阿司匹林剂量预防中高危因素孕妇早产子痫前期：系统评价和荟萃分析。
Dose of aspirin to prevent preterm preeclampsia in women with moderate or high-risk factors: A systematic review and meta-analysis.
机构信息
University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, United States of America.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.
出版信息
PLoS One. 2021 Mar 9;16(3):e0247782. doi: 10.1371/journal.pone.0247782. eCollection 2021.
OBJECTIVE
To evaluate the effect of aspirin dose on the incidence of all gestational age preeclampsia and preterm preeclampsia.
DATA SOURCES
Electronic databases (Cochrane, PubMed, Scopus, ClinicalTrials.gov and the Web of Science) were searched for articles published between January 1985 and March 2019 with no language restrictions.
METHODS
We followed the PRIMSA guidelines and utilized Covidence software. Articles were screened by 2 independent reviewers, with discrepancies settled by an independent 3rd party. Study selection criteria were randomized trials comparing aspirin for prevention of all gestational age and preterm preeclampsia to placebo or no antiplatelet treatment in women aged 15-55 years with moderate or high-risk factors according to the list of risk factors from American College of Obstetricians and Gynecologists and United States Preventive Services Task Force guidelines. The quality of trials was assessed using the Cochrane risk of bias tool. The data were pooled using a random-effects meta-analysis comparing aspirin at doses of <81, 81, 100, and 150 mg. Pre-specified outcomes were all gestational age and preterm preeclampsia.
RESULTS
Of 1,609 articles screened, 23 randomized trials, which included 32,370 women, fulfilled the inclusion criteria. In preterm preeclampsia, women assigned at random to 150 mg experienced a significant 62% reduction in risk of preterm preeclampsia (RR = 0.38; 95% CI: 0.20-0.72; P = 0.011). Aspirin doses <150 mg produced no significant reductions. The number needed to treat with 150 mg of aspirin was 39 (95% CI: 23-100). There was a maximum 30% reduction in risk of all gestational age preeclampsia at all aspirin doses.
CONCLUSIONS
In this meta-analysis, based on indirect comparisons, aspirin at a dose greater than the current, recommended 81 mg was associated with the highest reduction in preterm preeclampsia. Our meta-analysis is limited due to the deficiency of homogeneous high evidence data available in the literature to date; however, it may be prudent for clinicians to consider that the optimal aspirin dose may be higher than the current guidelines advise. Future research to compare the efficacy aspirin doses greater than 81 mg is recommended.
STUDY REGISTRATION
PROSPERO, CRD42019127951 (University of York, UK; http://www.crd.york.ac.uk/PROSPERO/).
目的
评估阿司匹林剂量对所有孕龄子痫前期和早产子痫前期发生率的影响。
资料来源
电子数据库（Cochrane、PubMed、Scopus、ClinicalTrials.gov 和 Web of Science）检索了 1985 年 1 月至 2019 年 3 月发表的文章，无语言限制。
方法
我们遵循 PRISMA 指南并使用 Covidence 软件。由 2 名独立评审员筛选文章，分歧由独立的第 3 方解决。研究选择标准为比较阿司匹林预防所有孕龄和早产子痫前期与安慰剂或无抗血小板治疗的随机试验，纳入标准为年龄在 15-55 岁、根据美国妇产科医师学会和美国预防服务工作组指南的危险因素清单具有中高危因素的妇女。使用 Cochrane 偏倚风险工具评估试验质量。使用随机效应荟萃分析比较剂量<81、81、100 和 150 mg 的阿司匹林的数据。预先指定的结局为所有孕龄和早产子痫前期。
结果
在筛选出的 1609 篇文章中，有 23 项随机试验符合纳入标准，共纳入 32370 名女性。在早产子痫前期中，随机分配到 150 mg 组的女性早产子痫前期的风险显著降低 62%（RR=0.38；95%CI：0.20-0.72；P=0.011）。剂量<150 mg 的阿司匹林并未显著降低风险。用 150 mg 阿司匹林治疗的患者人数为 39（95%CI：23-100）。在所有阿司匹林剂量下，所有孕龄子痫前期的风险降低了最大 30%。
结论
在这项基于间接比较的荟萃分析中，剂量大于目前推荐的 81 mg 的阿司匹林与早产子痫前期发生率的降低幅度最大相关。由于目前文献中缺乏同质的高证据数据，我们的荟萃分析存在局限性；然而，临床医生可能需要考虑，最佳的阿司匹林剂量可能高于目前的指南建议。建议进行比较大于 81 mg 阿司匹林剂量疗效的未来研究。
研究注册
PROSPERO，CRD42019127951（英国约克大学；http://www.crd.york.ac.uk/PROSPERO/）。
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