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| 静脉输注免疫球蛋白对呼吸机相关肺炎疗效的系统评价 |
| Effectiveness of intravenous immunoglobulin for ventilator-associated pneumonia: a systematic review |
| 投稿时间：2014-12-05 修订日期：2015-01-14 |
| DOI：10.3969/j.issn.1000-0399.2015.07.004 |
| 中文关键词: 呼吸机相关肺炎 静脉输注免疫球蛋白 系统评价 |
| 英文关键词: Ventilator-associated pneumonia(VAP) Intravenous immunoglobulin(IVIG) Systematic review |
| 基金项目:贵州省哲学社会科学规划基金(14GZYB58);遵义医学院博士启动基金(F-617) |
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| 中文摘要: |
| 目的 系统评价免疫球蛋白(IVIG)治疗呼吸机相关性肺炎(VAP)相关研究,分析其有效性,为临床治疗策略提供依据。方法 系统检索CNKI、万方、CBM、Pubmed、Embase、ISI及Cochrane数据库中相关文献,采用Cochrane标准评价纳入研究偏倚风险,Meta分析结合描述性分析研究数据。结果 ①纳入6个随机对照研究,435例低体质量儿、早产儿及婴儿VAP患者,质量一般。②Meta分析结果显示IVIG组死亡率低于非IVIG组[RR=0.33,95%CI(0.18~0.60),P=0.0002];IVIG组血液免疫球蛋白浓度比对照组高3.19 mg/L [MD=3.19,95%CI(3.02~3.37),P<0.05];③IVIG组败血症[RR=0.14,95%CI(0.04~0.51),P=0.003]和多器官功能衰竭发生率[RR=0.51,95%CI(0.30~0.88),P=0.02]低于对照。结论 IVIG主要用于早产儿及低体质量儿VAP患者,可能提高体液免疫,降低败血症和多器官功能衰竭发生率,减少患者病死率,改善预后。 |
| 英文摘要: |
| Objective To provide the evidences for the clinical strategies through systematically reviewing all related studies and analyzing the effectiveness of intravenous immunoglobulin(IVIG) for ventilator-associated pneumonia(VAP). Methods We retrieved all related studies in CNKI, Wanfang, VIP, CBM, Pubmed, ISI, Embase and Cochrane library and evaluated the risk of bias by criteria of the Cochrane Handbook and analyzed all data by meta-analysis. Results Seven RCTs involving 435 low birth weight, preterm or children VAP patients were included, with medium-quality in most trials. ① Meta-analysis results showed that the mortality rate in IVIG group was lower than that in no-IVIG group [RR=0.33,95%CI(0.18,0.60) P=0.0002]. The immunoglobulin concentrations in IVIG group were 3.19mg/L higher than those in no-IVIG group [MD=3.19,95%CI (3.02,3.37) P<0.05]. ② The incidence of sepsis or multiple organ failure in IVIG group was lower than that in non-IVIG group [RR=0.14,95%CI(0.04,0.51) P=0.003] or [RR=0.51,95%CI(0.30,0.88) P=0.02]. All had statistical significance. Conclusion IVIG is mainly used for the preterm, low birth weight or children with VAP and may reduce their mortality and improve their prognosis through enhancing the humoral immunity and decreasing the incidence of sepsis and multiple organ failure. |
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