摘要
目的：本文旨在应用Meta分析的方法评价基因分型指导华法林预防和治疗血栓栓塞性疾病的有效性与安全性。方法：计算机系统检索Pub Med、Cochrane图书馆、万方、维普（VIP）、中国知网（CNKI）等数据库有关基因分型指导华法林预防和治疗血栓栓塞性疾病的文献,检索日期由建库截止2014年1月1日。由2位作者独立进行数据提取和文献质量方法学评价。应用Rev Man5.2进行统计分析。结果：共有11项研究最终被纳入系统评价,最终对10项随机对照研究（2 905名受试者）进行定量分析。Meta分析结果显示：基因分型组与对照组比较,在国际标准化比值（international normalized ratio,INR）处于治疗范围的时间百分比（SMD=0.11,95%CI=-0.06～0.29,P=0.21）,稳定剂量达标率[相对危险度（relative risk,RR）=1.13;95%CI=1.00～1.28,P=0.05],抗凝过度（RR=0.95,95%CI=0.83～1.08,P=0.44）,出血事件（RR=0.89,95%CI=0.78～1.01,P=0.08）,栓塞事件（RR=0.61,95%CI=0.30～1.23,P=0.17）等方面,2组之间的差异均无统计学意义;对INR处于治疗范围的时间百分比和稳定剂量达标率2方面进行亚组分析,结果提示2组之间仍未见统计学差异。对结局指标进行敏感性分析显示结果稳定可靠。结论：基因分型指导华法林预防和治疗血栓栓塞性疾病较对照方案在有效性与安全性方面的优势性证据仍不足。
Objective：To evaluate the efficacy and safety of genotype-guided warfarin in preventing and treating thromboembolic dis- ease using Meta-analysis. Methods：PubMed database, Cochrane Library, Wanfang, VIP and CNKI were systemically searched for lit- erature of genotype-guided warfarin in preventing and treating thromboembolic disease. The searching date was up to January 1,2014. The data extraction and methodological grading were performed independently by two authors. RevMan version 5.2 was used for sta- tistical analysis. Results：A total of 11 randomized controlled trials （RCTs） were included in systematic review and 10 RCTs （2 905 cases） were quantitatively analyzed. The results of Meta-analysis showed that there was no significant difference between genotypic warfarin-dosing group and control dosing group in the aspects of percentage of time in the international normalized ratio therapeutic range（SMD=0.11,95%CI=-0.06 to 0.29,P=0.21）,patients with stable dose（RR=l.13;95%Cl=l.00 to 1.28,P=0.05）,over coagulation （RR=0.95,95%CI=0.83 to 1.08, P=0.44）, bleeding （RR=0.89,95%CI=0.78 to 1.01, P=0.08）, thromboembolism （RR=0.61,95%CI= 0.30 to 1.23,P=0.17）. There was no significant difference between genotypic warfarin-dosing group and control dosing group in per- centage of time in the INR therapeutic range and patients with stable dose. The sensitivity analysis of outcomes showed that the re- suits were stable and reliable. Conclusion： The evidence of superiority in efficacy and safety of genotype-guided warfarin in prevent- ing and treating thromboembolic disease is still insufficient.
出处
《重庆医科大学学报》
CSCD
北大核心
2014年第10期1425-1431,共7页
Journal of Chongqing Medical University
