重组人促红细胞生成素对足月儿中重度缺氧缺血性脑病疗效的Meta分析

Meta analysis of recombinant human erythropoietin in treatment of moderate-to-severe hypoxic-ischemic encephalopathy in term infants

目的通过循证方法,评价重组人促红细胞生成素(recombinant human erythropoietin,rh EPO)对新生儿中重度缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)的疗效。方法计算机检索近10年(2004年1月~2014年8月)有关文献,根据纳入和排除标准,收集符合要求的文献,应用Rev Man 5.1版软件进行分析。结果共纳入10篇文献,Meta分析结果如下:新生儿神经行为评分(neonatal behavioral neurologic assessment,NBNA)计量资料组和计数资料组中,与对照组比较,rh EPO组能提高HIE患儿7、14、28 d的NBNA评分[加权均数差(weighted mean difference,WMD)(95%CI)依次为0.68(-0.52,1.88)、2.09(1.72,2.46)、1.70(1.13,2.28),OR(95%CI)依次为2.06(0.84,5.04)、3.59(1.58,8.16)、3.69(1.62,8.39)],但7 d的差异均无统计学意义(P=0.27;P=0.11),14 d、28 d差异有统计学意义(P<0.001,P<0.001;P=0.002,P=0.002)。血红蛋白(hemoglobin b,Hb)、网积红蛋白(reticulocyte,Ret)、血小板(platelets,PLT)、rh EPO能提高HIE患儿血Hb、Ret水平[WMD(95%CI)依次为9.87(4.99,14.76)、1.04(0.84,1.25)],且差异具有统计学意义(P<0.001);对血PLT水平改变不显著[WMD(95%CI)=-5.62(-15.54,4.31)],差异无统计学意义(P=0.27)。结论 rh EPO能提高HIE患儿14 d、28 d的NBNA评分,从而促进神经功能恢复。且近期安全性较好,并能在一定程度上提高血Hb、Ret含量,对PLT改变不明显。

Objective To evaluate the effects of recombinant human erythropoietin(rh EPO) in the treatment of moderate-to-severe hypoxicischemic encephalopathy(HIE) in term infants by evidence-based approach. Methods Clinical trials of the therapeutic effects of rh EPO for HIE were searched in recent 10 years,from Jan. 2004 to Aug. 2014. Literatures matched the indusion and exclusion criteria were analyzed by the software of Revman5. 1. Results Ten trials were included in total. Meta analyses showed that:(neonatal behavioral neurologic assessment(NBNA) score compared with control group,rh EPO group can improve the NBNA score of HIE children patients on the 7th day,14 th day and 28 th day in count data group and measurement data group,the value of WMDs and 95% CIs were 0. 68(-0. 52,1. 88),2. 09(1. 72,2. 46) and 1. 70(1. 13,2. 28) and the value of OR and 95% CIs were 2. 06(0. 84,5. 04),3. 59(1. 58,8. 16) and 3. 69(1. 62,8. 39),respectively. But it was nonsignificant on the 7th day(P = 0. 27,P =0. 11) and significant on the 14 th day and 28 th day(P < 0. 001,P < 0. 001; P = 0. 002,P = 0. 002).(Blood Hb、Ret and PLT Rh EPO can improve the blood level of Hb、Ret of HIE children patients after 2 weeks,the value of WMDs and 95% CIs were 9. 87(4. 99,14. 76) and 1. 04(0. 84,1. 25),with statistical significance(P < 0. 001). However,it showed no significance at blood level of PLT(P = 0. 27),the value of WMD and 95% CI was-5. 62(-15. 54,4. 31). Conclusion Rh EPO can improve the NBNA score of HIE children patients to promote neural functional recovery. Meanwhile,the safety of rh EPO is better in recent term. It could improve the blood level of Hb and Ret,but has no obvious effect on blood level of PLT.