维生素 C 治疗感染性休克患者的临床疗效和安全性：系统评价和荟萃分析。
Clinical efficacy and safety of vitamin C in the treatment of septic shock patients: systematic review and meta-analysis.
机构信息
Department of Critical Medicine, The People's Hospital of Wanning, Wanning, China.
Department of Emergency ICU, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
出版信息
Ann Palliat Med. 2022 Apr;11(4):1369-1380. doi: 10.21037/apm-22-225.
BACKGROUND
Vitamin C deficiency is common in sepsis patients and is related to disease severity. At present, sepsis still has a high incidence and fatality rate. In sepsis, the body may develop microcirculation disorders and even develop organ failure. Exogenous vitamin C supplementation may be one of the effective adjuvant treatment measures for sepsis, which can not only improve the microcirculation of the body, but also affect the prognosis of patients by participating in the synthesis of norepinephrine, improving peripheral vascular resistance and increasing perfusion pressure. The efficacy and safety of vitamin C adjuvant therapy for septic shock are inconsistent in many studies, so it is very important to systematically evaluate the adjuvant effect of intravenous vitamin C in the treatment of septic shock.
METHODS
Literature search of PubMed, EMBASE, The Cochrane Library, Web of Science, Wanfang, China Biology Medicine (CBM), and China National Knowledge Infrastructure (CNKI) electronic databases for vitamin C data since August 2021 for the treatment of patients with sepsis and septic shock. After screening, data extraction and quality evaluation were performed according to inclusion criteria, and meta-analysis was conducted using RevMan 5.3.
RESULTS
The final 13 studies comprised 6 cohort studies and 7 randomized controlled trials (RCTs), with a total of 1,423 patients enrolled. Meta-analysis showed no significant effect of intravenous vitamin C on reducing in-hospital mortality rate [odds ratio (OR) =0.91, 95% confidence interval (CI): 0.76-1.08, P=0.27], intensive care unit (ICU) mortality rate (OR =0.84, 95% CI: 0.69-1.01, P=0.07), ICU stay (OR =0.88, 95% CI: 0.72-1.08, P=0.23) or total stay (OR =0.91, 95% CI: 0.68-1.21, P=0.51) in sepsis patients, nor did it improve the 72-h sequential organ failure assessment (72-h SOFA) score (OR =0.95, 95% CI: 0.77-1.18, P=0.66).
DISCUSSION
Intravenous vitamin C showed no efficacy in the treatment of sepsis.
背景
维生素 C 缺乏在脓毒症患者中很常见，且与疾病严重程度有关。目前，脓毒症的发病率和死亡率仍然很高。在脓毒症中，机体可能会发生微循环障碍，甚至发生器官衰竭。外源性维生素 C 补充可能是脓毒症的一种有效辅助治疗措施，它不仅可以改善机体的微循环，还可以通过参与去甲肾上腺素的合成、提高外周血管阻力和增加灌注压来影响患者的预后。在许多研究中，维生素 C 辅助治疗脓毒性休克的疗效和安全性并不一致，因此系统评估静脉用维生素 C 辅助治疗脓毒性休克的效果非常重要。
方法
检索 2021 年 8 月之前PubMed、EMBASE、The Cochrane Library、Web of Science、万方、中国生物医学文献数据库（CBM）和中国知网（CNKI）电子数据库中有关维生素 C 治疗脓毒症和脓毒性休克患者的数据。经过筛选、纳入标准下的数据提取和质量评价后，使用 RevMan 5.3 进行荟萃分析。
结果
最终纳入了 13 项研究，包括 6 项队列研究和 7 项随机对照试验（RCTs），共纳入 1423 例患者。荟萃分析结果显示，静脉用维生素 C 对降低住院死亡率[比值比（OR）=0.91，95%置信区间（CI）：0.76-1.08，P=0.27]、重症监护病房（ICU）死亡率（OR=0.84，95%CI：0.69-1.01，P=0.07）、ICU 住院时间（OR=0.88，95%CI：0.72-1.08，P=0.23）或总住院时间（OR=0.91，95%CI：0.68-1.21，P=0.51）均无显著影响，也不能改善 72 小时序贯器官衰竭评估（72-h SOFA）评分（OR=0.95，95%CI：0.77-1.18，P=0.66）。
讨论
静脉用维生素 C 对脓毒症的治疗无效。
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