肝素对紫癜性肾炎预防作用的Meta分析

Preventive Effect of Heparin on Henoch-Schnlein Purpura Nephritis:A Meta-Analysis

目的:综合文献评价肝素对过敏性紫癜性肾炎的预防作用。方法:检索PubMed、SpringLink、Cochrane图书馆、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库等,获得肝素对紫癜性肾炎(HSPN)预防作用的随机对照试验(RCT)文献。对符合要求的文献进行质量评估,以HSPN发生率为疗效判定指标,采用RevMan4.2软件进行Meta分析,检验异质性,根据异质性结果选择相应的效应模型分析。计数资料采用RR值及其95%CI表示。结果:共检索到14篇文献,其中6篇RCT满足纳入条件进行Meta分析。治疗组肾损害发生率为13.7%(60/437),对照组肾损害发生率为30.0%(123/410),两组比较差异有统计学意义;肝素早期应用有利于减少肾损害发生(RR=0.36,95%CI:0.26,-0.52);治疗组未出现明显不良反应。结论:过敏性紫癜患儿早期应用肝素治疗可显著减少肾损害的发生,且无明显不良反应。但本研究分析的试验例数较少,故需要大样本、多中心、设计良好的RCT进一步验证。

Objective： To assess the preventive efficacy of the early administration of heparin in children with Henoch-Schsnlein purpura （HSP） nephritis. Methods： The PubMed, SpringLink, Cochrane library, CNKI, VIP and Wanfang data were searched from the establishment of the database. All the studies were evaluated strictly. The incidence of HSPN was set as the index of therapeutic efficacy. Review Manage 4.2 software was used to analyze the data. Results ： Six RCTs meeting the inclusion criteria were enrolled. The Meta-analysis based on included studies showed： the incidence of renal involvement in the treatment group and in the controlled group were 13.7% （60/437） and 30.0% （123/410） ; there was a significant difference between the two groups. The RR was 0.36, with a 95% confidence interval （0.26, -0.52）. No serious side eft^cts were reported in the treatment group. Conclusions： Early heparin administration could reduce the rate of renal complication in children with HSP without serious side effects. But in this analysis, the amount of studies was not enough to obtain the reliable results. Large scale, multieentre, well-designed experiments should be adopted to confirm the conclusion.