Meta analysis on effectiveness of epidermal growth factor in treating patients with inhalation injury
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摘要: 目的 应用荟萃分析方法系统评价表皮生长因子(EGF)治疗吸入性损伤患者的有效性。 方法 以"inhalation injury、smoke inhalation injury、epidermal growth factor、EGF"为检索词,检索《PubMed》《Cochrane Library》《Embase》数据库,以"吸入性损伤、表皮生长因子"为检索词检索《中国期刊全文数据库》《中国生物医学文献数据库》《维普数据库》《万方数据库》,检索自数据库建库以来至2017年12月公开发表的有关EGF治疗吸入性损伤患者的随机对照试验。结局指标为:支气管肺泡灌洗液(BALF)中总蛋白和白蛋白含量、胶体渗透压(COP)、细胞总数、中性粒细胞百分比、淋巴细胞百分比、成纤维细胞百分比,肺部症状消失时间,坏死黏膜脱落时间,气管导管拔出时间,呼吸道分泌物量,以及肺部感染发生率。采用RevMan 5.3统计软件进行荟萃分析。 结果 共纳入6篇研究375例吸入性损伤患者,包括接受EGF治疗的EGF组182例和接受传统治疗的传统治疗组173例。纳入研究中6项研究偏倚风险均不确定。EGF组患者BALF中总蛋白和白蛋白含量、COP均明显低于传统治疗组,标准化均数差(SMD)分别为-9.37、-26.77、-8.13(95%置信区间分别为-14.11~-4.63、-41.85~-11.69、-9.54~-6.73,
P <0.001)。EGF组患者BALF中细胞总数、中性粒细胞百分比、淋巴细胞百分比均低于传统治疗组,成纤维细胞百分比高于传统治疗组,SMD分别为-20.22、-13.08、-12.28、2.99(95%置信区间分别为-22.27~-17.66、-14.76~-11.40、-13.86~-10.70、2.48~3.50,P <0.001)。EGF组患者肺部症状消失时间、坏死黏膜脱落时间、气管导管拔出时间均明显短于传统治疗组,SMD分别为-1.05 、-1.22、-1.11(95%置信区间分别为-1.36~-0.74、-1.54~-0.91、-1.39~-0.82,P <0.001)。EGF组患者呼吸道分泌物量明显少于传统治疗组,SMD为-1.44(95%置信区间为-1.90~-0.98,P <0.001)。EGF组患者肺部感染发生率低于传统治疗组,相对危险度为0.46(95%置信区间为0.24~0.89,P <0.05)。BALF中总蛋白和白蛋白含量、COP可能存在发表偏倚(P <0.05),坏死黏膜脱落时间、肺部症状消失时间、气管导管拔出时间不存在发表偏倚(P >0.05)。 结论 在传统治疗方式上增加EGF治疗吸入性损伤可减轻呼吸道炎症反应,促进呼吸道上皮的修复,缩短气管导管的拔出时间,降低患者肺部感染的概率,对吸入性损伤有良好的效果。Abstract: Objective To systematically evaluate the effectiveness of epidermal growth factor (EGF) in treating patients with inhalation injury by meta analysis. Methods Databases including PubMed, Cochrance Library, and Embase were searched using key words " inhalation injury, smoke inhalation injury, epidermal growth factor, and EGF" , and Chinese Journals Full-text Database, China Biology Medicine disc, VIP Database, and Wanfang Database were searched using key words in Chinese version "吸入性损伤,表皮生长因子" to obtain the randomized controlled trails about EGF published publicly in the treatment of patients with inhalation injury from the establishment of each database to December 2017. The measurement indexes included content of total protein and albumin, colloid osmotic pressure (COP), the number of total cells, percentages of neutrophils, lymphocytes, and fibroblasts in bronchoalveolar lavage fluid (BALF), the time of disappearance of pulmonary symptoms, the time of exfoliation of necrotic mucous membrane, the time of removal of tracheal tube, the amount of respiratory secretions, and the incidence of lung infection. Meta-analysis was conducted by RevMan 5.3 statistical software. Results A total of 6 trials involving 375 patients were included, with 182 patients in group EGF who received EGF treatment and 173 patients in conventional treatment group who received conventional treatment. All of the 6 trails had unclear risk of bias. The content of total protein and albumin and COP in BALF of patients in group EGF were lower than those in conventional treatment group, with standardized mean differences (SMDs) respectively -9.37, -26.77 , and -8.13 [with 95% confidence intervals (CIs) respectively -14.11--4.63, -41.85--11.69, -9.54--6.73,P <0.001]. The number of total cells and percentages of neutrophils and lymphocytes in BALF of patients in group EGF were lower than those in conventional treatment group, while the percentage of fibroblasts in BALF of patients in group EGF was higher than that in conventional treatment group, with SMDs respectively -20.22, -13.08, -12.28, 2.99 (with 95% CIs respectively -22.27--17.66 , -14.76--11.40, -13.86--10.70, 2.48-3.50,P <0.001). The time of disappearance of pulmonary symptoms, the time of exfoliation of necrotic mucous membrane, and the time of removal of tracheal tube of patients in group EGF were shorter than those in conventional treatment group, with SMDs respectively -1.05, -1.22 , -1.11 (with 95% CIs respectively -1.36--0.74, -1.54--0.91, -1.39--0.82,P <0.001). The amount of respiratory secretions of patients in group EGF was lower than that in conventional treatment group, with SMD -1.44 (with 95% CI -1.90--0.98,P <0.001). The incidence rate of pulmonary infection of patients in group EGF was lower than that in conventional treatment group, with relative risk 0.46 (with 95% CI 0.24-0.89,P <0.05). There may be publication bias in the content of total protein, albumin, and COP in BALF (P <0.05), while the time of disappearance of pulmonary symptoms, the time of exfoliation of necrotic mucous membrane, and the time of removal of tracheal tube showed no significant publication bias (P >0.05). Conclusions Conventional treatment combined with EGF therapy can reduce respiratory inflammation of inhalation injury, promote restoration of respiratory epithelium, shorten the time of removal of tracheal tube, reduce the incidence of pulmonary infection of patients, and therefore has good effect on inhalation injury.-
Key words:
- Burns, inhalation /
- Epidermal growth factor /
- Inhalation injury /
- Meta analysis
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