細胞フリーヘモグロビンベースの血液代用品と心筋梗塞と死亡のリスク:メタ分析
Charles Natanson1, Steven J Kern, Peter Lurie
1Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892, USA. cnatanson@cc.nih.gov
JAMA
|April 30, 2008
まとめ
ヘモグロビンベースの血液代用品 (HBBS) は,患者にとってリスクが増加しています. 研究によると,これらの人工酸素運搬器を使用すると,死亡と心筋梗塞 (MI) の可能性が高いことが示されています.
科学分野:
- バイオメディカルエンジニアリング
- クリティカルケア・メディシン
- 血液学 ヘマトロジ
背景:
- ヘモグロビンベースの血液代用品 (HBBS) は,保存期間を延長し,冷蔵庫やクロスマッチングを必要としないなどの利点があります.
- HBBSは,特に遠隔地での出血性ショックの治療に考慮されています.
- 以前の試験では,明確な臨床的利益なしに,HBBSに関連したリスクの増加に関する懸念が高まっています.
研究 の 目的:
- ヘモグロビンベースの血液代用品 (HBBS) の安全性プロフィールを評価する.
- 手術,脳卒中,外傷患者の集団におけるHBBSのリスクを評価する.
主な方法:
- 1980年から2008年3月まで,PubMed,EMBASE,コクラン図書館の包括的な文献検索を実施しました.
- 19歳以上の患者におけるHBBSのランダム化比較試験 (RCT) を含む.
- 主要結果変数として死亡率と心筋梗塞 (MI) に関するデータを抽出.
主要な成果:
- 5種類のHBBS製品と3711人の患者を含む16件の試験を分析した.
- 治験の間で死亡率またはMIのアウトカムにおいて有意な異質性は見つかりませんでした (I2 = 0%).
- HBBSの使用で死亡リスク (RR,1.30; 95% CI,1.05-1.61) とMI (RR,2.71; 95% CI,1.67-4.40) の統計的に有意な増加が明らかになりました.
結論:
- ヘモグロビンベースの血液代用品 (HBBS) の使用は,死亡率の有意な増加と関連しています.
- HBBSは,心筋梗塞のリスクがかなり高まっていることも関連しています.
- これらの増加したリスクは,さまざまなHBBS製品と臨床用薬で観察されました.
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