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重组人可溶性血栓调节蛋白与弥散性血管内凝血感染患者的短期死亡率:一项荟萃分析

Recombinant human soluble thrombomodulin and short-term mortality of infection patients with DIC: a meta-analysis.

作者信息

Zhang Chao, Wang Huijuan, Yang Huqin, Tong Zhaohui

机构信息

Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.

Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.

出版信息

Am J Emerg Med. 2016 Sep;34(9):1876-82. doi: 10.1016/j.ajem.2016.06.001. Epub 2016 Jun 3.

Abstract

OBJECTIVE

Several studies have demonstrated that recombinant human soluble thrombomodulin (rhTM) has potential advantages for the treatment for patients with infection complicated by disseminated intravascular coagulation (DIC). However, whether injection of rhTM can affect the mortality of those patients in clinical treatment remains controversial. Therefore, we conducted a meta-analysis to evaluate the clinical efficacy for patients with infection complicated by DIC.

METHODS

The PubMed, Web of Science, Embase, and Cochrane Library databases were searched for relevant articles that met the inclusion criteria through April 2016. Reference lists of the retrieved articles were also reviewed. The 28- or 30-day mortality and bleeding risk after using rhTM were evaluated.

RESULTS

Ten observational studies and 2 randomized controlled trials (RCTs) involving 18288 patients were included in this meta-analysis. The risk ratio for the 28- or 30-day mortality was 0.81 (95% confidence interval, 0.61-1.06) in RCT studies and 0.96 (95% confidence interval, 0.92-1.01) in observational studies. There were no significant differences in the bleeding risk between the rhTM group and the control group.

CONCLUSION

Based on the current studies, using rhTM for the treatment for infection patients complicated with DIC does not decrease the short-term mortality of those patients. More high-quality RCT studies need to be performed to confirm this finding.

摘要

目的

多项研究表明,重组人可溶性血栓调节蛋白(rhTM)在治疗感染合并弥散性血管内凝血(DIC)的患者方面具有潜在优势。然而,在临床治疗中注射rhTM是否会影响这些患者的死亡率仍存在争议。因此,我们进行了一项荟萃分析,以评估rhTM治疗感染合并DIC患者的临床疗效。

方法

通过检索PubMed、Web of Science、Embase和Cochrane图书馆数据库,查找截至2016年4月符合纳入标准的相关文章。同时也对检索到的文章的参考文献列表进行了审查。评估使用rhTM后的28天或30天死亡率和出血风险。

结果

本荟萃分析纳入了10项观察性研究和2项随机对照试验(RCT),共涉及18288例患者。在RCT研究中,28天或30天死亡率的风险比为0.81(95%置信区间,0.61 - 1.06);在观察性研究中,该风险比为0.96(95%置信区间,0.92 - 1.01)。rhTM组和对照组之间的出血风险无显著差异。

结论

基于目前的研究,使用rhTM治疗感染合并DIC的患者并不能降低这些患者的短期死亡率。需要进行更多高质量的RCT研究来证实这一发现。

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