尿激酶治疗无包裹性结核性胸腔积液的Meta分析

The Effect of Urokinase on Unloculated Tuberculous Pleural Effusion:A Meta-analysis

目的系统评价胸腔内注入尿激酶对无包裹性结核性胸腔积液的疗效。方法系统检索中国期刊全文数据库、中国生物医学数据库、维普数据库、万方数据库、Cochrane图书馆、PubMed数据库、循证医学评价数据库,中文文献检索时间为2000年至2012年2月,英文文献检索时间为1991年至2012年2月,并查阅纳入研究中的参考文献来补充。纳入所有研究为尿激酶治疗无包裹性结核性胸腔积液的随机对照试验(RCT),采用均数差(MD)及其95%可信区间(95%CI),绘制森林图分析疗效。绘制漏斗图讨论发表性偏倚。结果共9项RCT 537例患者入选。尿激酶治疗组与常规治疗对照组比较:增加引流(抽液)总量(P<0.000 01),减少胸膜肥厚(P<0.000 01),改善肺功能FEV1%pred(P<0.000 01)。结论与常规治疗(抗结核治疗联合胸腔积液引流或抽液)相比,胸腔内注射尿激酶治疗无包裹性结核性胸腔积液可增加胸腔积液引流总量,减轻胸膜肥厚,改善肺功能FEV1%pred。

Objective To evaluate the efficacy of intrapleural urokinase treatment for unloculated tuberculous pleural effusion. Methods Chinese Conference Data, Chinese Biomedical Database, VIP Database,Wanfang Database, Cochrane Library, PubMed, and Evidence-based Medical Evaluation Database were searched up to February 2012, and the studies as references of eligible articles were also searched. Randomized controlled trials were included for evaluating the efficacy of intrapleural urokinase treatment for unloculated tuberculous pleural effusion. Mean difference MD and 95% confidence interval（95% C1） were calculated for the efficacy of urokinase in the treatment. After the test for heterogeneity,forest map was used to analyze the efficacy of intrapleural urokinase treatment. The funnel plot was used to discuss the publication bias. Results Nine randomized controlled trials met all eligible criteria. This meta-analysis indicated that compared with the conventional treatment, the urokinase treatment increased total drainage （pumping liquid） （P 〈 0. 000 01 ）, decreasd residual pleural thickening （ P 〈 0.000 01 ）, improved lung function with significant increase in FEV, % pred （ P 〈 0.000 01 ）. Conclusions Compared with the conventional treatment （anti-tubercular treatment in combination with pumping pleural effusion）, the treatment which injects urokinase to chest cavity can increase total pleural effusion, decrease residual pleural thickening, and improve the lung function.