乌司他丁治疗急性肺损伤和急性呼吸窘迫综合征：一项系统评价与荟萃分析。
Ulinastatin for acute lung injury and acute respiratory distress syndrome: A systematic review and meta-analysis.
作者信息
Leng Yu-Xin, Yang Shu-Guang, Song Ya-Han, Zhu Xi, Yao Gai-Qi
机构信息
Yu-Xin Leng, Shu-Guang Yang, Xi Zhu, Gai-Qi Yao, Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China.
出版信息
World J Crit Care Med. 2014 Feb 4;3(1):34-41. doi: 10.5492/wjccm.v3.i1.34.
AIM
To investigate the efficacy and safety of ulinastatin for patients with acute lung injury (ALI) and those with acute respiratory distress syndrome (ARDS).
METHODS
A systematic review of randomized controlled trials (RCTs) of ulinastatin for ALI/ARDS was conducted. Oxygenation index, mortality rate [intensive care unit (ICU) mortality rate, 28-d mortality rate] and length of ICU stay were compared between ulinastatin group and conventional therapy group. Meta-analysis was performed by using Rev Man 5.1.
RESULTS
Twenty-nine RCTs with 1726 participants were totally included, the basic conditions of which were similar. No studies discussed adverse effect. Oxygenation index was reported in twenty-six studies (1552 patients). Ulinastatin had a significant effect in improving oxygenation [standard mean difference (SMD) = 1.85, 95%CI: 1.42-2.29, P < 0.00001, I(2) = 92%]. ICU mortality and 28-d mortality were respectively reported in eighteen studies (987 patients) and three studies (196 patients). We found that ulinastatin significantly decreased the ICU mortality [I(2) = 0%, RR = 0.48, 95%CI: 0.38-0.59, number needed to treat (NNT) = 5.06, P < 0.00001], while the 28-d mortality was not significantly affected (I(2) = 0%, RR = 0.78, 95%CI: 0.51-1.19, NNT = 12.66, P = 0.24). The length of ICU stay (six studies, 364 patients) in the ulinastatin group was significantly lower than that in the control group (SMD = -0.97, 95%CI: -1.20--0.75, P < 0.00001, I(2) = 86%).
CONCLUSION
Ulinastatin seems to be effective for ALI and ARDS though most trials included were of poor quality and no information on safety was provided.
目的
探讨乌司他丁对急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）患者的疗效及安全性。
方法
对乌司他丁治疗ALI/ARDS的随机对照试验（RCT）进行系统评价。比较乌司他丁组与传统治疗组的氧合指数、死亡率[重症监护病房（ICU）死亡率、28天死亡率]及ICU住院时间。采用Rev Man 5.1进行荟萃分析。
结果
共纳入29项RCT，1726例参与者，其基本情况相似。无研究讨论不良反应。26项研究（1552例患者）报告了氧合指数。乌司他丁在改善氧合方面有显著效果[标准均差（SMD）=1.85，95%CI：1.42 - 2.29，P < 0.00001，I² = 92%]。18项研究（987例患者）和3项研究（196例患者）分别报告了ICU死亡率和28天死亡率。我们发现乌司他丁显著降低了ICU死亡率[I² = 0%，RR = 0.48，95%CI：0.38 - 0.59，需治疗人数（NNT）= 5.06，P < 0.00001]，而28天死亡率未受到显著影响（I² = 0%，RR = 0.78，95%CI：0.51 - 1.19，NNT = 12.66，P = 0.24）。乌司他丁组的ICU住院时间（6项研究，364例患者）显著低于对照组（SMD = -0.97，95%CI：-1.20 - -0.75，P < 0.00001，I² = 86%）。
结论
尽管纳入的大多数试验质量较差且未提供安全性信息，但乌司他丁似乎对ALI和ARDS有效。
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