血必净注射液治疗急性百草枯中毒临床疗效的Meta分析
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摘要
目的探讨血必净注射液治疗急性百草枯中毒(APQ)的临床疗效。方法计算机检索Pub Med、The Cochrane Library、EMbase、CNKI、CBM及万方数据库,查找血必净治疗急性百草枯中毒的随机对照试验(RCT),检索时限为建库至2017年10月15日,按照纳入及排除标准独立筛选文献、提取资料并用Rev Man5.3软件行Meta分析。结果纳入22个RCT,共计患者1240例。Meta分析结果显示:血必净组较对照组丙氨酸氨基转移酶低[MD=-115.53,95%CI(-182.50,-48.56)]、肌酐低[MD=-180.31,95%CI(-240.48,-120.14)]、白细胞计数低[MD=-6.89,95%CI(-9.54,-4.24)]及C反应蛋白低[MD=-7.65,95%CI(-8.75,-6.55)];氧饱和度高[MD=17.65,95%CI(13.45,21.85)]及近远期总体生存率高[RR=1.42,95%CI(1.30,1.55)];但两组在氧分压、二氧化碳分压及多器官功能衰竭发生率上差异无统计学意义。结论血必净注射液可较好改善急性百草枯中毒患者肝肾功能、减轻炎症反应、提高氧合水平及近远期生存率。
Objective To systematically evaluate the efficacy of Xuebijing injection in treating acute paraquat poisoning( APQ). Methods The randomized controlled trials( RCTs) about Xuebijing injection for treatment of APQ was searched in Pub Med,The Cochrane Library,EMbase,CNKI,CBM and Wan Fang Database from the date of their establishment to Oct 15 th,2017.Two researchers independently screened the literature according to the inclusion and exclusion criteria,and extracted the data. Then,Meta-analysis was performed using Rev Man 5. 3 software. Results A total of 20 RCTs( 1240 patients) were included.The results of meta-analysis showed that compared with control groups,Xuebijing groups had lower ALT [MD =-115.53,95%CI:-182.50,-48.56],lower Crea [MD =-180.31,95%CI(-240.48,-120.14) ],lower WBC [MD =-6.89,95%CI(-9.54,-4.24) ],lower CRP [MD =-7.65,95%CI(-8.75,-6.55) ],and higher Sp O2[MD = 17.65,95%CI( 13.45,21.85) ],meanwhile recent and long-term survival rate was much higher [RR = 1. 42,95% CI( 1. 30,1. 55) ]. However,there were no significant statistical differences in Pa O2,Pa CO2 and the incidence of multiple organ dysfunction syndrome( MODS). Conclusion Xuebijing injection can protect APQ patients kidney and liver function,reduce inflammatory response,improve oxygenation level as well as recent and long-term survival rate.
Objective To systematically evaluate the efficacy of Xuebijing injection in treating acute paraquat poisoning( APQ). Methods The randomized controlled trials( RCTs) about Xuebijing injection for treatment of APQ was searched in Pub Med,The Cochrane Library,EMbase,CNKI,CBM and Wan Fang Database from the date of their establishment to Oct 15 th,2017.Two researchers independently screened the literature according to the inclusion and exclusion criteria,and extracted the data. Then,Meta-analysis was performed using Rev Man 5. 3 software. Results A total of 20 RCTs( 1240 patients) were included.The results of meta-analysis showed that compared with control groups,Xuebijing groups had lower ALT [MD =-115.53,95%CI:-182.50,-48.56],lower Crea [MD =-180.31,95%CI(-240.48,-120.14) ],lower WBC [MD =-6.89,95%CI(-9.54,-4.24) ],lower CRP [MD =-7.65,95%CI(-8.75,-6.55) ],and higher Sp O2[MD = 17.65,95%CI( 13.45,21.85) ],meanwhile recent and long-term survival rate was much higher [RR = 1. 42,95% CI( 1. 30,1. 55) ]. However,there were no significant statistical differences in Pa O2,Pa CO2 and the incidence of multiple organ dysfunction syndrome( MODS). Conclusion Xuebijing injection can protect APQ patients kidney and liver function,reduce inflammatory response,improve oxygenation level as well as recent and long-term survival rate.
引文
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[11]汪秋艳,高言国,李小彬.血必净在急性百草枯中毒治疗中的疗效观察[J].医学综述,2009,15(9):1417-1418.
[12]李铁刚,张静萍,赵敏,等.血必净注射液治疗百草枯中毒的临床观察[J].中国中西医结合急救杂志,2007,14(2):122-123.
[13]时晔,高路,郭伟,等.血必净治疗百草枯中毒的疗效观察[J].基层医学论坛,2009,13(28):879-881.
[14]张卫,付金孝.血必净治疗百草枯中毒的临床观察(附51例分析)[J].吉林医学,2012,33(6):1199.
