摘要
目的系统评价丙种球蛋白对成人心肌炎患者的影响。方法计算机检索中国知网、万方以及PubMed数据库从建库至2019年3月发表的关于丙种球蛋白治疗成人心肌炎患者的随机对照研究。由2名研究员独立筛选文献、数据提取及质量评价后,采用Review Manager 5.2软件进行Meta分析。结果共纳入文献27篇,合计患者2272例,实验组患者1067例,对照组患者1205例。Meta分析结果显示,与对照组患者比较,实验组患者的临床疗效更好[比值比(OR)=4.88,95%置信区间(CI)(3.38,7.05),Z=8.45,P<0.001],左室射血分数更高[均数差(MD)=0.07,95%CI(0.05,0.09),Z=6.97,P<0.001],左室舒张末内径[MD=-0.19,95%CI(-0.22,-0.15),Z=10.86,P<0.001]、肌酸激酶同工酶[MD=-10.72,95%CI(-13.03,-8.40),Z=9.07,P<0.001]及脑钠肽含量[MD=-173.32,95%CI(-230.22,-116.43),Z=6.97,P<0.001]均更低,而两组患者间肌钙蛋白T水平[MD=-0.47,95%CI(-1.05,0.11),Z=1.58,P=0.11]及住院病死率[OR=0.59,95%CI(0.08,4.22),Z=0.52,P=0.60]比较,差异均无统计学意义。结论丙种球蛋白可明显提高成人心肌炎患者的临床疗效,增加左室射血分数,减少左室舒张末内径,降低肌酸激酶同工酶及脑钠肽的含量,但不影响肌钙蛋白T水平及住院病死率变化。
Objective To systematically evaluate the effect of gamma-globulin in adult patients with myocarditis.Methods The randomized controlled trials about gamma-globulin for the treatment of adult myocarditis patients were retrieved from the CNKI,Wanfang and PubMed databases published up to March 2019.Two reviewers independently screened articles,extracted data and evaluated the quality of included studies.Then meta-analysis was performed using the Review Manager 5.2.Results A total of 27 articles with 2272 patients were included in this study,1067 patients in the experimental group and 1205 in the control group.Meta-analysis demonstrated that as compared with the control group,the clinical efficacy was better[odds ratio(OR)=4.88,95%confidence interval(CI)(3.38,7.05),Z=8.45,P<0.001],and the left ventricular ejection fraction(LVEF)was higher[mean differences(MD)=0.07,95%CI(0.05,0.09),Z=6.97,P<0.001],and the left ventricular end diastolic diameter(LVDD)[MD=-0.19,95%CI(-0.22,-0.15),Z=10.86,P<0.001],creatine kinase isoenzyme MB(CK-MB)[MD=-10.72,95%CI(-13.03,-8.40),Z=9.07,P<0.001]and brain natriuretic peptide(BNP)[MD=-173.32,95%CI(-230.22,-116.43),Z=6.97,P<0.001]were lower in the experimental group.However,the cardiac troponin T[MD=-0.47,95%CI(-1.05,0.11),Z=1.58,P=0.11]and in-hospital mortality[OR=0.59,95%CI(0.08,4.22),Z=0.52,P=0.60]were not significantly different between the two groups.Conclusion Gamma-globulin can obviously improve the clinical efficacy,increase LVEF and reduce LVDD,CK-MB and BNP in adult patients with myocarditis,but it does not affect their troponin T and in-hospital mortality.
作者
徐斯驰
闫杰
卞洲艳
周晓阳
唐其柱
Xu Sichi;Yan Jie;Bian Zhouyan;Zhou Xiaoyang;Tang Qizhu(Department of Cardiology,Renmin Hospital of Wuhan University,Hubei Key Laboratory of Metabolic and Chronic Diseases,Wuhan 430060,China)
出处
《中华危重症医学杂志（电子版）》
CAS
CSCD
2019年第6期393-401,共9页
Chinese Journal of Critical Care Medicine:Electronic Edition
基金
国家自然科学基金(重点项目)(81530012)
国家重点研发计划资助项目(2018YFC1311300)
