中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (08): 534-538.doi: 10.3969/j.issn.1671-4091.2018.08.007

• 临床研究 • 上一篇    下一篇

阿加曲班与低分子肝素在血液透析中应用的Meta 分析

谢欢1,刘洋1,罗磊1,谢红萍1   

  1. 1.南华大学附属第一医院肾内科
  • 收稿日期:2018-02-07 修回日期:2018-04-17 出版日期:2018-08-12 发布日期:2018-08-12
  • 通讯作者: 谢红萍 2543238807@qq.com E-mail:2543238807@qq.com

The safety and efficacy of argatroban and low-molecular-weight heparin in hemodialysis: A meta analysis

  • Received:2018-02-07 Revised:2018-04-17 Online:2018-08-12 Published:2018-08-12

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摘要： 【摘要】目的评价阿加曲班与低分子肝素在血液透析中应用的安全性及有效性。方法以“阿加曲班”、“低分子肝素”、“血液透析”为关键词，在PubMed、EMBASE、Cochrane 图书馆、中国知网、万方数据等生物医学数据库检索关于阿加曲班与低分子肝素在血液透析中应用的随机对照试验。采用RevMan5.3软件进行分析。结果最终纳入6 篇文献，共467 例患者，阿加曲班组236 例，低分子肝素组231 例。Meta 分析结果显示，阿加曲班组与低分子肝素组在管路凝血发生率方面无统计学差异［相对危险度(RR)=0.740，95%可信区间(95%CI)0.470～1.150,P=0.180］，阿加曲班组血液透析后血小板计数明显高于低分子肝素组［均数差(MD)=20.000，95% CI 10.120～29.870,P＜0.001］，阿加曲班组血液透析中出血发生率明显低于低分子肝素组［RR=0.220，95%CI 0.070～0.680, P=0.009］, 阿加曲班组穿刺点止血时间明显短于低分子肝素组［MD=-1.350，95% CI -1.850～-0.840,P＜0.001］。结论阿加曲班与低分子肝素在血液透析抗凝效果中管路凝血发生率无明显差异，但阿加曲班对血小板影响小，出血发生率低，穿刺点止血时间短，安全性更高。

关键词: 阿加曲班, 低分子肝素, 血液透析, Meta分析

Abstract: 【Abstract】Objective To evaluate the safety and efficacy of argatroban and low-molecular-weight heparin (LMWH) in hemodialysis. Method PubMed, EMBASE, Cochrane library, CNKI, and Wanfang were searched for randomized controlled trials for argatroban and LMWH in hemodialysis. RevMan5.3 was used to perform statistical analyses. Result A total of 6 studies were enrolled, including 467 patients (236 in argatroban group, 231 in LMWH group). Meta analysis showed that argatroban group and LMWH group had no significant differences in clotting events in extracorporeal circuit during hemodialysis (RR=0.740, 95% CI0.470～1.150, P=0.180); platelet counts were significantly higher in argatroban group than in LMWH group (MD=20.000, 95% CI 10.120～29.870, P＜0.001), bleeding rate during hemodialysis was significantly lower in argatroban group than in LMWH group (RR=0.220, 95% CI 0.070～0.680, P=0.009); and the ligature time for puncture site was significantly shorter in argatroban group than in LMWH group (MD=-1.350, 95% CI -1.850～-0.840, P＜0.001). Conclusion The ratio of clotting events in extracorporeal circuit during hemodialysis was similar between argatroban group and LMWH group. Argatroban seems safer than LMWH in less influence on PLT, lower bleeding rate and shorter ligature time for puncture site.

Key words: argatroban, low-molecular-weight heparin, hemodialysis, meta-analysis