肝硬化并门静脉血栓抗凝治疗的安全及有效性：观察性研究的Meta分析

发布时间：2017-12-28 02:01

本文关键词：肝硬化并门静脉血栓抗凝治疗的安全及有效性：观察性研究的Meta分析　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本文用系统综述和Meta分析的方法,研究抗凝治疗对肝硬化并PVT病人的有效性和安全性的比较。方法:制定原始文献纳入标准及检索策略,以肝硬化(“liver cirrhosis”or“hepatic cirrhosis”or“cirrhotic liver”or cirrhosis)、门静脉血栓(“portal vein thrombosis,portal venous thrombosis”or“thrombosis portal vein”or“thromboses portal vein”)及抗凝(anticoagulation or anticoagulant or anticoagulants”为中英文主题词进行全面检索,选择检索数据库:Pubmed、Science Direct、Cochrane图书馆、万方、中国知网、维普等网络数据库所有关于肝硬化并PVT抗凝治疗的研究,同时通过手工检索相关系统评价的参考文献作为补充。检索日期为自建库至2016年3月27日。根据纳入研究是否随机对照试验、有无随机化隐藏、是否采用盲法及有无退出或失访对文献的质量进行评价,并采用Endnote软件管理文献,Stata12.1软件进行Meta分析。结果:检索出1506篇文献,总共22篇文献符合标准纳入研究,均为英文文献,且都为观察性研究,符合纳入标准,未纳入中文文献。严格选择的不同研究之间所选用的样本数、用药时间及随访时间均有较大差距。其中11篇文献报道了抗凝后出现并发症及疾病进展,如出血、肝硬化恶化、门静脉血栓进展等不良结局,但均无致命的事件发生。8篇回顾性研究抗凝相关并发症为3%-30%,均无严重的出血事件报告。抗凝相关并发症点发生率9%(95%CI=5.1%-12.9%)。研究之间异质性有统计学意义(р=0.999;I2=68.4%,95%CI=0% 56.3%)。14篇观察性研究中抗凝相关并发症为0%-14.3%,点发生率为3.3%(95%CI=1.1%-6.7%)。异质性检验具有统计学意义(P=0.018;I2=53.5%,95%CI=0%-74.9%)。文献研究病例抗凝后门静脉再通率为36%-93%,抗凝后再通率均,抗凝相关再通点发生率76%(95%CI=73%-79%)。研究之间异质性无统计学意义(р0.0001;I2=77.5%,95%CI=0% 80.1%)。12篇文献抗凝后门静脉完全再通发生率为0%-75%,抗凝后完全再通发生率也较高。抗凝相关完全再通点发生率41.5%(95%CI=29.2%-54.5%)。研究之间异质性有统计学意义(р0.001;I2=82.2%,95%CI=68.8% 88.3%)。8篇回顾性研究共204例患者,结果显示,р=0.371,I2=7.7%,研究间无明显异质性,所以取固定效应模型结果。经剪补后合并的OR点估计及95%可信区间为3.966(2.269,6.932)与剪补前的5.342(3.084,9.253),差异无统计学意义。结论:1.在肝硬化门静脉血栓形成进行抗凝治疗后门静脉再通率增加。2.抗凝治疗后相关并发症发生率较低。3.鉴于只有少量的非随机性比较研究报道,需更多随机对照试验(RCT Randomized Controlled Trial)来证实这些患者抗凝治疗的风险受益,尤其是抗凝相关出血。
[Abstract]:Objective: To compare the efficacy and safety of anticoagulant therapy in patients with cirrhosis with PVT by means of systematic review and Meta analysis. Methods: to make the original literature inclusion criteria and search strategy to cirrhosis ("liver cirrhosis" or "hepatic cirrhosis" or "cirrhotic liver or" cirrhosis), portal vein thrombosis ("portal vein thrombosis portal venous thrombosis" or "thrombosis portal vein" or "thromboses portal vein" (anticoagulation or anticoagulant) and anticoagulation or anticoagulants "in English subject comprehensive retrieval, retrieval database: Pubmed, Science Direct, Cochrane library, Wan Fang, China HowNet and VIP network database etc. all about PVT anticoagulant therapy in patients with cirrhosis and study, at the same time through the manual retrieval system evaluation related references as a supplement. The retrieval date is from the library to March 27, 2016. The quality of literature was evaluated according to whether randomized controlled trials, randomization and concealment, whether blindness and whether to quit or lose visit. According to Endnote software, Stata12.1 software was used to manage Meta analysis. Results: a total of 1506 articles were retrieved, a total of 22 articles met the criteria, all of them were English literatures, all of which were observational studies, which met the inclusion criteria and were not included in Chinese literature. There is a large gap between the selected samples, the time of drug use and the time of follow-up. 11 literatures reported complications and progress of anticoagulation, such as bleeding, cirrhosis, portal vein thrombosis and other adverse outcomes, but no fatal events occurred. 8 retrospective studies of anticoagulant related complications were 3%-30%, and no serious bleeding events were reported. The incidence of anticoagulant related complications was 9% (95%CI=5.1%-12.9%). Heterogeneity among studies was statistically significant (P =0.999; I2=68.4%, 95%CI=0% 56.3%). In 14 observational studies, the anticoagulant complications were 0%-14.3%, and the point incidence was 3.3% (95%CI=1.1%-6.7%). The heterogeneity test was statistically significant (P=0.018; I2=53.5%, 95%CI=0%-74.9%). The rate of recanalization of the portal vein after anticoagulation was 36%-93%, and the rate of recanalization after anticoagulation was all, and the incidence of anticoagulant related recanalization was 76% (95%CI=73%-79%). No statistically significant heterogeneity among studies (I2=77.5%, 0.0001; 95%CI=0%, 80.1%). The incidence of complete recanalization of the portal vein after anticoagulation in 12 articles was 0%-75%, and the incidence of complete recanalization after anticoagulation was also high. The incidence of anticoagulant related complete recanalization was 41.5% (95%CI=29.2%-54.5%). Heterogeneity among studies was statistically significant (I2=82.2%, 0.001; 95%CI=68.8%, 88.3%). 8 retrospective studies of 204 patients, the results showed that, =0.371, I2=7.7%, no significant heterogeneity among the studies, so take the fixed effect model results. The OR point estimation and the 95% confidence interval of 3.966 (2.269,6.932) and 5.342 (3.084,9.253) before the shear were not statistically significant. Conclusion: 1. the rate of portal vein recanalization is increased after anticoagulant therapy for cirrhotic portal vein thrombosis. 2. after anticoagulant treatment, the incidence of related complications was low. 3., in view of only a small number of non randomized comparative studies, more randomized controlled trials (RCT Randomized Controlled Trial) are needed to confirm the risk of anticoagulant therapy in these patients, especially anticoagulation related bleeding.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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