肺血栓栓塞症溶栓与抗凝治疗效果比较的meta分析

目的　根据现有临床研究评价肺血栓栓塞症 (PTE)溶栓治疗的有效性和安全性。方法　从 196 6～ 2 0 0 3年 5月MEDLINE光盘数据库和 1978～ 2 0 0 3年 5月中国生物医学光盘数据库 ,检索以大面积和次大面积PTE为研究对象、比较溶栓治疗与抗凝治疗效果的随机对照试验 (RCT)文献 ,并对RCT结果进行meta分析。结果　共 12项RCT 884例患者入选。与抗凝治疗比较 ,溶栓治疗降低PTE病死率和复发率的合并比数比 (OR)分别是 0 975 (95 %可信限为 0 5 0 4～ 1 886 )和0 6 5 3(95 %可信限为 0 378～ 1 12 7) ,两者比较差异无显著性 (P >0 0 5 ) ;溶栓治疗增加出血并发症的OR为 2 4 6 1(95 %可信限为 1 6 36～ 3 70 2 ,P <0 0 1)。结论　与抗凝治疗比较 ,溶栓治疗不能进一步降低PTE病死率和复发率 ,且并发出血率较高。

Comparison of thrombolysis and anticoagulation in pulmonary thromboembolism: a meta-analysis

Objective To pool the data of studies about thrombolysis in pulmonary thromboembolism(PTE) and evaluate the efficacy and safety of thrombolysis. Methods The randomized clinical trials(RCTs) that compared the efficacy or safety of thrombolysis and anticoagulation in massive or submassive PTE were chosen from MEDLINE disks from 1966 to May of 2003 and CBM disks from 1978 to May of 2003. A meta-analysis was employed to evaluate the results of the two therapies. Results Twelve RCTs including 884 cases were analyzed. Compared with anticoagulation, the total OR of mortality and recurrence of patients with PTE treated with thrombolysis were 0.975(95%CI 0.504-1.886) and 0.653(95%CI 0.378-1.127) respectively, non-significant difference ( P>0.05). The total OR of bleeding in thrombolysis was 2.461 (95%CI 1.636-3.702, P<0.01). Conclusions Compared with anticoa- gulation, thrombolysis cannot reduce the mortality or recurrence of PTE. Thrombolysis increases the risk of complication of bleeding.