华法林自我管理的Meta分析

Meta-analysis on self-management of warfarin

目的系统评价使用华法林的患者华法林自我管理是否优于常规管理。方法计算机检索Cochrane Database、Med-line、Embase数据库中关于使用华法林的的患者自我管理和常规管理的随机对照实验(RCT),检索时间从2001年1月—2012年1月。对纳入资料的质量进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。统计学软件采用RevMan5.0.25软件。结果共纳入5个RCT。对5个RCT进行Meta分析,累计华法林自我管理组1 917人,常规使用华法林组1 848人,华法林国际标准化比率(INR)值在治疗范围内的时间比例自我管理组与常规组的均差为3.66(95%CI为2.59～4.73,P<0.01),两组差异有统计学意义,即华法林自我管理优于常规管理。去除样本量最大的研究,对剩余的4个RCT进行Meta分析,累计华法林自我管理组454人,常规使用华法林组396人,华法林INR值在治疗范围内的时间比例自我管理组与常规组的均差为2.71(95%CI为-0.26～5.69,P>0.05),两组差异无统计学意义,即华法林自我管理效果不优于常规管理。结论华法林自我管理效果优于或等效与常规管理效果,不差于常规管理。

[Objective]To evaluate whether the effect of the self-management of warfarin is better than the that of conventional management in patients treated by warfarin.[Methods]The randomized controlled trails（RCT） about comparing the self-management of warfarin with the conventional management in patients treated by warfarin were searched in Cochrane Database,Medline and Embase,which were published between January 2001 and January 2011.The quality of adopted RCT data was strictly evaluated and the information extracted.Finally Meta-analysis was performed on the qualified RCT.RevMan5.0.25 software was applied on statistical analysis.[Results]Five RCTs were identified.Meta-analysis results showed that there were 1 917 individuals in warfarin self-management group and 1 848 in the conventional management group.The average deviation of INR time proportion of the self-management group to the conventional management group was 3.66（95%CI was 2.59~4.73,P0.01）,the difference between two groups was significant,that means self-management of warfarin was better than the conventional management.Removing the RCT with the largest sample size,the Meta-analysis results of rest four RCTs showed that there were 454 individuals in self-management group and 369 in the conventional management group.The average deviation of INR time proportion of the self-management group to the conventional management group was 2.71（95% CI was-0.26~5.69,P0.05）,the difference between two groups was not significant,that means self-management of warfarin was not better than the conventional management.[Conclusion]The effect of warfarin self-management is better than or similar to that of the conventional management,and it is not inferior to the conventional management.