基于累积Meta分析的活血化瘀类中药复方预防全髋关节置换术后深静脉血栓疗效及安全性研究

Efficacy and Safety of Chinese Herbal Compounds for Promoting Blood Circulation and Removing Blood Stasis to Prevent Deep Venous Thrombosis after Total Hip Arthroplasty Based on Cumulative Meta-Analysis

目的基于累积Meta分析,系统评价活血化瘀类中药复方预防全髋关节置换术后深静脉血栓的疗效及安全性。方法全面检索PubMed、The Cochrane Library、EMbase、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库等国内外权威数据库,运用STATA 14.0进行累积Meta分析。结果共纳入30篇文献,按照发表年限进行累积Meta分析提示活血化瘀类中药复方预防THA术后DVT有确切疗效初次被证明是在2015年,OR=0.59,95%CI[0.41,0.85],其OR值停留在0.38,95%CI[0.30,0.48],提示治疗组DVT发生率低于对照组;运用Egger检验法进行发表偏移检验,P=0.005<0.05,其95%CI[-2.37,-0.46]不包含0,提示发表偏倚可能性大,考虑与纳入文献质量较低相关,后期研究应增加高质量文献以减少发表偏倚。按发表年限进行累积Meta分析提示活血化瘀类中药复方减少THA术后不良反应发生率初次被证明有效是在2016年,OR=0.15,95%CI[0.04,0.62],其OR值停留在0.32,95%CI[0.19,0.56],提示治疗组在减少不良反应发生率方面优于对照组;按样本量进行累积Meta分析提示其OR值停留在0.32,95%CI[0.19,0.56],亦提示治疗组在减少不良反应发生率方面优于对照组;运用Egger检验法进行发表偏移检验,P=0.476>0.05,其95%CI[-12.62,7.49]包含0,提示发表偏倚可能性小。结论活血化瘀类中药预防THA术后DVT是一种安全有效的治疗方法,但更加确切的结论仍需高质量大样本多中心的随机对照试验加以验证。

Objective Based on cumulative meta-analysis,to systematically evaluate the efficacy and safety of Chinese herbal compounds for promoting blood circulation and removing blood stasis in preventing deep venous thrombosis after total hip replacement.Methods Cochrane Library,Pubmed,EMbase,CBM,CNKI and Wanfang Resource Database were searched comprehensively,and the cumulative meta-analysis was performed using STATA 14.0.Results A total of 30 literatures were included.A total of 30 literatures were included.According to the published years,the cumulative meta-analysis showed that the effective effect of Huoxue Huayu TCM compound on preventing DVT after THA was proved for the first time in 2015,OR=0.59,95%CI[0.41,0.85],and the OR value remained at 0.38,95%CI[0.30,0.48],suggesting that the incidence of DVT in the treatment group was lower than that in the control group.The ger test showed that P=0.005<0.05,and 95%CI[-2.37,-0.46]did not contain 0,suggesting that publication bias is likely to be high.Considering the low quality of the included literature,high quality literature should be added to reduce publication bias in later studies.Accumulative Meta-analysis based on published years indicated that Huoxue Huayu TCM compound was effective in reducing the incidence of adverse reactions after THA for the first time in 2016,OR=0.15,95%CI[0.04,0.62],and its OR value remained at 0.32,95%CI[0.19,0.56],suggesting that the treatment group was superior to the control group in reducing the incidence of adverse reactions.The cumulative meta-analysis showed that the OR value was 0.32,95%CI[0.19,0.56],which also indicated that the treatment group was better than the control group in reducing the incidence of adverse reactions.The Egger test was used to publish the deviation test,P=0.476>0.05,and its 95%CI[-12.62,7.49]contained 0,suggesting that the possibility of publication bias was low.Conclusion The prevention of DVT after THA with Chinese herbal compounds for promoting blood circulation and removing blood stasis is a safe and effective method,but more accurate conclusions still need to be verified by high quality,large sample and multi-center randomized controlled trials.