重组人血小板生成素治疗脓毒症相关性血小板减少症临床疗效的Meta分析

Clinical efficacy of recombinant human thrombopoietin for treating sepsis-associated thrombocytopenia:a meta-analysis

目的系统评价重组人血小板生成素(rhTPO)治疗脓毒症相关性血小板减少症(SAT)的临床疗效。方法计算机检索PubMed数据库、EMbase数据库、Cochrane library数据库、中国知网数据库、万方数据库、维普数据库自建库至2019年8月15日间关于rhTPO治疗SAT的相关文献。由3名研究人员独立进行筛选文献、提取文献资料及评估方法学质量后,采用Review Manager 5.3软件进行Meta分析。结果最终纳入9项临床研究,共653例SAT患者。Meta分析结果显示,与对照组比较,应用rhTPO治疗SAT不能改善患者28 d病死率[相对危险度=0.83,95%置信区间(CI)(0.62,1.10),Z=1.29,P=0.20],但是可降低患者ICU住院时间[标准化均数差(SMD)=-0.49,95%CI(-0.85,-0.13),Z=2.65,P=0.008],改善治疗第7天外周血血小板计数[SMD=2.16,95%CI(1.13,3.19),Z=4.11,P<0.0001],减少血小板输注量[SMD=-1.29,95%CI(-1.65,-0.93),Z=7.09,P<0.00001]、血浆输注量[SMD=-2.08,95%CI(-3.53,-0.64),Z=2.82,P=0.005]及红细胞输注量[SMD=-1.33,95%CI(-2.22,-0.44),Z=2.94,P=0.003]。结论rhTPO治疗可降低SAT患者的ICU住院时间,改善外周血血小板计数,减少血小板、血浆及红细胞的输注量,但对患者28 d病死率无明显改善作用。

Objective To systematically evaluate the clinical efficacy of recombinant human thrombopoietin(rhTPO)in the treatment of sepsis-associated thrombocytopenia(SAT).Methods Clinical trials about rhTPO for treating patients with SAT were retrieved from the PubMed,Embase,Cochrane library,CNKI,Wanfang and VIP databases published up to August 15,2019.Three reviewers independently screened articles,extracted data and evaluated methodological quality.Then meta-analysis was conducted using the Review Manager 5.3 software.Results Nine articles with 653 SAT patients were enrolled in this study.Meta-analysis showed that as compared with the control group,the 28-day mortality was not significantly lower[relative risk=0.83,95%confidence interval(CI)(0.62,1.10),Z=1.29,P=0.20],while the length of ICU stay was much shorter[standard mean difference(SMD)=-0.49,95%CI(-0.85,-0.13),Z=2.65,P=0.008],and the peripheral blood platelet count on 7 d after treatment was much better[SMD=2.16,95%CI(1.13,3.19),Z=4.11,P<0.0001],and the transfusion volumes of platelet[SMD=-1.29,95%CI(-1.65,-0.93),Z=7.09,P<0.00001],plasma[SMD=-2.08,95%CI(-3.53,-0.64),Z=2.82,P=0.005]and red blood cell[SMD=-1.33,95%CI(-2.22,-0.44),Z=2.94,P=0.003]were much lower in the experimental group.Conclusion rhTPO can shorten length of ICU stay,improve platelet counts in peripheral blood,and reduce transfusion volumes of platelet,plasma and red blood cell,but it cannot ameliorate 28-day mortality in patients with SAT.