小剂量阿司匹林联合低分子肝素治疗子痫前期的疗效及安全性的Meta分析及系统性评价

摘要：目的 研究小剂量阿司匹林联合低分子肝素治疗子痫前期的疗效及安全性。方法 以计算机检索PubMed、中国生物医学文献服务系统、中国知网、万方数据库等中英文数据库，收集自建库到2019年6月与小剂量阿司匹林联合低分子肝素治疗子痫前期的疗效及安全性的相关研究，由两名研究人员严格按照纳入/排除标准独立完成文献筛选、相关资料提取以及质量评价等，数据采用RevMan5.3统计学软件进行Meta分析。结果 最终纳入8篇研究，包括909例患者。Meta分析结果显示：观察组的收缩压与对照组相比，差异显著[MD=-10.97, 95%CI（-13.31,-8.63），P＜0.00001]；观察组的舒张压与对照组相比，差异显著[MD=-9.24, 95%CI（-14.22,-4.26），P=0.0003]。观察组的24h尿蛋白与对照组相比，差异有统计学意义[MD=-2.24,95%CI（-3.97,-0.50），P=0.01]。观察组的PT [MD=1.43,95%CI（0.56,2.30），P=0.001]、APTT[MD=2.85,95%CI（2.05,3.66），P＜0.00001]、 FIB[MD=-1.22,95%CI（-1.30, -1.14），P＜0.00001]与对照组相比，差异皆有统计学意义。观察组的围生儿不良结局与对照组相比，差异无统计学意义[RR=0.47,95%CI（0.20,1.10），P=0.08]。观察组的孕妇不良反应发生情况与对照组相比，差异有统计学意义[RR=0.58,95%CI（0.37,0.91），P=0.02]。结论 小剂量阿司匹林联合低分子肝素治疗子痫前期可更好地改善其血压、24h蛋白尿、凝血功能，疗效显著，并且在不增加围生儿不良结局的前提下减少了孕妇不良反应的发生，安全性高，可为临床上治疗子痫前期提供参考。

Systematic evaluation of efficacy and safety of low-dose aspirin combined with low-molecular-weight heparin in the treatment of preeclampsia

Abstract: Objective To study the efficacy and safety of low dose aspirin combined with low molecular weight heparin in the treatment of preeclampsia. Methods PubMed, China Biomedical Literature Service System, China HowNet and Wanfang database were searched by computer. The relevant studies on the efficacy and safety of self-built database in the treatment of pre-eclampsia with low-dose aspirin and low-molecular-weight heparin were collected from June 2019./ Exclusion criteria independently completed literature screening, related data extraction and quality evaluation, and data were analyzed by RevMan 5.3 statistical software. Results Eight studies were included, including 909 patients. Meta-analysis showed that there were significant differences in systolic blood pressure between the observation group and the control group [MD=-10.97, 95% CI (-13.31,-8.63), P<0.00001]; there were significant differences in diastolic blood pressure between the observation group and the control group [MD=-9.24, 95% CI (-14.22, -4.26), P=0.0003]. The 24-hour urinary protein in the observation group was significantly different from that in the control group [MD=-2.24, 95% CI (-3.97, -0.50), P=0.01]. There were significant differences in P T [MD=1.43, 95%CI(0.56, 2.30), P=0.001], APTT[MD=2.85, 95% CI(2.05, 3.66), P<0.00001], FIB [MD=-1.22, 95% CI(-1.30,-1.14), P<0.00001] between the observation group and the control group. There was no significant difference in adverse perinatal outcomes between the observation group and the control group [RR =0.47,95%CI(0.20, 1.10), P=0.08]. The adverse reactions of pregnant women in the observation group were significantly different from those in the control group [RR =0.58,95%CI(0.37,0.91),P=0.02]. Conclusion Low-dose aspirin combined with low-molecular-weight heparin can better improve blood pressure, 24-hour proteinuria and coagulation function of preeclampsia. The effect is remarkable, and the adverse reactions of pregnant women can be reduced without increasing the adverse outcomes of perinatal infants. It has high safety and can provide reference for clinical treatment of preeclampsia.