低分子肝素改善急性脑梗死患者运动功能的系统评价

Amelioration of motor function with low-molecular weight heparin in patients with acute cerebral infarction

目的:评价低分子肝素(low-molecularweightheparin,LMWH)与其他药物改善急性脑梗死(acutecerebralinfarction,ACI)患者运动功能的疗效差异及安全性。方法:应用Meta分析方法对LMWH与其他药物治疗ACI的14项对照研究进行同质性检验和合并效应量的检验。结果:①同质性检验:χ2=15.05,自由度为13,P>0.05。②合并效应量的检验:OR合并=3.0850,OR合并95%可信区间为2.35～4.04。OR合并的检验:χ2=66.38,P<0.001。③LMWH组共发生注射局部皮下出血71例(8.9%),上消化道出血11例(1.4%),牙龈出血4例(0.5%),阴道出血4例(0.5%),血尿1例(0.1%);对照组发生上消化道出血6例(0.9%),与LMWH组比较差异无显著性意义(P>0.05)。④LMWH组治疗前后出、凝血时间,血浆凝血酶时间,活化部分凝血活酶时间,血小板计数及肝功能检查均正常。结论:LMWH改善ACI患者运动功能的疗效显著优于目前常用药物,且无严重不良反应。

AIM:To assess the effective differences between low-molecular weight heparin(LMWH) and other drugs in the amelioration of motor function in patients with acute cerebral infarction(ACI) and the safety of LMWH. METHODS:Fourteen control trials of LMWH and other drugs in the treatment of ACI were analyzed by Meta-analysis in homogeneity test and combined test. RESULTS:①Homogeneity test: χ2 =15.05,degree of freedom 13,P >0.05.②Combined test:OR combination=3.085 0 and OR combination 95%confidence interval was between 2.35 to 4.04. OR combination test:χ2=66.38,P< 0.001.③In LMWH group,the hemorrhage rate under skin in injected location was 8.9%(71 patients),upper gastrointestinal hemorrhage rate was 1.4%(11 patients),gingival hemorrhage rate was 0.5%(4 patients), vaginal hemorrhage rate was 0.5%(4 patients),and hematuria rate was 0.1%(1 patient).In control group, upper gastrointestinal hemorrhage rate was 0.9%(6 patients), which was not significantly different from that in LMWH group(P >0.05).④In LMWH group,measurement of bleeding time,clotting time, prothrombin time(PT),activated partial thromboplastin time(APTT),platelet count and liver function test were normal before and after treatment. CONCLUSION:The therapeutic effects of LMWH on motor function for ACI patients are significantly superior to other medications used at present,and it has not serious side effects.