复方丹参注射液联合硫酸镁对子痫前期患者凝血指标及妊娠结局影响的Meta分析

Effects of Compound Danshen Injection Combined with Magnesium Sulfate on Coagulation Indexes and Pregnancy Outcomes in Patients with Preeclampsia:A Meta-analysis

目的基于Meta分析评价复方丹参注射液联合硫酸镁治疗子痫前期对患者凝血指标及妊娠结局的影响。方法计算机检索中英文数据库,包括万方数据库、中国知网(CNKI)、维普数据库(VIP)、PubMed、Embase、Cochrane Library等数据库。筛选整理丹参注射液联合硫酸镁治疗妊娠期高血压的随机对照试验(RCT),对筛选的文献进行整理后采用Revman 5.3.1软件进行Meta分析。结果最终纳入12篇RCT,Meta分析结果示:收缩压[MD=-9.09,95%CI(-12.07,-6.12),P<0.01]、舒张压[MD=-7.47,95%CI(-11.15,-3.78),P<0.01]、平均动脉压[MD=-11.87,95%CI(-14.33,-9.41),P<0.01]、24 h尿蛋白水平[SMD=-3.79,95%CI(-5.09,-2.50),P<0.01]、D-二聚体[SMD=-1.56,95%CI(-2.23,-0.90),P<0.01]、部分活化凝血酶原时间[SMD=0.82,95%CI(0.24,1.40),P<0.01]、活化凝血酶原时间[SMD=0.84,95%CI(0.29,1.40),P<0.01]、纤维蛋白原[SMD=-1.51,95%CI(-2.39,-0.63),P<0.01]、新生儿体质量[SMD=1.22,95%CI(0.37,2.07),P<0.01]、产后出血发生率[RR=0.33,95%CI(0.19,0.57),P<0.01]、新生儿窘迫发生率[RR=0.30,95%CI(0.17,-0.50),P<0.01]、新生儿窒息发生率[RR=0.20,95%CI(0.16,-0.47),P<0.01]。结论丹参注射液联合硫酸镁治疗子痫前期患者可以获得更理想的血压水平,并可以改善患者的凝血水平,且不会增加出血的发生率,降低不良妊娠结局的发生率,但由于大部分指标具有较高的异质性,评价结果可能存在发表偏倚。

Objective:To evaluate the effect of Compound Danshen Injection combined with magnesium sulfate on coagulation indexes and pregnancy outcomes in patients with preeclampsia based on meta-analysis.Methods:The Chinese and English databases including Wanfang database,China National Knowledge Infrastructure(CNKI),VIP database,PubMed,Embase,Cochrane Library were searched by computer.Randomized controlled trials(RCTs)of Danshen Injection combined with magnesium sulfate in the treatment of gestational hypertension were screened and summarized.Revman 5.3.1 software was used for meta-analysis after sorting out the selected literature.Results:12 RCTS were finally included.Meta-analysis showed that the systolic blood pressure[MD=-9.09,95%CI(-12.07,-6.12),P<0.01],diastolic blood pressure[MD=-7.47,95%CI(-11.15,-3.78),P<0.01],mean arterial pressure[MD=-11.87,95%CI(-14.33,-9.41),P<0.01],24 h urine protein level[SMD=-3.79,95%CI(-5.09,-2.50),P<0.01],D-dimer[SMD=-1.56,95%CI(-2.23,-0.90),P<0.01],partial activated prothrombin time[SMD=0.82,95%CI(0.24,1.40),P<0.01],activated prothrombin time[SMD=0.84,95%CI(0.29,1.40),P<0.01],fibrinogen[SMD=-1.51,95%CI(-2.39,-0.63),P<0.01],neonatal weight[SMD=1.22,95%CI(0.37,2.07),P<0.01],postpartum hemorrhage incidence[RR=0.33,95%CI=(0.19,0.57),P<0.01],incidence of neonatal distress[RR=0.30,95%CI(0.17,-0.50),P<0.01],incidence of neonatal asphyxia[RR=0.20,95%CI(0.16,-0.47),P<0.01].Conclusion:Danshen Injection combined magnesium sulfate in the treatment of preeclampsia patients can obtain a more ideal blood pressure level,and can improve the patient′s level of coagulation,and does not increase the incidence of bleeding,reduce the incidence of adverse pregnancy outcomes.However,since most of the indicators have high heterogeneity,the evaluation results may have publication bias.