肝素用于血浆置换及分子吸附再循环系统治疗肝衰竭安全性的Meta分析

Safety of heparin used in plasma exchange and molecular absorbent recirculating system forhepatic failure： a Meta-aualysis

目的评价肝素用于血浆置换及分子吸附再循环系统治疗肝衰竭的安全性。方法计算机检索CNKI、CBM、万方、维普、PubMed、WebofScience、Coehrane和EMBASE8个数据库。文献筛选、提取数据与纳入研究偏倚风险的评估均由2名研究人员独立完成。采用RevMan5．3软件根据异质性检验结果选择随机效应模型或固定效应模型合并结局数据。结果共纳入6个研究，863例患者。血浆置换疗法中相比于无肝素组，肝素的使用会增加管路滤器凝血、穿刺点微量渗血和穿刺点血肿的发生概率（RR=6．05，95％CI2．00～18．30，P=0．001；RR=10．80，95％CI4．78～24．37，P〈0．05；RR=6．34，95％CI1．13—35．53，P=0．04），而在管路及分离器堵塞、其他不良反应的发生上不受影响（RR=5．61，95％CI0．99～31．89，P=0．05；RR=1．17，95％CIO．73～1．86，P=0．51）。而分子吸附再循环系统（MARS）治疗肝衰竭时，肝素的使用会增加出血死亡事件的概率（RR=12．04，95％CI1．69—85．66，P=0．01），而对管路滤器凝血的发生情况无明显影响（RR=0．20，95％CI0．00～11．93，P=0．44）。结论治疗肝衰竭时，血浆置换中肝素的使用会增加管路滤器凝血、穿刺点微量渗血与穿刺点血肿的发生概率；MARS中肝素的使用会增加出血死亡事件的发生概率。相比之下，无肝素血浆置换及MARS治疗肝衰竭有更好的安全保障。

Objective To evaluate the safety of heparin used in plasma exchange （PE） and molecular absorbent recirculating system （MARS） for hepatic failure. Methods 8 databases were electronically searched including CNKI, CBM, WANFANG, VIP, PubMed, Web of Science, Cochrane and EMBASE. Two researchers individually performed the literature screening, data extraction and evaluation of risk of bias. Random or fixed effect model based on the result of the test of heterogeneity were chosento synthesize the datausing RevMan 5.3 software. Results 6 eligible studies with 863 patientswere included. Compared to omitting of heparin, the heparin PE could increase the probability of circuit clotting, hemorrhage in puncture point, puncture hematoma （RR = 6.05, 95%CI：2.00-18.30, P=0.001; RR =10.80, 95%CI：4.78-24.37, P 〈 0.05; RR = 6.34, 95%CI：1.13-35.53, P=0.04）, but the probability of circuit blocking and other adverse reactions are not influenced （RR = 5.61, 95%CI：0.99-31.89, P=0.05; RR = 1.17,95% CI： 0.73-1.86, P=0.51）. As for the treatment with MARS, heparin could increase the chance bleeding death （RR =12.04, 95% CI：1.69-85.66, P=0.01）, but had no obvious effect on circuit clotting. Conclusion When curing the hepatic failure, heparin PE can increase the probability of circuit clotting, hemorrhage in puncture point and puncture hematoma, and heparin MARSE can increase the probability of bleeding death. On the contrary, no-heparin PE and MARSE will be safer in treatment of hepatic failure.