目的系统评价低剂量阿司匹林(LDA )对子痫前期(PE)高危人群的预防作用。方法计算机全面检索相关文献数据库关于 LDA对PE高危人群预防作用的相关文献,英文数据库包括：Embase、PubMed、Cochrane Central Register of Controlled Trials (CCRT)、Web of Science、ACP、Medline 及 Ovid；中文数据库包括：中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普(VIP)及万方数据库；手工检索相关会议资料、论文集及学位论文汇编等。检索时间为自各数据库建库至2014年4月,检索内容为关于 LDA对PE高危人群预防作用的随机对照试验(RCT)。采用 Cochrane系统评价法,对检索文献进行质量评价和Meta分析。各研究间的异质性采用 I2检验,I2<50%采用固定效应模型Meta分析, I2>50%采用随机效应模型 Meta 分析。采用 Mantel-Haenszel 法评估相关因素的 OR 值和95%CI。结果通过相关文献检索,检索出关于 LDA对PE高危人群预防作用的 RCT 文献共计29篇符合本研究纳入标准,RCT共计29个,纳入受试者共计21403例。对纳入文献的方法学质量评价结果显示,纳入文献质量均较高。LDA对PE高危人群的预防效果评估,LDA组与对照组妊娠结局的Meta分析结果比较：PE风险(OR=0.78,95%CI：0.66~0.91,P=0.00100),早产风险(OR=0.85,95%CI ：0.79~0.91,P<0.00001),胎盘早剥风险(OR=1.34,95%CI：1.05~1.71,P=0.02000),胎儿生长受限(IUGR)风险(OR=0.80,95%CI：0.73~0.91,P=0.00030),围生儿死亡风险(OR=0.91,95%CI ：0.76~1.09,P=0.31000),产后出血风险(OR=1.02,95%CI：0.95~1.09,P=0.57000),剖宫产风险(OR=1.00,95%CI：0.96~1.05,P=0.97000),自然流产风险(OR=0.56,95%CI：0.31~1.07,P=0.08000)。早孕期(孕龄≤16孕周)预防性应用 LDA,可更显著降低 PE 及 IUGR 发生风险(P<0.05)。结论 LDA 对PE高危人群中PE、早产、IUGR具有预防作用,不增加产后出血、剖宫产、自然流产及围生儿死亡等的发生风险。PE高危人群早期应用 LDA能更显著降低PE及 IUGR发生风险。
目的繫統評價低劑量阿司匹林(LDA )對子癇前期(PE)高危人群的預防作用。方法計算機全麵檢索相關文獻數據庫關于 LDA對PE高危人群預防作用的相關文獻,英文數據庫包括：Embase、PubMed、Cochrane Central Register of Controlled Trials (CCRT)、Web of Science、ACP、Medline 及 Ovid；中文數據庫包括：中國生物醫學文獻數據庫(CBM)、中國期刊全文數據庫(CNKI)、維普(VIP)及萬方數據庫；手工檢索相關會議資料、論文集及學位論文彙編等。檢索時間為自各數據庫建庫至2014年4月,檢索內容為關于 LDA對PE高危人群預防作用的隨機對照試驗(RCT)。採用 Cochrane繫統評價法,對檢索文獻進行質量評價和Meta分析。各研究間的異質性採用 I2檢驗,I2<50%採用固定效應模型Meta分析, I2>50%採用隨機效應模型 Meta 分析。採用 Mantel-Haenszel 法評估相關因素的 OR 值和95%CI。結果通過相關文獻檢索,檢索齣關于 LDA對PE高危人群預防作用的 RCT 文獻共計29篇符閤本研究納入標準,RCT共計29箇,納入受試者共計21403例。對納入文獻的方法學質量評價結果顯示,納入文獻質量均較高。LDA對PE高危人群的預防效果評估,LDA組與對照組妊娠結跼的Meta分析結果比較：PE風險(OR=0.78,95%CI：0.66~0.91,P=0.00100),早產風險(OR=0.85,95%CI ：0.79~0.91,P<0.00001),胎盤早剝風險(OR=1.34,95%CI：1.05~1.71,P=0.02000),胎兒生長受限(IUGR)風險(OR=0.80,95%CI：0.73~0.91,P=0.00030),圍生兒死亡風險(OR=0.91,95%CI ：0.76~1.09,P=0.31000),產後齣血風險(OR=1.02,95%CI：0.95~1.09,P=0.57000),剖宮產風險(OR=1.00,95%CI：0.96~1.05,P=0.97000),自然流產風險(OR=0.56,95%CI：0.31~1.07,P=0.08000)。早孕期(孕齡≤16孕週)預防性應用 LDA,可更顯著降低 PE 及 IUGR 髮生風險(P<0.05)。結論 LDA 對PE高危人群中PE、早產、IUGR具有預防作用,不增加產後齣血、剖宮產、自然流產及圍生兒死亡等的髮生風險。PE高危人群早期應用 LDA能更顯著降低PE及 IUGR髮生風險。
목적계통평개저제량아사필림(LDA )대자간전기(PE)고위인군적예방작용。방법계산궤전면검색상관문헌수거고관우 LDA대PE고위인군예방작용적상관문헌,영문수거고포괄：Embase、PubMed、Cochrane Central Register of Controlled Trials (CCRT)、Web of Science、ACP、Medline 급 Ovid；중문수거고포괄：중국생물의학문헌수거고(CBM)、중국기간전문수거고(CNKI)、유보(VIP)급만방수거고；수공검색상관회의자료、논문집급학위논문회편등。검색시간위자각수거고건고지2014년4월,검색내용위관우 LDA대PE고위인군예방작용적수궤대조시험(RCT)。채용 Cochrane계통평개법,대검색문헌진행질량평개화Meta분석。각연구간적이질성채용 I2검험,I2<50%채용고정효응모형Meta분석, I2>50%채용수궤효응모형 Meta 분석。채용 Mantel-Haenszel 법평고상관인소적 OR 치화95%CI。결과통과상관문헌검색,검색출관우 LDA대PE고위인군예방작용적 RCT 문헌공계29편부합본연구납입표준,RCT공계29개,납입수시자공계21403례。대납입문헌적방법학질량평개결과현시,납입문헌질량균교고。