4753,P=0.0177).I^(2)=92.0%(84.3%-95.9%),and H=3.53(2.52-4.95),which suggested heterogeneity in this study.Meta-regression suggested that the year of publication was the main source of heterogeneity(P=0.0431),and age might be a secondary source of heterogeneity(P=0.1573).Conclusion CRRT can help reduce the mortality and APACHEⅡin SAP patients.However,largescale multicenter RCTs are still unavailable.

关 键 词：连续肾脏替代治疗 重症急性胰腺炎 荟萃分析 血液净化 炎症反应 

分 类 号：R576[医药卫生—消化系统]