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中华危重症医学杂志(电子版) ›› 2019, Vol. 12 ›› Issue (06) : 393 -401. doi: 10.3877/cma.j.issn.1674-6880.2019.06.007

所属专题: 文献

荟萃分析

丙种球蛋白对成人心肌炎患者影响的Meta分析
徐斯驰1, 闫杰1, 卞洲艳1, 周晓阳1, 唐其柱1,()   
  1. 1. 430060 武汉,武汉大学人民医院心血管内科、代谢与相关慢病湖北省重点实验室
  • 收稿日期:2019-08-19 出版日期:2019-12-01
  • 通信作者: 唐其柱
  • 基金资助:
    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)

Effect of gamma-globulin in adult patients with myocarditis: a meta-analysis

Sichi Xu1, Jie Yan1, Zhouyan Bian1, Xiaoyang Zhou1, Qizhu Tang1,()   

  1. 1. Department of Cardiology, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Metabolic and Chronic Diseases, Wuhan 430060, China
  • Received:2019-08-19 Published:2019-12-01
  • Corresponding author: Qizhu Tang
  • About author:
    Corresponding author: Tang Qizhu, Email:
引用本文:

徐斯驰, 闫杰, 卞洲艳, 周晓阳, 唐其柱. 丙种球蛋白对成人心肌炎患者影响的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2019, 12(06): 393-401.

Sichi Xu, Jie Yan, Zhouyan Bian, Xiaoyang Zhou, Qizhu Tang. Effect of gamma-globulin in adult patients with myocarditis: a meta-analysis[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(06): 393-401.

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2 272例,实验组患者1 067例,对照组患者1 205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 2 272 patients were included in this study, 1 067 patients in the experimental group and 1 205 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.

表1 纳入研究的基本特征及质量评价
纳入研究 样本量(例) 年龄[岁,±sMP25P75)或范围] 病程(范围或±s 临床表现 质量级别
实验组 对照组 实验组 对照组 实验组 对照组
丁健[8]2013 27 25 40.5 43.5 10 d ~ 3.7年 15 d ~ 14年 ①②③④
唐玉立[9]2014 37 29 39.7(20,58) 42.4(22,60) 1~3年 1~4年 ①③④
庞秀梅[10]2016 47 47 38.86 ± 2.91 38.27 ± 2.16 - - ②③
郭伟民等[11]2016 30 30 35.8 ± 6.2 - - ①②⑤
王平[12]2017 23 23 43.24 ± 6.85 - - -
覃露海等[13]2017 28 27 31.19 ± 9.89 28.11 ± 9.54 - -
郝翠芹等[14]2012 60 60 35 ± 2 - - ①②③④⑤⑥
贺文强[15]2015 11 9 17 ~ 51 16 ~ 50 - - ①②③④⑥
余海波[16]2014 15 15 35.4 ± 1.9 34.1 ± 1.6 - - -
任琳琳[17]2016 41 41 33.9 ± 5.7 33.4 ± 5.6 - - -
孙明月等[18]2011 18 15 32.6 ± 10.6 31.0 ± 10.1 急性 ①②③④⑤⑥
李延召[19]2016 30 30 32.7 ± 4.3 33.1 ± 3.8 - - -
陈孟青[20]2017 20 20 33.9 ± 4.5 32.1 ± 2.5 - - -
郑炜华[21]2015 35 35 31.7 ± 4.1 31.9 ± 4.3 - - -
梁美华[22]2017 55 55 36 ± 15.68 37 ± 15.46 - - -
高飞等[23]2015 18 15 32.6 ± 10.6 31.0 ± 10.1 急性 -
张秀华[24]2014 32 32 42 ± 1.2 1.2 d ~ 2.8年 ②③④
黄锦浪等[25]2016 30 30 28.5 ± 3.2 28.20 ± 3.4 (5.8 ± 2.1)d (5.6 ± 1.8)d ①⑥⑦
陈心涛等[26]2016 50 50 43.9 ± 2.3 - - - -
张广成等[27]2015 40 40 42.8 ± 2.13 43.5 ± 1.01 急性 -
王罡[28]2016 50 50 34.38 ± 2.7 35.5 ± 2.2 - - -
牟斌[29]2018 26 26 34.18 ± 3.36 32.65 ± 3.17 (3.02 ± 0.75)年 (3.01 ± 0.86)年
王念龙[30]2018 36 36 32.58 ± 5.76 33.74 ± 5.91 (9.47 ± 1.65)年 (9.22 ± 1.63)年 ⑦⑧
郭宏等[31]2016 20 20 32.24 ± 5.48 31.79 ± 4.87 (9.16 ± 1.27)年 (9.12 ± 1.04)年 ②③④⑤⑥⑦⑧
朱德才等[32]2016 36 36 31.3 ± 4.7 31.0 ± 4.2 (9.6 ± 1.4)d (9.5 ± 1.8)d -
Yu等[33]2014 32 26 30.6 ± 14.1 30.0 ± 16.6 < 3个月 ⑥⑦⑧
Isogai等[34]2015 164 164 16 ~ 70 - - -
图1 实验组与对照组治疗对成人心肌炎患者临床疗效的森林图
图2 实验组与对照组治疗对成人心肌炎患者左室射血分数影响的森林图
图3 实验组与对照组治疗对成人心肌炎患者左室舒张末内径影响的森林图
图4 实验组与对照组治疗对成人心肌炎患者肌酸激酶同工酶影响的森林图
图5 实验组与对照组治疗对成人心肌炎患者肌钙蛋白T影响的森林图
图6 实验组与对照组治疗对成人心肌炎患者脑钠肽影响的森林图
图7 实验组与对照组治疗对成人心肌炎患者住院病死率影响的森林图
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