[15]王建峰,吴晓珂.血必净治疗百草枯中毒后肺损伤162例临床分析报告[J].中国社区医师,2013,15(4):38.
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[17]秦克秀.血必净注射液对急性百草枯中毒的疗效观察[J].安徽医科大学学报,2011,46(4):376-378.
[18]徐敏,徐继扬,陆明峰,等.血必净注射液对急性百草枯中毒患者脏器损害及炎症因子的影响[J].长春中医药大学学报,2015,31(2):342-344.
[19]徐泽鹤,易佳佳.血必净注射液对急性百草枯中毒疗效观察[J].亚太传统医药,2013,9(6):180-181.
[20]田杰,陈晓曦.血必净注射液治疗急性百草枯中毒临床分析[J].深圳中西医结合杂志,2016,26(1):134-135.
[21]梁高永,赵宁军,许铁,等.血必净注射液治疗急性百草枯中毒临床观察[J].中国现代医药杂志,2009,11(5):37-39.
[22]田丰,黄坚,代将.血必净注射液治疗百草枯中毒的效果观察[J].临床合理用药,2009,2(5):12-13.
[23]李军.血必净注射液治疗急性百草枯中毒的疗效观察[J].医药论坛杂志,2010,31(20):154-155.
[24]李艳.血必净注射液治疗急性百草枯中毒疗效分析[J].医药论坛杂志,2010,31(23):167-168.
[25]王煜,赵敏.血必净注射液对急性百草枯中毒患者的多器官保护作用[J].中国中西医结合急救杂志,2011,18(5):296-298.
[26]李晓岚,高景利,王爱田.早期血必净联合血液灌流治疗急性百草枯中毒的疗效观察[J].中国急救医学,2008,28(8):745-747.
[27]马西凡.血必净注射液联合血液灌流治疗急性百草枯中毒的临床观察[J].医药论坛杂志,2010,31(24):138-139.
[28]周丽程,刘先发,黄家淦,等.血必净注射液治疗急性百草枯中毒的临床研究[J].临床医药实践,2017,26(6):403-406.
[29]龚晓亮,樊菲菲,高新星,等.血必净注射液联合血液灌流早期治疗急性百草枯中毒效果观察[J].解放军医药杂志,2017,29(8):14-17.
[30]DENG J,HUO D,WU Q,et al.Xuebijing for paraquat poisoning[J].Cochrane Database Syst Rev,2013,29(7):CD010109.
[31]卢海儒,樊凌沁.血必净注射液的循证应用、不良反应及使用注意事项[J].中国新药杂志,2013,22(20):2449-2452.
[32]张韻慧,胡文文,任斯嘉,等.HPLC法同时测定血必净中多指标成分的含量[J].光谱实验室,2013,30(5):2305-2308.
[33]俞洋.血必净对急性胰腺炎的临床疗效、氧化应激及CRP、IL-6、TNF-α的影响[J].海南医学院学报,2016,22(14):1509-1511.
[34]王梅芳,熊畅,刘玉全,等.血必净治疗老年吸入性肺炎35例[J].医药导报,2016,35(4):360-362.
[35]张淑文,孙成栋,文燕,等.血必净注射液对脓毒症大鼠血清内毒素及脾脏特异性免疫功能的影响[J].中国中西医结合急救杂志,2007,14(2):91-94.
[36]刘永宇.血必净注射液抗百草枯中毒作用机制研究进展[J].天津中医药,2013,30(8):510-512.
[37]WOOD L,EGGER M,GLUUD L L,et al.Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes:Metaepidemiological study[J].BMJ,2008,336(7644):601-605.
[2]曹书华,王今达,李银平.从“菌毒并治”到“四证四法”—关于中西医结合治疗多器官功能障碍综合征辩证思路的深入与完善[J].中国危重病急救医学,2005,17(11):641-643.
[3]王靓,郑云辉.血必净注射液药理研究进展[J].临床医药实践,2016,25(7):542-543.
[4]DINIS-OLIVEIRE R J,DUARTE J A,SANCHEZ-NAVARRO A,et al.Paraquat poisonings:mechanisms of lung toxicity,clinical features,and treatment[J].Crit Rev Toxicol,2008,38(1):13-71.
[5]宁彰,王屏,魏晓晨.血必净注射液治疗百草枯中毒疗效的Meta分析[J].现代药物与临床,2014,29(9):1063-1067.
[6]百草枯中毒诊断与治疗“泰山共识”专家组,菅向东.百草枯中毒诊断与治疗“泰山共识”(2014)[J].中国工业医学杂志,2014,27(2):117-119.
[7]JULIAN PT,HIGGIN S,SALLY G.Cochrane Handbook for Systematic Reviews of Interventions[EB/OL].The Cochrane Collaboration,2013.http://www.community.cochrane.org/handbook.
