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目的 探讨不同种类注射用免疫球蛋白(IVIG)作为严重脓毒症患者的辅助疗法能否改善预后.方法 通过计算机检索美国国立医学图书馆PubMed数据库、荷兰医学文摘EMBase数据库、Cochrane临床试验数据库、中国知网、万方数据库等自建库至2015年9月发表的中、英文文献,纳入IVIG对成人严重脓毒症患者治疗有效性的前瞻性研究.主要结局指标为总病死率;次要结局指标为短期(＜7 d)病死率、28 d病死率、重症加强治疗病房(ICU)住院时间、总住院时间及脓毒性休克或多器官功能衰竭(MOF)病死率.采用RevMan5.3软件进行Meta分析.结果 最终纳入16篇文献、共计1 819例患者,随机对照试验(RCT) 12篇,前瞻性队列研究4篇.IVIG治疗组892例,对照组(人血白蛋白、安慰剂或空白对照)927例.与对照组比较,IVIG治疗组能降低严重脓毒症患者总病死率[相对危险度(RR) =0.71,95％可信区间(95％CI) =0.57 ～ 0.87,P=0.001].在剔除高风险研究后显示,IVIG治疗组严重脓毒症患者总病死率仍能降低(RR=0.80,95％CI=0.65～ 0.98,P=0.03),但不能降低严重脓毒症患者28 d病死率(RR=0.60,95％CI=0.35～ 1.04,P=0.07)、短期病死率(RR=1.06,95％CI=0.76～ 1.46,P=0.74)、脓毒性休克病死率(RR=0.55,95％CI=0.29 ～ 1.03,P=0.06)和MOF病死率(RR=0.91,95％CI=0.63 ～ 1.33,P=0.64);也不能缩短ICU住院时间[加权均数差(WMD)=-0.02,95％CI=-0.03 ～ 0.25,P=0.86]和总住院时间(WMD=-2.34,95％CI=-7.05～2.37,P=0.33).在亚组分析中,IgM组严重脓毒症患者28 d病死率(RR=0.50,95％CI=0.25 ～ 1.01,P=0.05)要明显低于IgG组(RR=0.72,95％CI=0.40 ～ 1.30,P=0.28).结论 IVIG能降低严重脓毒症患者总病死率,相比于IgG,富含IgM的IVIG对降低严重脓毒症患者28 d病死率有一定优势,但并不能降低短期病死率及脓毒性休克和MOF病死率,也不能缩短ICU住院时间和总住院时间.“,”Objective To investigate the possibility of improving the prognosis of patients with severe sepsis by different kinds of intravenous immunoglobulin (IVIG).Methods PubMed database,EMBase,Cochrane clinical trial database,CNKI,and Wangfang database etc were retrieved.The search time was from database creation to September 2015,which included all prospective studies of the effectiveness of IVIG compared with non-IVIG in all adult patients with severe sepsis.Main end-point parameter was total mortality rate;secondary end-point parameters were short-term (＜ 7 days) mortality,28-day mortality,length of intensive care unit (ICU) and hospital stay,and mortality due to septic shock or multiple organ failure (MOF).RevMan 5.3 was used for Meta analysis.Results Finally,16 prospective studies including 12 randomized controlled trails (RCT) and 4 prospective cohort studies were enrolled,referred to 1 819 patients,892 patients were in IVIG group,927 patients receiving human albumin,placebo or blank control were in control group.Compared with the control group,IVIG could reduce the total mortality rate of patients with severe sepsis [relative risk (RR) =0.71,95％ confidence interval (95％CI) =0.57-0.87,P =0.001].After the high-risk research was eliminated,it was shown that the IVIG could reduce the total mortality rate in patients with severe sepsis (RR =0.80,95％CI =0.65-0.98,P =0.03).But IVIG could not reduce the 28-day mortality rate (RR =0.60,95％CI =0.35-1.04,P =0.07),short-term mortality rate (RR =1.06,95％CI =0.76-1.46,P =0.74),the mortality rate of septic shock (RR =0.55,95％CI =0.29-1.03,P =0.06) and the mortality rate of MOF (RR =0.91,95％CI =0.63-1.33,P =0.64).In fact,the length of stay in ICU [weighted mean difference (WMD) =-0.02,95％CI =-0.03-0.25,P =0.86] and the total length of stay in hospital (WMD =-2.34,95％CI =-7.05-2.37,P =0.33) were similar.In subgroup,the 28-day mortality rate of patients with severe sepsis in the IgM group (RR =0.50,95％CI =0.25-1.01,P =0.05) was significantly lower than that of IgG group (RR =0.72,95％CI =0.40-1.30,P =0.28).Conclusions IVIG can reduce the total mortality rate of patients with severe sepsis.Compared with IgG,IgM-enriched IVIG has certain advantages in patients with severe sepsis,but cannot reduce the short-term mortality rate,mortality rate of septic shock and MOF,and also cannot shorten the length of ICU stay and the total length of hospital day.