Qing Zuo, Luo Yan, Yan Shanshan, Zhu Honquan, Huang Peikai, Zhou Zixuan, Shen Hongyi, Xie Bifang, He Weigun, Liu Xiaoqing, Li Yimin, Xu Yuanda
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2016 May;28(5):407-12.
To investigate the possibility of improving the prognosis of patients with severe sepsis by different kinds of intravenous immunoglobulin (IVIG).
PubMed database, EMBase, Cochrane clinical trial database, CNKI, and Wangfang database etc were retrieved. The search time was from database creation to September 2015,which included all prospective studies of the effectiveness of IVIG compared with non-IVIG in all adult patients with severe sepsis. Main end-point parameter was total mortality rate; secondary end-point parameters were short-term (＜ 7 days) mortality,28-day mortality, length of intensive care unit (ICU) and hospital stay, and mortality due to septic shock or multiple organ failure (MOF). RevMan 5.3 was used for Meta analysis.
Finally,16 prospective studies including 12 randomized controlled trails (RCT) and 4 prospective cohort studies were enrolled, referred to 1 819 patients, 892 patients were in IVIG group, 927 patients receiving human albumin, placebo or blank control were in control group. Compared with the control group, IVIG could reduce the total mortality rate of patients with severe sepsis [relative risk (RR) =0.71,95％ confidence interval (95％CI) =0.57-0.87,P =0.001].After the high-risk research was eliminated, it was shown that the IVIG could reduce the total mortality rate in patients with severe sepsis (RR =0.80, 95％CI =0.65-0.98, P =0.03).But IVIG could not reduce the 28-day mortality rate (RR =0.60, 95％CI =0.35-1.04, P =0.07), short-term mortality rate (RR =1.06, 95％CI =0.76-1.46,P =0.74), the mortality rate of septic shock (RR =0.55, 95％CI =0.29-1.03, P =0.06) and the mortality rate of MOF (RR =0.91, 95％CI =0.63-1.33, P =0.64).In fact, the length of stay in ICU [weighted mean difference (WMD) =-0.02, 95％CI =-0.03-0.25, P =0.86] and the total length of stay in hospital (WMD =-2.34,95％CI =-7.05-2.37,P =0.33) were similar. In subgroup, the 28-day mortality rate of patients with severe sepsis in the IgM group (RR =0.50, 95％CI =0.25-1.01, P =0.05) was significantly lower than that of IgG group (RR =0.72, 95％CI =0.40-1.30, P =0.28).
IVIG can reduce the total mortality rate of patients with severe sepsis. Compared with IgG, IgM-enriched IVIG has certain advantages in patients with severe sepsis, but cannot reduce the short-term mortality rate, mortality rate of septic shock and MOF, and also cannot shorten the length of ICU stay and the total length of hospital day.
探讨不同种类静脉注射免疫球蛋白（IVIG）改善严重脓毒症患者预后的可能性。
检索PubMed数据库、EMBase、Cochrane临床试验数据库、CNKI和万方数据库等。检索时间从数据库创建至2015年9月，纳入所有比较IVIG与非IVIG对成年严重脓毒症患者有效性的前瞻性研究。主要终点参数为总死亡率；次要终点参数为短期（＜7天）死亡率、28天死亡率、重症监护病房（ICU）住院时间和住院总时间，以及感染性休克或多器官功能衰竭（MOF）导致的死亡率。采用RevMan 5.3进行Meta分析。
最终纳入16项前瞻性研究，包括12项随机对照试验（RCT）和4项前瞻性队列研究，涉及1819例患者，IVIG组892例，接受人血白蛋白、安慰剂或空白对照的对照组927例。与对照组相比，IVIG可降低严重脓毒症患者的总死亡率[相对危险度（RR）=0.71，95％置信区间（95％CI）=0.57 - 0.87，P =0.001]。排除高风险研究后，显示IVIG可降低严重脓毒症患者的总死亡率（RR =0.80，95％CI =0.65 - 0.98，P =0.03）。但IVIG不能降低28天死亡率（RR =0.60，95％CI =0.35 - 1.04，P =0.07）、短期死亡率（RR =1.06，95％CI =0.76 - 1.46，P =0.74）、感染性休克死亡率（RR =0.55，95％CI =0.29 - 1.03，P =0.06）和MOF死亡率（RR =0.91，95％CI =0.63 - 1.33，P =0.64）。实际上，ICU住院时间[加权均数差（WMD）=-0.02，95％CI =-0.03 - 0.25，P =0.86]和住院总时间（WMD =-2.34，95％CI =-7.05 - 2.37，P =0.33）相似。亚组分析中，IgM组严重脓毒症患者的28天死亡率（RR =0.50，95％CI =0.25 - 1.01，P =0.05）显著低于IgG组（RR =0.72，95％CI =0.40 - 1.30，P =0.28）。
IVIG可降低严重脓毒症患者的总死亡率。与IgG相比，富含IgM的IVIG在严重脓毒症患者中具有一定优势，但不能降低短期死亡率、感染性休克和MOF死亡率，也不能缩短ICU住院时间和住院总天数。
