LAUSR

BACKGROUND This study aimed to explore the efficacy of trypsin inhibitors in the treatment of severe pancreatitis (SP) by meta-analysis. METHODS The Boolean logic retrieval method was adopted to recruit the relevant literature. Chinese and English databases were respectively searched using a combination of the following search terms: "trypsin inhibitor", "acute pancreatitis", and "severe pancreatitis". The trypsin-treated SP group was set as the experimental group, and the blank control was set as the control group. Meta-analysis was performed using RevMan 5.3 software provided by the Cochrane system. RESULTS A total of 12 references were included. The meta-analysis suggested that the heterogeneity test results of pancreatic infection incidence were Chi2 =0.51, degrees of freedom (df) =7, I2 =0%<50%, and P=1.00>0.01, with risk ratio (RR): 0.80, 95% confidence interval (CI): (0.64, 1.01), Z=1.88, and P=0.06. The heterogeneity test results of extra-pancreatic infection incidence were Chi2 =0.20, df =5, I2 =0%<50%, and P=1.00>0.01, with RR: 0.81, 95% CI: (0.62, 1.05), Z=1.60, and P =0.11. The heterogeneity test results of the length of hospital stay were Tau2 =65.69, Chi2 =75.05, df =6, I2 =92%>50%, and P<0.0001. The length of hospital stay of the experimental group was shorter than that of the control group, with mean difference (MD): -23.31 and the 95% CI: (-29.60, -17.02), and the difference was statistically significant (Z=7.26, P<0.0001). The heterogeneity test results of the inflammatory factor tumor necrosis factor-α (TNF-α) level were Chi2 =67.28, df =3, I2 =96%>50%, and P<0.0001. The level of TNF-α in the experimental group was lower than that in the control group, with MD: -11.69, 95% CI: (-12.51, -10.87), and the difference was statistically significant (Z=27.88, P<0.0001). The heterogeneity test results of the mortality rate were Chi2 =2.52, df =5, I2 =0%<50%, and P=0.77>0.01. The mortality rate of the experimental group was lower than that of the control group, with RR: 0.27 and 95% CI: (0.19, 0.40), and the difference was notable (Z=1.60, P=0.0001). DISCUSSION The meta-analysis performed in this study confirmed that trypsin inhibitors can inhibit the release of inflammatory factors and reduce mortality rate of SP patients.