低分子肝素与常规西药治疗先兆流产有效性和安全性的Meta分析

Meta-analysis of efficacy and safety of low molecular weight heparin and conventional Western medicine in treatment of threatened abortion

目的系统评价低分子肝素治疗先兆流产的有效性和安全性,为临床提供循证参考。方法检索Pubmed、中国知网、万方数据库、维普数据库,检索时间为建库时间至2020年3月,收集有关低分子肝素治疗先兆流产的随机临床试验(RCT)。由2位研究员按纳入和排除标准独立进行文献筛选、资料提取和偏倚风险评价,用ReV Man5.3软件对纳入研究进行Meta分析。结果共纳入17篇随机临床试验文献,合计1829例患者,治疗组为低分子肝素联合常规西药治疗先兆流产,对照组为用常规西药治疗先兆流产。Meta分析结果显示,治疗组治疗先兆流产的总有效率显著高于对照组[OR=4.00,95%CI(2.74,5.85),P<0.001],且不良反应发生率显著低于对照组[OR=0.46,95%CI(0.30,0.71),P<0.001];治疗组可显著降低先兆流产患者血小板水平[MD=-15.71,95%CI(-22.17,-9.26),P<0.001]、纤维蛋白原水平[MD=-0.11,95%CI(-0.38,-0.16),P<0.001]以及D-二聚体水平[MD=-0.25,95%CI(-0.31,-0.20),P<0.001]。结论低分子肝素联合常规西药治疗先兆流产疗效优于常规西药,不良反应发生率较常规西药治疗小。

Objective:To evaluate the efficacy and safety of low molecular weight heparin(LMWH)in the treatment of threatened abortion by meta-analysis,so as to provide evidence-based reference for clinical practice.Methods:Pubmed,CNKI,Wanfang and VIP database were searched from the database establishment to March 2020 to collect randomized clinical trials(RCTs)of low molecular heparin in treatment of threatened abortion.Two researchers independently conducted literature screening,data extraction and bias risk assessment according to inclusion and exclusion criteria.The meta-analysis of the included studies was performed by using Rev man53.Results:Seventeen randomized clinical trials including 1839 patients were included in the meta-analysis.The patients with threatened abortion in the experimental group was treated with low molecular weight heparin combined with conventional Western medicine,while the patients in the control group was treated with conventional Western medicine.The results of meta-analysis showed that the total effective rate of treatment for threatened abortion in the experimental group was significantly higher than that in the control group[OR=4.00,95%CI(2.74,5.85),P<0.001],and the incidence of adverse reactions was significantly lower than that in the control group[OR=0.46,95%CI(0.30,0.71),P<0.001].The levels of platelet[MD=-15.72,95%CI(-22.26,-9.18),P<0.001],fibrinogen[MD=-0.28,95%CI(-0.32,-0.25),P<0.001]and D-dimer[MD=-0.25,95%CI(-0.31,-0.20),P<0.001]were significantly reduced in patients with threatened abortion of the experimental group.Conclusions:The efficacy of low molecular weight heparin combined with conventional Western medicine in the treatment of threatened abortion is better than that of conventional Western medicine only,and the incidence of adverse reactions is less than that of conventional Western medicine.