脓毒症相关弥漫性血管内凝血患者使用重组人可溶性血栓调节蛋白疗效的Meta分析

Effect of recombine human soluble thrombomodulin in severe sepsis patients with disseminated intravascular coagulation: a Meta-analysis

目的系统评价重组人可溶性血栓调节蛋白(rh TM)对脓毒症相关弥漫性血管内凝血(DIC)患者的影响。方法通过检索1990年1月至2015年1月美国《医学索引》(MEDLINE)、生物医学与药理学文摘数据库(Embase)、Cochrane临床试验数据库,纳入以rh TM为干预措施治疗脓毒症相关DIC患者的文献。由2名研究者按照纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用Rev Man5.0软件进行Meta分析,评价rh TM与肝素治疗及空白对照治疗后患者的28 d病死率及DIC缓解率。结果共纳入5项研究,1 199例患者。Meta分析结果显示,与不使用rh TM相比,应用rh TM能显著降低患者28 d病死率[OR=0.68;95%CI(0.49,0.93);Z=2.38;P=0.02],而使用rh TM与使用肝素患者间28 d病死率[OR=1.62;95%CI(0.87,3.01);Z=1.53;P=0.13]及DIC的缓解率[OR=0.67;95%CI(0.35,1.28);Z=1.21;P=0.23]比较,差异均无统计学意义。结论使用rh TM可以降低脓毒症相关DIC患者28 d病死率。

Objective To evaluate the effect of recombine human soluble thrombomodulin（rh TM） in severe sepsis patients with disseminated intravascular coagulation（DIC）. Methods A systematic search for clinical studies focused on rh TM treatment in severe sepsis patients with DIC were conducted in MEDLINE, Embase and Cochrane from January 1990 to January 2015.Two reviewers independently screened articles according to the inclusion and exclusion criteria,extracted the data and evaluated the quality of the included studies. The Meta-analysis was performed using Rev Man 5.0. Results Five retrospective comparative studies with a total of1 199 patients were enrolled. The Meta-analysis showed that the 28-day mortality in the experiment group was lower than that in the control group [OR = 0.68; 95%CI（0.49, 0.93）; Z = 2.38; P =0.02]. However, the 28-day mortality [OR = 1.62; 95%CI（0.87, 3.01）; Z = 1.53, P = 0.13] and the DIC resolution [OR = 0.67; 95% CI（0.35, 1.28）; Z = 1.21; P = 0.23] showed no significant differences between the experiment group and heparin group. Conclusion rh TM can reduce the 28-day mortality in severe sepsis patients with DIC.