入院病患的强化胰岛素治疗：系统评价

蓝鱼o_0

续上一篇“美国医师协会（ACP）指南不再建议强化血糖控制”里面提到一篇系统评价

即“入院病患的强化胰岛素治疗：系统评价”。
共享全文并翻译摘要如下：

Intensive Insulin Therapy in Hospitalized Patients: A Systematic Review

Background: The benefits and harms of intensive insulin therapy (IIT) titrated to strict glycemic targets in hospitalized patients remain uncertain.

研究背景：入院病患通过严格的目标血糖滴定来了解其胰岛素治疗水平，然而强化胰岛素（IIT）治疗的好处和坏处目前却并不明确。

Purpose: To evaluate the benefits and harms of IIT in hospitalized patients.

研究目的：了解入院病患IIT好处与坏处

Data Sources: MEDLINE and Cochrane Database of Systematic Reviews from 1950 to January 2010, reference lists, experts, and unpublished sources.

数据来源：MEDLINE数据库和考克兰系统评价数据库，从1950年到2010年1月，参考文献列表，专家，和未发表的资料。

Study Selection: English-language randomized, controlled trials comparing protocols titrated to strict or less strict glycemic targets.

研究的入选标准：对比滴定严格或者不太严格的目标血糖的随机对照临床试验，所有研究均为英文语言。

Data Extraction: Two reviewers independently abstracted data from each study on sample, setting, glycemic control interventions, glycemic targets, mean glucose levels achieved, and outcomes. Results were grouped by patient population or setting. A random ffects model was used to combine trial data on short-term mortality (≤28 days), long-term mortality (90 or 180 days), infection, length of stay, and hypoglycemia. The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate the overall body of evidence for each outcome.

数据提取：两个研究者独立的提取每个研究，包括样本量，研究地点，血糖控制干预措施，血糖目标，血糖水平平均数和预后。结果根据不同人群和研究地点分组。用随机效应模型来综合试验数据的短期死亡率(≤28 days)，长期死亡率（90 or 180 days），感染，入院时间和低糖血症。推荐评估的分级，进展，评价体系统被用来对每项成果的整体效果的证据进行评分。

Data Synthesis: In a meta-analysis of 21 trials in intensive care unit, perioperative care, myocardial infarction, and stroke or brain injury settings, IIT did not affect short-term mortality (relative risk, 1.00 [95% CI, 0.94 to 1.07]). No consistent evidence showed that IIT reduced long-term mortality, infection rates, length of stay, or the need for renal replacement therapy. No evidence of benefit from IIT was reported in any hospital setting, although the best evidence for lack of benefit was in intensive care unit settings. Data combined from 10 trials showed that IIT was associated with a high risk for severe hypoglycemia (relative risk, 6.00 [CI, 4.06 to 8.87]; P < 0.001). Risk for IIT-associated hypoglycemia was increased in all hospital settings.

资料综合：共有21篇研究纳入本研究荟萃分析中21在，包括围手术期护理，心肌梗死，中风或脑损伤。研究显示，IIT并不影响短期死亡率（相对危险度=1.00（0.94&#12316;1.07）。尚无一致的证据表明，IIT能降低长期死亡率，感染率，住院天数，或对换肾治疗的需求。评价IIT好处最有利的证据在于重症监护病房，然而此类证据却很缺乏，并且在任何医院部门IIT的好处均未见报道。综合10个试验数据显示，IIT可以增加严重低糖血症的血症的风险（相对风险度=6.00（4.06-8.87），P<0.001）。在所有医院的部门均显示这一效应。

Conclusion: No consistent evidence demonstrates that IIT targeted to strict glycemic control compared with less strict glycemic control improves health outcomes in hospitalized patients. Furthermore, IIT is associated with an increased risk for severe hypoglycemia.

研究结论：

目前尚无一致的证据表明，对比不严格的血糖控制，严格控制血糖的IIT治疗能改善住院患者的健康预后。此外，IIT可以显著增加低血糖的风险。