低分子肝素联合中药预防髋关节置换术后下肢深静脉血栓形成临床疗效Meta分析

A Meta Analysis on Clinical Therapeutic Effects of Low Molecular Weight Heparin Combined with TCM for Preventing Deep Vein Thrombosis of Patients with Total Hip Arthroplasty

目的系统评价低分子肝素联合中药预防髋关节置换术后下肢深静脉血栓形成的临床疗效。方法计算机检索中国知识资源总库(CNKI)、中文科技期刊数据库(VIP)、中国学术期刊数据库(万方数据)、Embase、Pub Med中2005年6月-2015年6月低分子肝素联合中药预防髋关节置换术后下肢深静脉血栓形成的临床随机对照试验相关文献,按照Cochrane偏倚风险评价标准对纳入文献进行质量评价,采用Rev Man 5.3软件进行Meta分析。结果共纳入17篇文献,受试者1542例。Meta分析结果显示:与单纯使用低分子肝素比较,低分子肝素联合中药组下肢深静脉血栓的发生率明显降低[OR=0.37,95%CI(0.26,0.51),Z=5.85,P<0.000 01],凝血酶原时间明显延长[MD=4.34,95%CI(4.24,4.45),Z=80.18,P<0.000 01],活化部分凝血活酶时间明显延长[MD=6.00,95%CI(5.40,6.60),Z=19.64,P<0.000 01],纤维蛋白原水平明显降低[MD=-0.66,95%CI(-0.78,-0.54),Z=10.81,P<0.000 01],D-二聚体水平明显降低[MD=-0.05,95%CI(-0.08,-0.02),Z=3.02,P=0.003],血小板计数差异无统计学意义[MD=-3.63,95%CI(-8.30,1.03),Z=1.53,P=0.13]。结论低分子肝素联合中药可降低髋关节置换术后下肢深静脉血栓的发生率,但尚需更多大样本、多中心、高质量的临床随机对照试验进一步验证。

Objective To systematically evaluate the clinical efficacy of low molecular weight heparin combinedwith TCM for preventing deep vein thrombosis of patients with total hip arthroplasty. Methods China NationalKnowledge Infrastructure (CNKI), Wanfang Data Resource, VIP Data Resource, PubMed and Embase were searchedfrom June 2005 to June 2015 to identify the formally published randomized controlled trials (RCTs) in which theefficacy of low molecular weight heparin combined with TCM (experiment group) or simple low molecular heparin(control group) for preventing deep vein thrombosis of patients with total hip arthroplasty were reported. TheCochrane system quality evaluation standard in Evaluation Handbook was applied to assess the methodologicalquality of literature. The Cochrane Collaboration's RevMan 5.3 software was used to conduct Meta analysis. ResultsA total of 17 RCTs including 1542 patients were recruited in this study. The results of Meta analysis showed thatcompared with the control group, the incidence rate of deep vein thrombosis in the experimental group decreasedsignificantly [OR=0.37, 95%CI(0.26, 0.51), Z=5.85, P<0.000 01]; prothrombin time was significantlyprolonged [MD=4.34, 95%CI(4.24, 4.45), Z=80.18, P<0.000 01]; activated partial thromboplastin time was aslo significantly prolonged [MD=6.00, 95%CI(5.40, 6.60), Z=19.64, P<0.000 01]; the level of fibrinogen wassignificantly decreased [MD=-0.66, 95%CI(-0.78, -0.54), Z=10.81, P<0.000 01]; the level of D-Dimer was aslo significantly decreased [MD=-0.05, 95%CI(-0.08, -0.02), Z=3.02, P=0.003]; the blood platelet count between the twogroups did not have statistical difference [MD=-3.63, 95%CI(-8.30, 1.03), Z=1.53, P=0.13]. Conclusion Lowmolecular weight heparin combined with TCM can reduce the the incidence rate of deep vein thrombosis. However,clinical RCTs with larger samples, multi-center and high quality are required for further vertification.