肝素与阿司匹林在复发性流产中抗磷脂抗体综合征应用的Meta分析

Heparin and aspirin in the treatment of recurrent spontaneous abortion associated with antiphospholipid antibody syndrome:a meta-analysis

目的:系统评价复发性流产(RSA)中抗磷脂综合征(APS)的治疗方案中肝素和阿司匹林联合治疗方案与阿司匹林单一用药方案对妊娠结局改善的影响。方法:在Pubmed、Medline、中国知网、万方数据库等电子数据库中,使用"阿司匹林"、"肝素"、"抗磷脂抗体"、"复发性流产"、"免疫性流产"等关键词搜集相关文献。使用Stata 12.0进行数据分析,用比值比(OR),95%可信区间(95%CI)来描述分析结果,并对纳入文章的异质性、发表偏倚及敏感性进行分析。结果:最终纳入6篇文献(共433例患者)。肝素联合阿司匹林联合治疗组和阿司匹林单一用药组的活产率分别为173/216(80.0%)、138/217(63.59%),联合治疗组的活产率明显高于单一用药组,差异有统计学意义(OR=2.75,95%CI 1.18~2.73,P<0.05),两组早产率、剖宫产率、少量出血发生率、胎儿宫内生长受限发生率比较,差异均无统计学意义(均P>0.05)。结论:联合使用肝素和阿司匹林对复发性流产中抗磷脂抗体综合征患者成功妊娠的治疗效果较单纯使用阿司匹林的效果好。

Objective：To explore the clinical effect of combination of heparin and aspirin and aspirin alone in the treatment of recurrent spontaneous abortion associated with antiphospholipid antibody synthesis. Meth- ods： Electronic English and Chinese databases including Pubmed, Medline, China National Knowledge Infrastructure （CNKI）, Wanfang Med Database etc. were used for key words searching in a highly sensitive search strategy. The extracted data were analyzed by the Stata 12.0 software. Results： 6 randomized controlled trials （RCT） involving 433 participants were included in the recta-analysis. Meta-analysis showed that the live birth rate of the combination therapy of heparin and low dose aspirin （80.0%） were higher than aspirin （63.59%） alone （0R=2.75, 95% CI： 1.18-2.73, P〈0.05）. There was no statistical signifi- cance in the preterm birth rate, cesarean section, minor bleeding and fetal growth restriction between the combo group and the single-use group （P〉0.05）. Conclusion： The combination therapy of heparin and low dose aspirin was better than aspirin alone in patients with recurrent spontaneous abortion associated with antiphospholipid antibody synthesis.