蛇毒类血凝酶治疗肺结核咯血的有效性与安全性Meta分析

Efficacy and Safety of Snake Venom Hemocoagulase in Hemoptysis Due to Pulmonary Tuberculosis:a Meta-Analysis

目的系统评价蛇毒类血凝酶治疗肺结核咯血的有效性与安全性。方法计算机检索PubMed、Web of Science、Clinical Trials Gov、The Cochrane Library、CNKI、VIP、WanFangData等数据库,检索时限为建库至2019年10月22日,搜集蛇毒类血凝酶治疗肺结核咯血的相关文献。根据纳入与排除文献标准提取文献,收集资料,采用Review Manager5.3软件进行Meta分析。结果共纳入17篇蛇毒类血凝酶治疗肺结核咯血随机对照试验(RCT)文献,共2237例患者。Meta分析结果显示:与对照组(给予非蛇毒类血凝酶治疗)相比,蛇毒类血凝酶组有效率显著升高(OR=4.95,95%CI:3.12~7.85,P<0.0001),24 h复发率显著降低(OR=0.25,95%CI:0.10~0.64,P<0.004)。蛇毒类血凝酶单用或与常规止血药物(不包括垂体后叶素)联合使用时,其不良反应发生率低于对照组(OR=0.03,95%CI:0.00~0.20,P<0.0001);蛇毒类血凝酶联合垂体后叶素时,2组不良反应发生率差异无统计学意义(P=0.37)。结论蛇毒类血凝酶应用于肺结核咯血可提高有效率,降低24 h复发率及不良反应发生率,但蛇毒类血凝酶不能降低垂体后叶素引起的不良反应发生率。

Objective To evaluate the efficacy and safety of snake venom hemocoagulase in hemoptysis due to pulmonary tuberculosis.Methods PubMed,Web of Science,Clinical Trials Gov,Cochrane Library,CNKI,VIP,WanFang Data and other databases were searched from inception to October 22,2019 for literature related to snake venom hemocoagulase for hemoptysis due to tuberculosis.The literature was extracted and data were collected according to the inclusion and exclusion criteria.Meta-analysis was conducted with Review Manager 5.3 software.Results A total of 17 randomized controlled trials(2237 patients)were included.Meta-analysis showed that the effective rate in hemocoagulase treatment group was higher than that in control group(OR=4.95,95%CI:3.12-7.85,P<0.0001).Furthermore,the 24-hour recurrence rate in hemocoagulase treatment group was lower than that in control group(OR=0.25,95%CI:0.10-0.64,P<0.004).Compared with control group,treatment with hemocoagulase alone or in combination with conventional hemostatics(excluding pituitrin)markedly decreased the incidence of adverse reactions(OR=0.03,95%CI:0.00-0.20,P<0.0001).The combination of hemocoagulase and pituitrin had no significant effect on the incidence of adverse reactions(P=0.37).Conclusion Snake venom hemocoagulase can improve the effective rate and reduce the 24-hour recurrence rate and the incidence of adverse reactions in the treatment of hemoptysis due to pulmonary tuberculosis.Nevertheless,hemocoagulase cannot decrease the incidence of pituitrin-caused adverse reactions.