国内应用低分子肝素治疗急性胰腺炎临床疗效的Meta分析

摘要

目的：采用Meta分析的方法对低分子肝素治疗急性胰腺炎（ AP）的临床疗效进行评价。方法计算机检索VIP（1989~2014年）、WANFANG（1999~2014年）、CNKI（1994~2014年）、CAJD数据库中关于低分子肝素治疗AP的临床随机对照试验（ RCT），对符合要求的RCT进行Meta分析。结果最终纳入13篇RCT，有960例患者符合纳入标准。Meta分析结果显示，低分子肝素治疗组的治愈时间[总效应Z=2.79，MD=-1.69，95%CI（-2.88~-0.50），p=0.005]，重症化例数[总效应Z=4.19，OR=0.35，95%CI（0.21~0.57），p<0.0001]，手术例数[总效应Z=2.24， OR=0.54，95%CI（0.31~0.93），p=0.03]，并发症[总效应Z=4.28，OR=0.28，95%CI（0.16~0.51），p<0.0001]，死亡率[总效应Z=2.37，OR=0.40，95%CI（0.21~0.77），p=0.006]，均明显优于对照组（ p<0.05，差异具有统计学意义）。结论在综合治疗基础上，低分子肝素对AP疗效确切，其可缩短AP的治愈时间，减少重症化及手术治疗例数，降低并发症及死亡率的发生。%Objective To evaluate the effectiveness of low molecular weight heparin(LMWH)in the treatment of acute pancreatitis( AP)by meta-analysis on published data. Methods A comprehensive search was performed in VIP(1989~2014),WANFANG(1999~2014),CNKI(1994~2014)and CAJD databases to collect the randomized controlled trials( RCTs)in which LMWH was used in the treatment of AP,and to analyze the RCTs in meta-analysis method. Results 960 patients were analyzed in the 13 RCTs which met the inclusion criteria. The meta-analysis results suggested that,compared with the control group,patients had shorter recovery time[test for overall effect:Z=2. 79,MD= -1. 69,95% CI( -2. 88,-0. 50),p=0. 005],fewer severe cases[test for overall effect:Z=4. 19,OR=0. 35,95% CI(0. 21, 0. 57),p<0. 0001],fewer surgical cases[test for overall effect:Z=2. 24,OR=0. 54,95% CI(0. 31, 0. 93),p=0. 03 ],fewer complications[ test for overall effect:Z =4. 28,OR =0. 28,95%CI( 0. 16, 0. 51),p<0. 0001]and lower mortality rates[Z=2. 73,OR=0. 40,95% CI(0. 21,0. 77),p=0. 006]in LMWH group(p<0. 05). Conclusion On the basis of conventional therapy,the effectiveness of LMWH is positive for AP,as it is able to significantly shorten the recovery time,reduce severe cases and surgical cases,and lower the incidence of complications and mortality rates.