Antioxidant therapy for pain relief in patients with chronic pancreatitis: systematic review and meta-analysis.
Antioxidant therapy for pain relief in patients with chronic pancreatitis: systematic review and meta-analysis.
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DOI：
10.36076/ppj.2013/16/e521
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发表时间：
2013-11
期刊：
影响因子：
3.7
通讯作者：
Guo-hong Cai;Jing Huang;Yan Zhao;J. Chen;Huang-Hui Wu;Yu-Lin Dong;H. Smith;Yun-Qing Li;Wen Wang;Sheng-Xi Wu
中科院分区：
文献类型：
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作者：
Guo-hong Cai;Jing Huang;Yan Zhao;J. Chen;Huang-Hui Wu;Yu-Lin Dong;H. Smith;Yun-Qing Li;Wen Wang;Sheng-Xi Wu
背景：慢性胰腺炎(CP)目前尚无特效治疗方法。微量营养素抗氧化剂治疗痛性脑瘫已有30多年的历史，但其疗效尚不清楚。目的探讨抗氧化剂治疗慢性阻塞性肺病(CP)疼痛的安全性和有效性。以中国大学附属医院为背景，采用研究设计、系统回顾和荟萃分析的方法，两位作者独立回顾了检索结果，并提取数据，通过讨论化解分歧。根据合适的效果模型，使用标准化平均差异(SMDS)、加权平均差异或优势比(OR)来总结效果。从1980年到2012年12月，检索Medline、SqucINFO、Scope us、EMBASE和Cochrane中央对照试验注册中心。对研究抗氧化剂补充缓解CP患者疼痛的随机对照试验(RCT)进行了分析。结果共纳入9个随机对照试验(RCT)，涉及390例患者。总体而言，抗氧化剂治疗与CP患者的疼痛减轻无关(SMD，-0.55；95%CI，-1.22至0.12；P=0.67)。然而，与安慰剂组相比，抗氧化剂治疗显著增加了CP患者血液中抗氧化剂的水平(SMD1.08；95%CI，0.74to1.43；P<；0.00001)。有趣的是，联合使用抗氧化剂(硒、β-胡萝卜素、维生素C、维生素E、蛋氨酸)与疼痛缓解相关(SMD值，-0.93；95%CI，-1.72~-0.14；P=0.02)，而单一抗氧化剂的试验显示CP患者的疼痛没有明显缓解(SMD值，-0.12；95%CI，-1.23~0.99；P=0.83)。有强有力的证据表明，抗氧化剂增加了不良反应(OR，6.09；95%CI，2.29至16.17，P<；0.01)；然而，没有一种是严重的。由于样本较小，无法根据目前的随机对照试验得出综合结论。需要大样本随机对照试验来阐明抗氧化剂对CP患者的止痛效果。结论联合抗氧化剂治疗慢性阻塞性肺疾病是一种安全有效的止痛方法。对总抗氧化状态的测量可能无助于监测CP患者的抗氧化治疗效果。
BACKGROUND Currently, there is no specific therapy for chronic pancreatitis (CP). The treatment of micronutrient antioxidant therapy for painful CP has been sporadically used for more than 30 years, however, its efficacy are still poorly understood. OBJECTIVE The purpose of this meta-analysis is to investigate the safety and efficacy of antioxidant therapy for pain relief in patients with CP. SETTING University Hospital in China STUDY DESIGN Systematic review and meta-analysis METHODS Two authors independently reviewed the search results and extracted data and disagreements were resolved by discussion. Effects were summarized using standardized mean differences (SMDs), weighted mean differences, or odds ratio (OR) according to the suitable effect model. MEDLINE, PsycINFO, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from 1980 through December 2012. Randomized controlled trials (RCTs) that studied antioxidant supplementation for pain relief in patients with CP were analyzed. RESULTS Nine randomized controlled trials (RCTs) involving 390 patients were included. Overall, there was no association of antioxidant therapy with pain reduction in CP patients (SMD, -0.55; 95% CI, -1.22 to 0.12; P = 0.67). However, antioxidant therapy significantly increased blood levels of antioxidants in CP patients versus the placebo group (SMD, 1.08; 95% CI, 0.74 to 1.43; P < 0.00001). Interestingly, combined antioxidant (selenium, β-carotene, vitamin C, vitamin E, methionine) therapy was found to be associated with pain relief (SMD, -0.93; 95% CI, -1.72 to -0.14; P = 0.02), while the trials in which a single antioxidant was used revealed no significant pain relief (SMD, -0.12; 95% CI, -1.23 to 0.99; P = 0.83) in CP patients. Strong evidence was obtained that the antioxidants increased adverse effects (OR, 6.09; 95% CI, 2.29 to 16.17, P < 0.01); nevertheless, none was serious. LIMITATIONS Because of the small sample, a consolidated conclusion cannot be reached based on current RCTs. Large-sample RCTs are needed to clarify the analgesic effect of antioxidants in CP patients. CONCLUSIONS Combined antioxidant therapy seems to be a safe and effective therapy for pain relief in CP patients. Measures of total antioxidant status may not help to monitor the efficacy of antioxidant therapy for patients with CP.