COVID-19患者凝血特征的Meta分析

Coagulation features of coronavirus disease 2019:a meta-analysis

目的系统分析2019新型冠状病毒肺炎(COVID-19)患者的凝血特征。方法计算机检索PubMed、Scopus、Web of Science、EMbase、中国知网数据库,搜集报道COVID-19凝血特征相关的文献,检索时限均为2020年1月1日至5月1日。由2名研究员独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Stata12.0软件对不同疾病分型COVID-19患者的血小板计数、D-二聚体、凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(FIB)进行Meta分析。结果共纳入39个回顾性研究,共计6994例COVID-19患者。Meta分析结果显示:(1)与重症患者相比,轻症患者的血小板计数较高[加权均值差(WMD)=20.11,95%CI 11.53~28.69,P<0.001],APTT(WMD=1.30,95%CI 0.31~2.30,P=0.01)更长,D-二聚体(WMD=-0.41,95%CI-0.58~-0.24,P<0.001)、FIB(WMD=-0.58,95%CI-0.76~-0.39,P<0.001)较低,凝血酶原时间(PT)(WMD=-0.51,95%CI-0.92~-0.10,P<0.001)更短;危重患者血小板计数较低(WMD=-14.75,95%CI-29.73~-0.23,P=0.044),D-二聚体较高(WMD=1.06,95%CI 0.65~1.47,P<0.001)。(2)与存活组相比,死亡组患者血小板计数较低(WMD=-36.40,95%CI-63.23~-9.58,P=0.008),D-二聚体较高(WMD=6.86,95%CI4.15~9.57,P<0.001),PT(WMD=1.37,95%CI0.73~2.02,P<0.001)更长。结论凝血功能紊乱在重症、危重症和死亡的COVID-19患者中较常见。血小板计数、D-二聚体和PT值与病情严重程度相关,可作为住院期间病情恶化的早期预警指标。

Objective To systematically analyse the blood coagulation features of coronavirus disease 2019(COVID-19)patients.Methods An electronic search in PubMed,Scopus,Web of Science,EMbase,and CNKI to collect studies related to the blood coagulation features of COVID-19 patients from 1 January 2020 to 1 May 2020.Two reviewers independently screened literatures,extracted data and assessed the risk of bias of included studies.Then,the platelet count,D-dimer value,prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen of patients with different types of diseases were analyzed by using Stata12.0 software.Results Thirty-nine retrospective studies involving 6994 COVID-19 patients were included.The results of meta-analysis showed that:(1)compared with severe group,the platelet count(Weighted mean difference;WMD=20.11,95%CI 11.53 to 28.69,P<0.001)and APTT(WMD=1.30,95%CI 0.31 to 2.30,P=0.01)were found to be higher while D-dimer(WMD=-0.41,95%CI-0.58 to-0.24,P<0.001),fibrinogen(WMD=-0.58,95%CI-0.76 to-0.39,P<0.001)and PT(WMD=-0.51,95%CI-0.92 to-0.10,P<0.001)were lower in mild group;the platelet count(WMD=-14.75,95%CI-29.73 to-0.23,P=0.044)was found to be lower while D-dimer(WMD=1.06,95%CI 0.65 to 1.47,P<0.001)was found to be higher in critical ill patients.(2)Compared with the survival group,the patients in death group displayed elevated levels of D-dimer(WMD=6.86,95%CI 4.15 to 9.57,P<0.001)and PT(WMD=1.37,95%CI 0.73 to 2.02,P<0.001)while platelet count(WMD=-36.40,95%CI-63.23 to-9.58,P=0.008)remained low.Conclusion Coagulation dysfunction was common in severe,critical ill and dead COVID-19 patients.Platelet count,D-dimer and PT levels were associated with the severity of the disease,and thus could be used as early warning indicators for the deterioration of the disease during hospitalization.