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【JAMA】对危重病老年患者进行严格血糖控制可能
对成人危重症患者严格控制血糖可能无法改善预后
News Author: Laurie Barclay, MD
新闻作者：Laurie Barclay, MD
August 26, 2008 — In critically ill adult patients, tight glucose control is not associated with significantly reduced hospital mortality rates but is associated with an increased risk for hypoglycemia, according to the results of a meta-analysis reported in the August 27 issue of the Journal of the American Medical Association.
2008年8月26日——明天出版的JAMA杂志将刊登一篇meta分析研究，文中认为对成人危重症患者进行严格血糖控制并不能显著降低住院死亡率，反而增加发生低血糖的危险。
"The American Diabetes Association and Surviving Sepsis Campaign recommend tight glucose control in critically ill patients based largely on 1 trial that shows decreased mortality in a surgical intensive care unit," write Renda Soylemez Wiener, MD, MPH, from Dartmouth Medical School in Hanover, New Hampshire, and colleagues. "Because similar studies report conflicting results and tight glucose control can cause dangerous hypoglycemia, the data underlying this recommendation should be critically evaluated."
文章的作者是达特毛斯医学院的医学博士、公共卫生硕士Renda Soylemez Wiener和他的同事们。文中阐述：“美国糖尿病学会和拯救脓毒血症全球行动（SSC）之所以推荐对危重症患者严格控制血糖，主要是基于之前一个临床试验的发现——严格控制血糖能降低外科ICU患者的死亡率。但其他类似研究得出的结论相互矛盾，并且可由此导致严重低血糖，所以需要批判性地分析这个治疗推荐背后的资料。
The goal of this meta-analysis was to assess the benefits and risks for tight glucose control vs usual care in critically ill adult patients. Using MEDLINE from 1950 to 2008, the Cochrane Library, clinical trial registries, reference lists, and abstracts from conferences from both the American Thoracic Society (2001-2008) and the Society of Critical Care Medicine (2004-2008), the reviewers searched for studies in any language in which adult patients in the intensive care unit (ICU) were randomly assigned to tight glucose control vs usual glucose control.
这个meta分析旨在评估对成人危重症患者进行严格血糖控制与普通血糖控制相比，有何益处和危险。资料来源包括MEDLINE(1950~2008), Cochrane图书馆，临床试验登记库，参考文献列表，以及ATS（2001~2008）和SCCM（2004~2008）会议的摘要。搜索任何语种发表的针对成年ICU患者的相关主题随机研究。
Of 1358 identified studies, 34 randomized trials met criteria for inclusion; of these, 23 were full publications, 9 were abstracts, and 2 were unpublished studies.
共搜索到1358个相关主题的研究，有34个随机试验达到入选要求，其中23个是全文发表的，9个发表了摘要，另外2个则未公开发表。
Using a pre-specified protocol and standardized scale, 2 reviewers independently extracted data and evaluated the methodologic quality of the included trials. Study investigators were contacted for missing details, and random-effects and fixed-effects models were used to estimate relative risks (RRs).
两个独立综述人按照事先拟定的标准对入选研究进行方法学评估和数据收录。联系研究者获取未发表的细节资料，并使用随机效应和固定效应模型评估相对危险度（RRs）
The 29 randomized controlled trials used for the meta-analysis enrolled a total of 8432 patients. Overall hospital mortality rate was not significantly different with tight glucose control vs usual care (21.6% vs 23.3%; RR, 0.93; 95% confidence interval [CI], 0.85 - 1.03). When stratified by glucose target, the analysis still showed no significant difference in mortality rates with very tight glucose control(≤ 110 mg/dL; 23% vs 25.2%; RR, 0.90; 95% CI, 0.77 - 1.04) or moderately tight glucose control (< 150 mg/dL; 17.3% vs 18.0%; RR, 0.99; 95% CI, 0.83 - 1.18).
其中29个随机对照试验共入选患者8432人。总体医院死亡率在严格控制血糖组和普通控制血糖组并无显著差异（(21.6% vs 23.3%; RR, 0.93; 95% confidence interval [CI], 0.85 - 1.03). 若按目标血糖水平细分为高度严格控制组(≤ 110 mg/dL)和中度严格控制组(< 150 mg/dL)，两亚组死亡率与普通控制组仍无显著差异(高度严格vs普通控制: 23% vs 25.2%; RR, 0.90; 95% CI, 0.77 - 1.04. 中度严格vs普通控制: 17.3% vs 18.0%; RR, 0.99; 95% CI, 0.83 - 1.18).
Mortality rates did not differ based on ICU setting when stratified by surgical ICU (8.8% vs 10.8%; RR, 0.88; 95% CI, 0.63 - 1.22), medical ICU (26.9% vs 29.7%; RR, 0.92; 95% CI, 0.82 - 1.04), or medical-surgical ICU (26.1% vs 27.0%; RR, 0.95; 95% CI, 0.80 - 1.13).
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作者:admin@医学,生命科学 2010-12-01 05:11
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