低分子肝素辅助治疗重症社区获得性肺炎患者的荟萃分析

A meta-analysis of low molecular weight heparin in treatment of patients with severe community-acquired pneumonia

目的探讨低分子肝素治疗重症社区获得性肺炎(CAP)患者的疗效评价。方法以英文"low molecular heparin"",severe community-acquired pneumonia"",prognosis";中文"低分子肝素"、"重症社区获得性肺炎"、"预后"为关键词,检索1994年1月—2014年1月英国医学会电子全文期刊数据库(BMA)、美国国立医学图书馆生物医学信息检索系统(Pub Med)、万方数据库(CECDB)、维普中文科技期刊全文数据库(CQVIP)等10多个数据库相关的随机对照试验(RCT),对纳入文献的质量进行严格评价和资料提取,使用Stata/SE version 12.0软件对纳入研究进行荟萃分析。结果最终纳入6篇RCT,共404例患者,其中治疗组患者208例、对照组患者196例。对照组予以常规治疗,治疗组在常规治疗基础上予以低分子肝素针剂行皮下注射。荟萃分析结果显示:应用低分子肝素7 d后,重症CAP患者的急性生理与慢性健康评分-Ⅱ(APACHEⅡ评分)显著降低(P=0.43、I2=0%、SMD=-0.70、95%CI=-0.90^-0.49),其发表偏倚性程度可控(bias_p=0.933、bias_CI=-6.79~6.37);重症CAP患者的PaO_2显著升高(P=0.858、I^2=0%、SMD=0.51、95%CI=0.30~0.72),其发表偏倚性程度可控(bias_p=0.77、bias_95 CI=-4.82~5.90)。但应用低分子肝素治疗重症CAP患者,荟萃分析显示患者经治疗7 d后PaCO_2未见显著影响(SMD=-0.17、95%CI=-0.38~0.04)。结论应用低分子肝素治疗重症CAP,可显著降低患者的APACHEⅡ评分、提升患者氧合,从而显著改善患者的生理状态、缓解临床症状,其疗效确切,具有推广性。

Objective To evaluate the clinical efficacy of low molecular weight heparin in treatment of patients with severe community-acquired pneumonia （CAP）. Methods PubMed, BMA, EMbase, ASP, Cochrane Library, EMCC, CBM, CNKI, CECDB, CQVIP, and VIP databases were searched to identify the relevant randomized clinical trials （RCTs） from the publications during the period from January 1994 to January 2014. The search terms were ＂low molecular heparin＂, ＂severe community-acquired pneumonia＂, ＂prognosis＂ in both Chinese and English. The quality of the included studies were strictly evaluated and data were extracted. Stata/SE version 12 software was used for systematic review and meta-analysis. Results Six RCTs were finally qualified in the analysis, including a total of 208 cases in treatment group and 196 cases in control group. The patients in control group received conventional therapy, while the patients in treatment group received low molecular weight heparin by subcutaneous injection as add- on to conventional therapy. Meta-analysis showed that after treatment with low molecular weight heparin for 7 days, the APACHE II score of severe CAP patients significantly decreased （P = 0.43, I2 = 0%, SMD = -0.70, 95% CI： - 0.90, -0.49） with controllable publication bias （bias_p = 0.93, bias_95 CI： -6.79, 6.37）. The PaO2 of severe CAP patients significantly increased （P = 0.858, I2 =0%,SMD = 0.51, 95% CI： 0.30, 0.72） with controllable publication bias （biasA3 =0.770, bias_95 CI： -4.82, 5.90）. However, after low molecular weight heparin treatment for 7 days, the PaCO2 of severe CAP patients did not change significantly （SMD = -0.17, 95 % CI： -0.38, 0.04）. Conclusion Low molecularweight heparin is beneficial in the treatment of severe CAP patients in terms of significantly decreased APACHE II score, increased oxygenation, and improved clinical symptoms.