重症急性胰腺炎抗生素预防的随机对照试验：方法学质量与结果之间的关系。

Randomized controlled trials of antibiotic prophylaxis in severe acute pancreatitis: relationship between methodological quality and outcome.

作者信息

de Vries Annemarie C, Besselink Marc G H, Buskens Erik, Ridwan Ben U, Schipper Maria, van Erpecum Karel J, Gooszen Hein G

机构信息

Gastrointestinal Research Unit, Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands.

出版信息

Pancreatology. 2007;7(5-6):531-8. doi: 10.1159/000108971. Epub 2007 Sep 27.

DOI:10.1159/000108971

PMID:17901714

Abstract

AIM

To evaluate the methodological quality of randomized controlled trials (RCTs) of systemic antibiotic prophylaxis in severe acute pancreatitis in relation to outcome.

METHODS

The MEDLINE, EMBASE and Cochrane databases were searched for RCTs that studied the effectiveness of systemic antibiotic prophylaxis in severe acute pancreatitis. A meta-analysis was performed with a random effects model. Methodological quality was quantified by a previously published scoring system (range 0-17 points).

RESULTS

Six studies, with a total of 397 participants, obtained a methodological score of at least 5 points and were included. Systemic antibiotic prophylaxis had no significant effect on infection of pancreatic necrosis (absolute risk reduction (ARR) 0.055; 95% CI -0.084 to 0.194) and mortality (ARR 0.058, 95% CI -0.017 to 0.134). Spearman correlation showed an inverse association between methodological quality and ARR for mortality (correlation coefficient -0.841, p = 0.036).

CONCLUSIONS

The inverse relationship between methodological quality and impact of antibiotic prophylaxis on mortality emphasizes the importance of high-quality RCTs. At present, adequate evidence for the routine use of antibiotic prophylaxis in severe acute pancreatitis is lacking.

摘要

目的

评估重症急性胰腺炎全身应用抗生素预防性治疗的随机对照试验（RCT）的方法学质量及其与预后的关系。

方法

检索MEDLINE、EMBASE和Cochrane数据库，查找研究重症急性胰腺炎全身应用抗生素预防性治疗有效性的随机对照试验。采用随机效应模型进行荟萃分析。方法学质量通过先前发表的评分系统进行量化（范围为0 - 17分）。

结果

六项研究，共397名参与者，方法学评分至少为5分，被纳入研究。全身应用抗生素预防性治疗对胰腺坏死感染（绝对风险降低（ARR）0.055；95%置信区间 - 0.084至0.194）和死亡率（ARR 0.058，95%置信区间 - 0.017至0.134）无显著影响。Spearman相关性分析显示，方法学质量与死亡率的ARR之间呈负相关（相关系数 - 0.841，p = 0.036）。