[8]GONG P,LU Z,XING J,et al.Traditional Chinese medicine Xuebijing treatment is associated with decreased mortality risk of patients with moderate paraquat poisoning[J].PLo S One,2015,10(4):e0123504.
[9]SHI X,ZHANG Y,WANG Y.Impact of Xuebijing and ulinastatin as assistance for hemoperfusion in treating acute paraquat poisoning[J].Int J Clin Exp Med,2015,8(8):14018-14023.
[10]柳琴.血必净在急性百草枯中毒治疗中的疗效观察[J].中国现代药物应用,2010,4(2):137-138.
[11]汪秋艳,高言国,李小彬.血必净在急性百草枯中毒治疗中的疗效观察[J].医学综述,2009,15(9):1417-1418.
[12]李铁刚,张静萍,赵敏,等.血必净注射液治疗百草枯中毒的临床观察[J].中国中西医结合急救杂志,2007,14(2):122-123.
[13]时晔,高路,郭伟,等.血必净治疗百草枯中毒的疗效观察[J].基层医学论坛,2009,13(28):879-881.
[14]张卫,付金孝.血必净治疗百草枯中毒的临床观察(附51例分析)[J].吉林医学,2012,33(6):1199.
[15]王建峰,吴晓珂.血必净治疗百草枯中毒后肺损伤162例临床分析报告[J].中国社区医师,2013,15(4):38.
[16]韩伟,刘瑞丽.血必净治疗急性百草枯中毒69例疗效分析[J].医药论坛杂志,2009,30(14):83,85.
[17]秦克秀.血必净注射液对急性百草枯中毒的疗效观察[J].安徽医科大学学报,2011,46(4):376-378.
[18]徐敏,徐继扬,陆明峰,等.血必净注射液对急性百草枯中毒患者脏器损害及炎症因子的影响[J].长春中医药大学学报,2015,31(2):342-344.
[19]徐泽鹤,易佳佳.血必净注射液对急性百草枯中毒疗效观察[J].亚太传统医药,2013,9(6):180-181.
[20]田杰,陈晓曦.血必净注射液治疗急性百草枯中毒临床分析[J].深圳中西医结合杂志,2016,26(1):134-135.
[21]梁高永,赵宁军,许铁,等.血必净注射液治疗急性百草枯中毒临床观察[J].中国现代医药杂志,2009,11(5):37-39.
[22]田丰,黄坚,代将.血必净注射液治疗百草枯中毒的效果观察[J].临床合理用药,2009,2(5):12-13.
[23]李军.血必净注射液治疗急性百草枯中毒的疗效观察[J].医药论坛杂志,2010,31(20):154-155.
[24]李艳.血必净注射液治疗急性百草枯中毒疗效分析[J].医药论坛杂志,2010,31(23):167-168.
[25]王煜,赵敏.血必净注射液对急性百草枯中毒患者的多器官保护作用[J].中国中西医结合急救杂志,2011,18(5):296-298.
[26]李晓岚,高景利,王爱田.早期血必净联合血液灌流治疗急性百草枯中毒的疗效观察[J].中国急救医学,2008,28(8):745-747.
[27]马西凡.血必净注射液联合血液灌流治疗急性百草枯中毒的临床观察[J].医药论坛杂志,2010,31(24):138-139.
[28]周丽程,刘先发,黄家淦,等.血必净注射液治疗急性百草枯中毒的临床研究[J].临床医药实践,2017,26(6):403-406.
[29]龚晓亮,樊菲菲,高新星,等.血必净注射液联合血液灌流早期治疗急性百草枯中毒效果观察[J].解放军医药杂志,2017,29(8):14-17.
[30]DENG J,HUO D,WU Q,et al.Xuebijing for paraquat poisoning[J].Cochrane Database Syst Rev,2013,29(7):CD010109.
[31]卢海儒,樊凌沁.血必净注射液的循证应用、不良反应及使用注意事项[J].中国新药杂志,2013,22(20):2449-2452.
[32]张韻慧,胡文文,任斯嘉,等.HPLC法同时测定血必净中多指标成分的含量[J].光谱实验室,2013,30(5):2305-2308.
[33]俞洋.血必净对急性胰腺炎的临床疗效、氧化应激及CRP、IL-6、TNF-α的影响[J].海南医学院学报,2016,22(14):1509-1511.
[34]王梅芳,熊畅,刘玉全,等.血必净治疗老年吸入性肺炎35例[J].医药导报,2016,35(4):360-362.
[35]张淑文,孙成栋,文燕,等.血必净注射液对脓毒症大鼠血清内毒素及脾脏特异性免疫功能的影响[J].中国中西医结合急救杂志,2007,14(2):91-94.
[36]刘永宇.血必净注射液抗百草枯中毒作用机制研究进展[J].天津中医药,2013,30(8):510-512.
[37]WOOD L,EGGER M,GLUUD L L,et al.Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes:Metaepidemiological study[J].BMJ,2008,336(7644):601-605.