Li J, Chen T R, Gong H L, Wan M H, Chen G Y, Tang W F
Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
West Indian Med J. 2012 Sep;61(6):574-9.
To assess the effect of intensive insulin therapy on outcomes of patients with severe acute pancreatitis.
Relevant literatures cited in these electronic databases: Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNK1) database, and Excerpta Medical database (Embase) were systematically searched for randomized controlled trials (RCTs) in which intensive insulin therapy was used in severe acute pancreatitis. Length of hospitalization, acute physiology and chronic health evaluation II (APACHE II) score, incidence of complications, and adverse effects were recorded for statistical analysis. The methodological quality of the eligible studies was assessed by Jadad scale. The results were analysed by Revman 4.3 software.
Three studies, which included a total of 118 cases, were finally reviewed. The methodological quality of the trials varied substantially In patients with severe acute pancreatitis, intensive insulin therapy was associated with shorter length of hospitalization (weighted mean difference (WMD) = -12.13, 95% confidence interval (CI) [-15.48, 8.78], p > 0.00001) and lower APACHE II score after 72 hours treatment (WMD = -3.80, 95% CI [-4.88,2. 72], p > 0.00001). One study reported insulin-related adverse event.
In patients with severe acute pancreatitis, intensive insulin therapy could relieve the patient's condition earlier and shorten the length of hospitalization without serious adverse effect.
评估强化胰岛素治疗对重症急性胰腺炎患者预后的影响。
系统检索电子数据库Medline、中国生物医学文献数据库、中国知网数据库（CNKI）和荷兰医学文摘数据库（Embase）中引用的相关文献，查找在重症急性胰腺炎中使用强化胰岛素治疗的随机对照试验（RCT）。记录住院时间、急性生理与慢性健康状况评分系统II（APACHE II）评分、并发症发生率及不良反应，进行统计分析。采用Jadad量表评估纳入研究的方法学质量。运用Revman 4.3软件分析结果。
最终纳入3项研究，共118例患者。试验的方法学质量差异较大。在重症急性胰腺炎患者中，强化胰岛素治疗与较短的住院时间相关（加权均数差（WMD）=-12.13，95%置信区间（CI）[-15.48，-8.78]，p<0.00001），且治疗72小时后APACHE II评分较低（WMD=-3.80，95%CI[-4.88，-2.72]，p<0.00001）。1项研究报告了胰岛素相关不良事件。
在重症急性胰腺炎患者中，强化胰岛素治疗可更早缓解患者病情，缩短住院时间，且无严重不良反应。
