Meta analysis of the effects of hemoperfusion combined with hemofiltration on inflammatory mediators and prognosis in sepsis
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目的 通过Meta分析评价血液灌流联合血液滤过对脓毒症炎症介质及预后的影响.方法 检索PubMed、Web of Science、Medline、中国知网(CNKI)、万方数据库、维普数据库,选取血液灌流联合血液滤过对脓毒症治疗的随机对照试验(观察组采用血液灌流联合血液滤过治疗,对照组采用单纯血液滤过治疗),检索时间为建库至2023年6月30日.采用RevMan 5.4软件进行Meta分析,采用漏斗图进行偏倚评估.结果 共纳入19篇文献,1322例患者.Meta分析结果显示:观察组与对照组患者相比C反应蛋白降低(SMD=-1.60,95％CI:-2.02～-1.18,P＜0.001)、肿瘤坏死因子-α 水平下降(SMD=-1.60,95％CI:-1.77～-1.43,P＜0.001)、白细胞介素-6水平下降(SMD=-1.29,95％CI:-1.43～-1.14,P＜0.001)、序贯器官衰竭评分降低(SMD=-0.74,95％CI:-0.98～-0.51,P＜0.001)、病死率降低(RR=0.50,95％CI:0.39～0.65,P＜0.001).结论 血液灌流联合血液滤过治疗可以下调脓毒症的炎症介质,降低序贯器官衰竭评分及病死率,改善预后.
Objective To evaluate the impact of hemoperfusion combined with hemofiltration on inflam-matory mediators and prognosis in sepsis through meta-analysis.Method A comprehensive literature search was conducted using PubMed,Web of Science,MedLine,China National Knowledge Infrastructure(CNKI),Wanfang Database,and VIP Database to collect randomized controlled trials of blood perfusion combined with blood filtration for the treatment of sepsis(observation group treated with blood perfusion combined with blood filtration,control group treated with pure blood filtration).The search was conducted from the es-tablishment of the database until June 30,2023.Meta-analysis was conducted by using RevMan 5.4 software,and funnel plots were used to analyze the publication bias of various studies.Results A total of 19 articles were included,including 1322 patients.Meta-analysis showed that compared to the control group,the observa-tion group had a lower level of C-reactive protein(SMD=-1.60,95％CI:-2.02～-1.18,P＜0.001),and a low-er level of tumor necrosis factor-α(SMD=-1.60,95％CI:-1.77～-1.43,P＜0.001),a lower level of interleu-kin-6(SMD=-1.29,95％CI:-1.43～--1.14,P＜0.001),a lower level of sequential organ failure scores(SMD=-0.74,95％CI:-0.98,-0.51,P＜0.00l),and decreased mortality rates(RR=0.50,95％CI:0.39～0.65,P＜0.001).Conclusion The combination of hemoperfusion and hemofiltration therapy can downregu-late the inflammatory mediators in sepsis,reduce SOFA scores and mortality,and improve prognosis.
NETL
NSTL
万方数据
