摘要
目的系统评价粒细胞-单核细胞集落刺激因子(GM—CSF)治疗脓毒症的有效性和安全性。方法计算机检索PubMed(1966年至2009年10月)、EMbase(1974年至2009年10月)、Cochrane临床试验数据库(2009年第4期)、中国生物医学文献数据库(CBM,1978年至2009年10月)、维普(VIP,1989年至2009年10月)、中国期刊网全文数据库(CNKI,1994年至2009年10月)、万方数据库(1997年至2009年10月)纳入的所有有关GM-CSF治疗脓毒症的临床随机对照试验(RCT),根据Cochrane评价手册5.0质量评价标准评价纳入文献的质量,并用RevMan5.0软件对数据进行荟萃分析(Meta分析)。结果最终纳入4个研究154例患者。Meta分析结果显示:与常规综合支持治疗(常规组)相比,GM—CSF在治疗脓毒症28d病死率方面差异无统计学意义[相对危险度(RR)=0.63,95%可信区间(95%CI)0.27~1.45,P=0.283,在不良事件发生率方面差异亦无统计学意义(RR=0.89,95%C10.34~2.33,P=0.82)。描述性结果显示:GM—CSF治疗脓毒症能够改善免疫抑制,减少感染并发症,缩短机械通气时间;但两组医院及重症监护病房(ICU)停留时间、感染相关器官功能衰竭评分系统(SOFA)评分均无明显差异。结论现有临床证据表明:GM—CSF辅助治疗脓毒症较常规治疗可以改善免疫抑制,减少感染并发症,缩短机械通气时间;但对病死率、不良事件发生率、医院及ICU停留时间、SOFA评分无明显影响。
Objective To systematically assess the effects and safety of granulocyte-monocyte colony-stimulating factor (GM-CSF) in the treatment of sepsis. Methods All randomized controlled trials (RCTs) of GM-CSF for the treatment of sepsis were retrieved from the databases, including PubMed (1966 - 2009.10), EMbase (1974- 2009.10), Cochrane Clinical Trials Library (Issue 4, 2009), China Biomedicine Literature Database (CBM, 1978 - 2009. 10), Weipu (VIP, 1989 - 2009. 10), China National Knowledge Internet (CNKI, 1994 - 2009. 10) and Wanfang Database (1997 - 2009. 10). The quality of the included RCTs was assessed with the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0. The Cochrane Collaborationrs software RevMan 5.0 was used for Meta-analysis. Results Four RCTs (154 patients) were included. Meta-analysis showed that there was no significant difference between the GM-CSF treatment and traditional therapy regarding 28-day mortality rate (relative risk (RR)=0. 63, 95%confidence interval (95%CI) 0.27 -1.45, P = 0. 283. Meta-analysis also showed that there was no significant difference in the rate of adverse events (RR=0.89, 95%CI 0. 34 - 2.33, P= 0. 82). Descriptive analysis showed that GM-CSF could improve immuno-suppression, reduce the complications of infection and shorten the duration of mechanical ventilation, but there was no difference in length of stay in hospital or intensive care unit (ICU) and sepsis-related organ failure assessment (SOFA) score. Conclusion The current evidence shows that, compare with the conventional therapy the GM-CSF has the benefit of improving immune function, reducing the complications of infection, and shortening the duration of mechanical ventilation. However, there is no difference in reducing mortality and adverse event, or shortening the length of stay in hospital or ICU and SOFA score with the use of GM-CSF.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2011年第5期294-298,共5页
Chinese Critical Care Medicine
基金
兰州大学循证医学创新项目(2009LDEBM-A)