重组人可溶性血栓调节蛋白对脓毒症继发弥散性血管内凝血患者短期死亡率影响：Meta分析

发布时间：2018-06-01 20:45

本文选题：脓毒症 + 弥散性血管内凝血　；参考：《首都医科大学》2017年硕士论文

【摘要】：研究目的:脓毒症及其相关并发症的诊断及治疗一直是临床上比较棘手的问题。目前关于血栓调节蛋白治疗脓毒症合并弥散性血管内凝血(Disseminated Intravascular Coagulation,DIC)成为了研究热点,但就现在国际上已经发表的众多研究来看,究竟其是否可以降低患者死亡率还尚无定论。因此,我们系统回顾并分析了国内外相关临床研究来综合评价血栓调节蛋白(thrombomodulin,TM)对于脓毒症继发DIC患者的疗效。研究方法:我们在Pub Med,Web of Science,Embase及Cochrane Library数据库中仔细搜索了2017年3月以前所有符合纳入标准的相关文章,并提取文章中重要数据,主要对各个研究中患者的28天或30天死亡率进行评估比较。研究结果:我们最终共纳入了3篇随机对照研究及10篇观察性研究,共计18380个脓毒症合并DIC患者(随机对照研究组共913人,观察性研究组共17467人),各研究中实验组患者均接受重组人可溶性血栓调节蛋白(Recombinant human soluble thrombomodulin,rh TM)的治疗。分析结果显示:在随机对照组,患者28天或者30天死亡率的相对危险度(Relative risk,RR)值为0.83(95%可信区间,0.64-1.07);观察性研究组中RR值为0.96(95%可信区间,0.92-1.01)。在严重出血事件方面,实验组和对照组并没有显著差异。结论:根据目前现有的研究结果来看,与其他抗凝剂治疗效果相比较,rh TM并不能显著降低患者短期死亡率,但同时也需要更多高质量的临床研究来进一步证实该结论。
[Abstract]:Objective: the diagnosis and treatment of sepsis and its related complications has been a difficult problem in clinic. At present, thrombomodulin has become a hot topic in the treatment of sepsis with disseminated intravascular coagulation (Intravascular Coagulation). However, it is still unclear whether thrombomodulin can reduce the mortality rate of patients with sepsis. Therefore, we systematically reviewed and analyzed the clinical studies at home and abroad to evaluate the efficacy of thrombomodulin in patients with DIC secondary to sepsis. Research methods: we searched the Pub MedWeb of Science Embase and Cochrane Library databases for all relevant articles that meet the inclusion criteria by March 2017, and extracted important data from the articles. The 28-day or 30-day mortality rates in each study were evaluated and compared. Results: we eventually included 3 randomized controlled trials and 10 observational studies, with a total of 18 380 septic patients with DIC. 17467 patients in the observational study group were treated with recombinant human soluble thrombomodulin human soluble (Recombinant human soluble thrombomodulin rh TMH). The results showed that in the randomized control group, the relative risk of mortality on day 28 or 30 was 0.83V 95% CI 0.64-1.07g, and the RR in the observational study group was 0.9695% CI 0.92-1.01g. There was no significant difference between the experimental group and the control group in severe bleeding events. Conclusion: compared with other anticoagulants, rh TM can not significantly reduce the short-term mortality rate, but more high quality clinical studies are needed to further confirm this conclusion.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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