预防性抗生素不能降低急性坏死性胰腺炎的感染性胰腺坏死及死亡率：一项随机对照试验的荟萃分析证据

Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from a meta-analysis of randomized controlled trials.

作者信息

Bai Yu, Gao Jun, Zou Duo-Wu, Li Zhao-Shen

机构信息

Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.

出版信息

Am J Gastroenterol. 2008 Jan;103(1):104-10. doi: 10.1111/j.1572-0241.2007.01575.x. Epub 2007 Oct 9.

DOI:10.1111/j.1572-0241.2007.01575.x

PMID:17925000

Abstract

BACKGROUND

There is no agreement whether intravenous prophylactic antibiotics can reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis (ANP). We performed a meta-analysis comparing intravenous antibiotics with placebo or no treatment in randomized controlled trials (RCTs).

METHODS

Databases including MEDLINE, EMBASE, the Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were infected necrosis and mortality.

RESULTS

Seven trials involving 467 patients were included. Analysis suggested infected pancreatic necrosis rates were not significantly different (antibiotics 17.8%, controls 22.9%), RR 0.81 (95% CI 0.54-1.22). There was nonsignificantly decreased mortality with antibiotics (9.3%) versus controls (15.2%), RR 0.70 (95% CI 0.42-1.17). Subsequent subgroup analysis confirmed antibiotics were not statistically superior to controls in reduction of infected necrosis and mortality.

CONCLUSIONS

Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in patients with ANP.

摘要

背景

对于静脉注射预防性抗生素能否降低急性坏死性胰腺炎（ANP）患者的感染性胰腺坏死及死亡率，目前尚无定论。我们进行了一项荟萃分析，比较随机对照试验（RCT）中静脉使用抗生素与使用安慰剂或不进行治疗的效果。

方法

检索包括MEDLINE、EMBASE、Cochrane对照试验注册库、Cochrane图书馆和科学引文索引在内的数据库，以查找相关试验。观察指标为感染性坏死和死亡率。

结果

纳入了7项涉及467例患者的试验。分析表明，感染性胰腺坏死率无显著差异（抗生素组为17.8%，对照组为22.9%），相对危险度（RR）为0.81（95%置信区间[CI]为0.54 - 1.22）。抗生素组的死亡率（9.3%）与对照组（15.2%）相比有非显著性降低，RR为0.70（95% CI为0.42 - 1.17）。随后的亚组分析证实，在降低感染性坏死和死亡率方面，抗生素在统计学上并不优于对照组。