低分子肝素治疗慢性阻塞性肺疾病急性加重期患者的Meta分析

Low Molecular Weight Heparin in Treating Patients with Acute Exacerbation of COPD: A Meta-Analysis

目的系统评价低分子肝素治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效。方法计算机检索PubMed、h e Cochrane Library、EMbase、CBM、CNKI、VIP和WanFang Data数据库,查找低分子肝素治疗AECOPD疗效的随机对照试验(RCT),检索时限均为从建库至2013年10月。由2位研究者按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入6个RCT,共501例患者。Meta分析结果显示:与对照组相比,低分子肝素可改善AECOPD患者D-二聚体水平[MD=–0.28,95%CI(–0.50,–0.05),P=0.02]、降低二氧化碳分压(PaCO2)[MD=–3.42,95%CI(–6.66,–0.18),P=0.04]、改善凝血功能[MD=1.85,95%CI(1.29,2.42),P<0.000 01],改善临床症状体征[RR=1.33,95%CI(1.12,1.58),P=0.001]、缩短住院天数[MD=–2.02,95%CI(–2.18,–1.86),P<0.000 01],但在改善氧分压(PaO2)方面差异无统计学意义[MD=0.28,95%CI(–3.04,3.61),P=0.87]。治疗期间,两组均未发生严重不良反应。结论低分子肝素的应用能显著改善AECOPD的症状。受纳入研究数量及质量限制,上述结论还需更多大样本高质量的RCT来证实。

Objective To systematically review the clinical efficacy of low molecular weight heparin （LMWH） in treating patients with acute exacerbation of chronic obstructive pulmonary disease （COPD）. Methods Databases includ- ing PubMed, The Cochrane Library （Issue 10, 2013）, EMbase, CBM, CNKI, VIP and WanFang Data were searched for the randomized controlled trials （RCTs） about LMWH in treating acute exacerbation of COPD from the establishment to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of the included studies. Meta-analysis was then performed using RevMan 5.2 software. Results A total of 6 RCTs involving 501 patients were finally included. The results of meta-analysis showed that： compared with the control group, LMWH significantly improved levels of D-dimmer （MD= -0.28, 95%CI -0.50 to -0.05, P=0.02）, reduced carbon dioxide partial pressure （PaCO2） （MD= -3.42, 95%CI -6.66 to -0.18, P=0.04）, improved coagulation （PT） （MD=l.85, 95%CI 1.29 to 2.42, P〈0.000 01）, and improved clinical symptoms and signs （RR=l.33, 95%CI 1.12 to 1.58, P=0.001）, but it did not improve oxygen partial pressure （PaO2） （MD=0.28, 95%CI -3.04 to 3.61, P=0.87）. During treatment, no severe adverse reaction occurred in both groups. Conclusion LMWH could significantly improve symptoms caused by acute exacerbation of COPD. Due to limited quantity and quality of the included studies, the above conclusion needs to be confirmed by conducting more high quality RCTs with larger sample size.