低分子肝素对早发子痫前期妊娠结局影响的Meta分析

Meta-analysis of Treating Early Onset Pre-eclampsia by the Low-molecular-weight Heparin

目的:评价应用低分子肝素治疗早发子痫前期对妊娠结局的影响。方法:通过计算机检索Pub Med、Cochrane图书馆、中国期刊全文数据库、万方数据库及维普中文期刊数据库建库至2015年11月国内外公开发表的低分子肝素治疗早发子痫前期的相关文献,对研究数据采用Rev Man 5.0软件进行Meta分析。结果:未检索到符合条件的外文文献,纳入相关中文文献35篇,包括2691例患者,其中高质量文献5篇。Meta分析结果显示,加用低分子肝素能延长孕周时间(WMD 5.78,95%CI5.61~5.96,P<0.00001);减少胎盘早剥的发生(RR 0.51,95%CI 0.53~0.91,P=0.02);增加新生儿出生体质量(WMD 67.01,95%CI 48.39~85.62,P<0.00001);降低围生儿死亡率(RR 0.39,95%CI0.26~0.59,P<0.0001);产后出血量差异无统计学意义(WMD 8.00,95%CI-3.03~19.02,P=0.16)。结论:基于现有的资料分析认为低分子肝素治疗早发子痫前期能改善母儿结局,是有效且安全的,但尚需要国外的相关研究及国内大样本、多中心的研究文献来证实其临床应用价值。

Objective：To evaluate the efficacy of Low-molecular-weight heparin for early onset pre-eclampsia. Methods..A search for relevant articles published since their establishment until november 2015 was run on PubMed 、Cochrane library、CNKI 、VIP and WanFang databases,All researches on the treating early onset pre-ec- lampsia by the low-molecular-weight heparin were included. The revman 5.0 software was used for Meta-analy- sis. Results：No abroad study was searched, a total of 35 chinese studies were collected where 2691 patients were included. Meta-analysis showed that Low-molecular-weight heparin comparing with routine treatment signifi- cantly more effective in the prolongation of gestational age （ WMD 5.78,95% CI 5.61 -5.96, P 〈 0. 00001 ） ;the occurrence rate of placental abruption were significantly lower（ RR 0. 51,95% CI 0.53 ~ 0.91, P = 0.02） ;neonatal quality increased significantly（ WMD 67.01,95% CI 48.39 -85.62, P 〈 0. 00001 ） ;more effective in reduce the rate of perinatal death（ RR 0.39,95%CI 0. 26 -0, 59, P 〈0. 0001 ） ;while there was no difference in postpartum hemorrhage between the two groups（ WMD 8.00,95% CI -3.03 -19.02, P = 0. 16 ）, Conclusions：Base on the limited evidence, The treatment of early onset pre-eclampsia by the addition of LMWH to routine method could im- prove the outcome of maternal and neonatal, and it was effective and safely. But abroad researches and large sample size randomized clinical trials are required to further demonstrate and support the conclusion.