LDA대PE고위인군적예방효과평고,LDA조여대조조임신결국적Meta분석결과비교：PE풍험(OR=0.78,95%CI：0.66~0.91,P=0.00100),조산풍험(OR=0.85,95%CI ：0.79~0.91,P<0.00001),태반조박풍험(OR=1.34,95%CI：1.05~1.71,P=0.02000),태인생장수한(IUGR)풍험(OR=0.80,95%CI：0.73~0.91,P=0.00030),위생인사망풍험(OR=0.91,95%CI ：0.76~1.09,P=0.31000),산후출혈풍험(OR=1.02,95%CI：0.95~1.09,P=0.57000),부궁산풍험(OR=1.00,95%CI：0.96~1.05,P=0.97000),자연유산풍험(OR=0.56,95%CI：0.31~1.07,P=0.08000)。조잉기(잉령≤16잉주)예방성응용 LDA,가경현저강저 PE 급 IUGR 발생풍험(P<0.05)。결론 LDA 대PE고위인군중PE、조산、IUGR구유예방작용,불증가산후출혈、부궁산、자연유산급위생인사망등적발생풍험。PE고위인군조기응용 LDA능경현저강저PE급 IUGR발생풍험。
Objective To evaluate the effectiveness of low-dose aspirin (LDA )on preventing preeclampsia (PE)in high-risk pregnancies.Methods Based on the principles and methods of Cochrane systematic reviews. We searched Embase, PubMed, Cochrane Central Register of Controlled Trials (CCRT),Web of Science,ACP,Medline,Ovid;CBM,CNKI,VIP and Wanfang database;related conference papers and dissertations were also searched manually.The search limits were:from database inception to April 2014,articles about prophylactic used LDA to prevent preeclampsia with randomized controlled trial (RCT)were selected.The assessment of methodological quality and data extraction of the included studies were performed independently by two reviewers,and Meta-analysis was conducted by RevMan 5 .0 software.The heterogeneity of treatment was evaluated by I2 .A fixed-effect model was used for Meta-analysis (I2<50%)and a radom-effect model was used for Meta-analysis (I2>50%).Mantel-Haenszel method was used to evaluese the odds ratio (OR)value and 95%CI.Results A tota1 of 29 RCT, involving 21 403 patients met the inclusion criteria.We graded the methodological quality of included studies as good.The function of LDA on preventing preeclampsia in high-risk pregnancies as below:preeclampsia (OR=0.78,95%CI:0.66-0.91,P=0.001 00);pretrem birth (OR=0.85,95%CI:0.79-0.91,P<0.000 01);placental abruption(OR=1.34,95%CI:1.05-1.71,P=0.020 00);intrauterine growth restriction (IUGR)(OR=0.80,95%CI:0.73-0.91,P=0.000 30),and the differences were statistically significant (P<0.05),and spontaneous abortion (OR=0.50,95%CI:0.31-1.07,P=0.080 00);postpartum hemorrhage (OR=1.02,95%CI:0.95-1.09,P=0.570 00);cesarean section (OR=1.00, 95%CI:0.96-1.05,P=0.970 00);perinatal death (OR=0.91,95%CI:0.76-1.09,P=0.310 00),and the differences were not statistically significant (P>0.05).LDA initiated at early pregnancy (gestational age ≤ 16 weeks ) could significantly reduce the risk of preeclampsia and IUGR (P < 0.05 ). Conclusions LDA has effect on preventing preeclampsia,preterm birth,IUGR in women considered to be at high risk.However,it dose not increase the incidence of perinatal death,postpartum hemorrhage, cesarean section,spontaneous abortion.Prophylactic use LDA at early pregnancy is associated with a greater reduction of preeclampsia and IUGR than those other adverse outcomes.
