摘要
目的系统评价七叶皂苷钠对骨科术后下肢静脉血栓的防治效果。方法检索PubMed、Embase、Cochrane Library、中国知网、万方、维普网数据库中七叶皂苷钠防治下肢静脉血栓的相关文献,检索时限为建库至2025年4月,以七叶皂苷钠(Sodium aescinate)、静脉血栓(Venous thrombosis)、骨科术后(Orthopedic surgery)为检索词,提取相关文献资料。采用Cochrane系统评价员手册和纽卡斯尔-渥太华量表(NOS)评估检索文献,结局指标包括用药后静脉血栓发生率、C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、D-二聚体、活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、全血高切黏度、全血低切黏度、血浆黏度和不良反应发生率。结果共纳入21篇文献、2324例患者,其中七叶皂苷钠组1221例、非七叶皂苷钠组1103例。与非七叶皂苷钠组比较,七叶皂苷钠组下肢静脉血栓发生率低(RR=0.51,95%CI:0.41~0.64,P<0.05)。七叶皂苷钠组和非七叶皂苷钠组在血清IL-6(SMD=−1.90,95%CI:−2.82~−0.98)、TNF-α(SMD=−1.00,95%CI:−1.33~−0.67)、D-二聚体(SMD=−1.35,95%CI:−2.29~−0.42)、APTT(SMD=5.37,95%CI:1.74~9.00)、全血高切黏度(mPa•s)(SMD=−2.50,95%CI:−3.65~−1.35)、血浆黏度(mPa•s)(SMD=−1.57,95%CI:−2.40~−0.74)、全血高切黏度(剪切速率150/s)(SMD=2.37,95%CI:0.48~4.26),全血低切黏度(剪切速率10/s)(SMD=2.99,95%CI:1.31~4.66)、血浆黏度(剪切速率120/s)(SMD=2.32,95%CI:2.00~2.64)等差异具有统计学意义(P<0.05);两组CRP(SMD=−0.83,95%CI:−1.94~0.28)、PT(SMD=0.72,95%CI:−0.36~1.79)、FIB(SMD=−0.55,95%CI:−1.66~0.57)、全血低切黏度(mPa•s)(SMD=−1.46,95%CI:−3.49~0.56)、不良反应发生率间差异均无统计学意义(P均>0.05)。结论七叶皂苷钠防治骨科术后下肢静脉血栓的效果较好,具有较好的安全性。
Objective To systematically evaluate the clinical efficacy of sodium aescinate in the prevention and treatment of lower extremity venous thrombosis following orthopedic surgery.Methods A comprehensive search was conducted in both English and Chinese databases,including PubMed,Embase,Cochrane Library,CNKI,Wanfang,and VIP,from database inception to April 2025.The search terms used were"sodium aescinate","venous thrombosis",and"orthopedic surgery".Relevant literature was selected after applying inclusion and exclusion criteria and We evaluated the studies using the Cochrane Handbook for Systematic Reviews and the Newcastle-Ottawa Scale(NOS).Outcome indicators included the incidence of venous thrombosis,C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),D-dimer,activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB),whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity,and adverse event rates.Results A total of 21 studies,involving 2,324 patients,were included,with 1,221 patients in the sodium aescinate group and 1,103 in the control group.The incidence of venous thrombosis was significantly lower in the sodium aescinate group than in the control group(RR=0.51,95%CI:0.41-0.64,P<0.05).Significant differences were found in serum IL-6(SMD=−1.90,95%CI:−2.82-−0.98),TNF-α(SMD=−1.00,95%CI:−1.33-−0.67),D-dimer(SMD=−1.35,95%CI:−2.29-−0.42),APTT(SMD=5.37,95%CI:1.74-9.00),whole blood high shear viscosity(mPa•s)(SMD=−2.50,95%CI:−3.65-−1.35),plasma viscosity(mPa•s)(SMD=−1.57,95%CI:−2.40-−0.74),whole blood high shear viscosity(at shear rate of 150/s)(SMD=2.37,95%CI:0.48-4.26),whole blood low shear viscosity(at shear rate of 10/s)(SMD=2.99,95%CI:1.31-4.66),and plasma viscosity(at shear rate of 120/s)(SMD=2.32,95%CI:2.00-2.64)between these two groups(all P<0.05).No significant differences were found in CRP(SMD=−0.83,95%CI:−1.94-0.28),PT(SMD=0.72,95%CI:−0.36-1.79),FIB(SMD=−0.55,95%CI:−1.66-0.57),whole blood low shear viscosity(SMD=−1.46,95%CI:−3.49-0.56)or adverse event rates between these two groups(all P>0.05).Conclusion Sodium aescinate is effective in preventing and treating lower extremity venous thrombosis after orthopedic surgery,with a favorable safety profile.
作者
马彤彤
王娜
田庆杰
刘英杰
郑军
王宏伟
蒋雨宸
李旻
MA Tongtong;WANG Na;TIAN Qingjie;LIU Yingjie;ZHENG Jun;WANG Hongwei;JIANG Yuchen;LI Min(Department of Traumatology,The Affiliated Hospital of North China University of Science and Technology,Tangshan 063000,China)
出处
《山东医药》
2025年第9期29-34,共6页
Shandong Medical Journal
基金
河北省医学科学研究课题计划项目(20201241)
河北省政府资助临床医学优秀人才培养项目(ZF2024200)。
关键词
七叶皂苷钠
静脉血栓
下肢静脉血栓
炎症因子
凝血功能
sodium aescinate
venous thrombosis
lower extremity venous thrombosis
inflammatory cytokines
coagulation function
