低分子肝素治疗重症急性胰腺炎疗效的META分析

目的评估低分子肝素治疗重症急性胰腺炎的疗效。方法计算机检索PubMed、EMbase、Cochrane、万方和CNKI数据库,检索时间从2000年1月-2019年1月。收集低分子肝素治疗重症急性胰腺炎(SAP)的临床对照研究或随机对照研究的临床研究成果。纳入数据包括:主要指标(病死率)、次要指标(治愈率、中转手术率、并发症率和住院时间)。提取的数据应用Review Manager5.3进行meta分析,Stata 15.0软件进行累积meta分析。采用χ²检验和I²检验进行异质性检验,采用固定效应或随机效应模型计算统计量。结果符合标准的文献16篇,其中13篇中文,3篇英文。纳入文献的累计样本量1 415例,其中低分子肝素(Low molecular weight heparin,LMWH)组705例,常规治疗组710例。Meta结果显示:与常规治疗组相比,低分子肝素组可显著提高重症急性胰腺炎患者的治愈率(OR=3.02, 95%CI为2.13~4.28,P<0.05),降低病死率(OR=0.32, 95%CI为0.22~0.46,P<0.05)、中转手术率(OR=0.42, 95%CI为0.32~0.56,P<0.05)、并发症率(OR=0.30, 95%CI为0.22~0.40,P<0.05)及住院天数(MD=-6.94, 95%CI为-10.88~-3.00,P<0.05);根据发表年份的先后顺序,进行累积meta分析,OR估计值及可信区间趋于稳定,有较好的变化趋势。各研究间无异质性(I²=0,P=0.957),在选定的检验标准下,可以发现,最初证实治疗效果具有统计学意义的时间为2003年(OR=0.28,95%CI为0.13~0.62,P<0.05),随着时间推移,效应值OR逐渐稳定,95%CI逐渐缩短,最终累积效应值OR为0.32,95%CI为0.22~0.46,P<0.05,表明LMWH可以明显降低病死率,且其效应值随时间推移而趋于稳定。结论低分子肝素治疗重症急性胰腺炎可明显提高临床疗效,是一种安全、有效的治疗方法。

Efficacy of low molecular weight heparins in treatment of severe acute pancreatitis:meta analysis

OBJECTIVE To evaluate the efficacy of low molecular weight heparins in treatment of severe acute pancreatitis.METHODS The controlled or random clinical trials literatures that low molecular weight heparin was used to treat severe acute pancreatitis(SAP)were searched from PubMed,EMBASE,Cochrane,Wanfang,and China National Knowledge Infrastructure(CNKI)by computer retrieval.The retrieval time was from January 2000 to January 2019.The data were as the following:the major indexes(mortality rate),the secondary indexes(cure rate,transferring surgery rate,incidence of complications,length of hospital stay.Meta analysis was carried out for the extracted data by means of Review Manager 5.3,cumulative meta analysis was performed by using Stata 15.0 software.The heterogeneity test of the studies was performed using the chi-square test and the I~2 test,and the fixed effect or random effect model was used to calculate the combined effect.RESULTS Totally 16 articles,including 13 Chinese articles and 3 English articles,were included.The cumulative sample size included in the literatures was 1415 cases,including 705 cases in the low molecular weight heparin(LMWH)group and 710 cases in the routine treatment group.The results of meta-analysis showed that the cure rate of SAP of the LMWH group was significantly higher than that of the routine treatment group(OR=3.0295%CI 2.13~4.28,P<0.05),the mortality rate(OR=0.3295%CI 0.22~0.46,P<0.05),transferring surgery rate(OR=0.4295%CI 0.32~0.56,P<0.05),incidence of complications(OR=0.3095%CI 0.22~0.40,P<0.05)and length of hospital stay(MD=-6.9495%CI-10.88~-3.00,P<0.05)of the LMWH group were significantly lower than those of the routine treatment group.The cumulative meta analysis based on the order of publication indicated that the estimated value and confidence interval of OR point tended to be stable and had a good trend of change.There was no heterogeneity among the studies(I²=0,P=0.957),under the selected test criteria,the time when the therapeutic effect was proved with significant difference at the very beginning was 2003(OR=0.28,95%CI was 0.13~0.62,P<0.05);as time went by,the effect size OR became stable,95%CI was gradually shortened,and the final cumulative effect value OR was 0.32,95%CI 0.22~0.46,P<0.05,indicating that LMWH can significantly reduce the mortality rate and its effect value tended to be stable with the time.CONCLUSION The low molecular weight heparin can significantly improve the clinical effect on treatment of SAP,and it is a safe and effective treatment method.