低分子肝素联合硫酸镁治疗早发型重度子痫前期疗效评价的meta分析

A meta analysis on the effectiveness of low molecular weight heparin combined with magnesium sulfate for patients with early onset severe preeclampsia

目的:运用循证医学方法评价低分子肝素(LMWH)联合硫酸镁治疗早发型重度子痫前期的疗效。方法:计算机检索Cochrane Library、PubMed、Web of Science、CA、CNKI、万方等数据库并查阅检索到的纳入文献的参考文献,尽可能获取所有相关文献。制定严格的纳入和剔除标准,依据Cocharane手册5.1.0质量评价标准对纳入文献进行质量评价。采用Review Manager5.3软件进行meta分析。结果:最终纳入27篇RCT,共纳入2363例早发型重度子痫前期患者。meta分析结果显示,低分子肝素联合硫酸镁治疗能改善早发型重度子痫前期患者平均动脉压(MAP)[均数差(WMD)=-6.73,95%CI:-9.65～-3.81,P<0.001]、收缩压(SBP)(WMD=-6.46,95%CI:-12.33～-0.58,P<0.001)、舒张压(DBP)(WMD=-6.01,95%CI:-8.34～-3.68,P<0.001)、24h尿蛋白(WMD=-0.87,95%CI:-1.22～-0.53,P<0.001)、24h尿量(WMD=640.14,95%CI:301.06～979.22,P<0.001)、血小板计数(PLT)(WMD=3.61,95%CI:1.44～5.79,P=0.71)、活化部分凝血酶时间(APTT)(WMD=2.20,95%CI:0.94～3.46,P<0.001)、血红细胞压积(HCT)(WMD=-1.36,95%CI:-1.62～-1.10,P<0.001)、凝血酶原时间(PT)(WMD=0.85,95%CI:0.07～1.63,P<0.001)、纤维蛋白原(FIB)(WMD=0.24,95%CI:0.05～0.43,P<0.001)等。结论:LMWH联合硫酸镁对早发型重度子痫前期有较好的疗效。

Objective：The Meta-analysis was conducted to evaluate the effectiveness of low molecular weight heparin（LMWH）combined with magnesium sulfate to treat early onset severe preeclampsia（sPE）.Methods：The literatures were searched from several databases without language restriction,which included Cochrane Library,PubMed,Web of Science,CA,CNKI and WanFang Data.At the same time,the references of the searched articles were also collected.The including and excluding criteria were performed precisely and assessment of literatures was conducted by two researchers independently according to the Cochrane Handbook of Systematic Reviews 5.1.0.Review Manager 5.3software was used for Meta analysis.Results：A total of 27 randomized controlled trials（RCTs）with 2,363 patients were finally included.The results indicated that magnesium sulfate combined with LMWH to treat earlyonset sPE had better effectiveness.As for The mean artery pressure（MAP）,WMD（Weighted Mean Difference）was 6.73 and its 95%CI（confidence interval）was 9.65-3.81（P〈0.001）;for systemic blood pressure（SBP）,WMD was 6.46 and its 95%CI was12.33-0.58（P〈0.001）;for diastolic blood pressure（DBP）,WMD was 6.01 and its 95%CIwas 8.34-3.68（P〈0.001）;for 24 hour urine protein,WMD was 0.87 and its 95%CI was 1.220.53（P〈0.001）;for 24 hour urine volume,WMD was 640.14 and its 95%CI was 301.06-979.22（P〈0.001）;for platelet counts（PLT）,WMD was 3.61and its 95%CI was 1.44-5.79（P=0.71）;for activated partial thromboplastin Time（APTT）,WMD was 2.20 and its95%CI was 0.94-3.46（P〈0.001）;for whole blood hematocrit（HCT）,WMD was 1.36 and its 95%CI was 1.62-1.10（P〈0.001）;for prothrombin time（PT）,WMD was 0.85 and its 95%CI was 0.07-1.63（P〈0.001）;for fibrinogen（FIB）,WMD was 0.24 and its 95%CI was 0.05-0.43（P〈0.001）.Conclusion：Therapy of LMWH combined with magnesium sulfate is more effective in treating patients with early onset sPE.