导管溶栓治疗早期髂股静脉血栓形成的疗效及安全性系统评价

Catheter-directed thrombolysis for early iliofemoral venous thrombosis:a systematic review and meta-analysis of randomized controlled trials

目的系统评价导管直接溶栓(CDT)与单纯抗凝(AC)治疗早期髂股静脉血栓形成(IF-VT)的有效性和安全性。方法计算机检索Cochrane Library(2010年第2期),PubMed(1990—2010.6),MEDLINE(OVID,1990—2010.6),EMBASE(1990—2010.6),中国生物医学文献数据库,中文科技期刊全文数据库,中国期刊全文数据库等数据库,并辅以手工检索。对纳入的随机对照试验采用RevMan5.0.18软件进行Meta分析。结果仅2个随机对照试验可供纳入研究。Meta分析结果显示:治疗后6个月,CDT组髂股静脉通畅率高于AC组[45/68 vs.21/70,OR=4.47,95% CI(2.19,9.12),P<0.0001],6个月后髂股静脉闭塞和(或)静脉返流率CDT组少于AC组[12/68 vs.33/70,OR=0.24,95% CI(0.11,0.53),P=0.004]。CDT组与AC组的主要并发症差异无统计学意义[2/68vs.1/70,OR=1.53,95%CI(0.25,9.24),P=0.65],但CDT组的次要并发症和总并发症的发生率较AC组高[11/68vs.2/70,OR=5.48,95%CI(1.33,22.51),P=0.02]和[13/68vs.3/70,OR=3.55,95%CI(1.20,10.45),P=0.02]。结论 CDT是一种疗效肯定的治疗早期IFVT的方式。无明显禁忌证的患者应选择实施CDT,治疗效果良好。

Objective To evaluate the efficacy and safety of catheter-directed thrombolysis （CDT）compared with traditional treatment（Anticoagulant alone AC）for early（pristine） iliofemoral venous thrombosis （IFVT）. Methods We searched MEDLINE（OVID,1990 to June 2010）, EMBASE（1990 to June 2010）,Cochrane Central Register of Controlled Trials（1991 to June 2010）, PubMed（1990 to June 2010）, Chinese Biomedical Literature Database（CBM）, Chinese Scientific Journal, Full-text Database（CSJD）, and Chinese Journal Full-text Database（CJFD）, added with handsearching and other retrievals. The Cochrane Collaboration′s RevMan 5.0.18 was used for meta-analyses.Results Only two randomized controlled trials were available and were included in the study. Meta-analysis showed that 6 months after treatment, iliofemoral vein patency rate of CDT group was higher than that of AC group[45/68 vs. 21/70,OR=4.47,95% CI（2.19,9.12）,P0.0001], the iliofemoral vein occlusion and （or） venous reflux rate of CDT group was less than that of AC group [12/68 vs. 33/70,OR=0.24,95% CI（0.11,0.53）,P=0.004]. Major complications of CDT group compared to those of AC group were not statistically significant [2/68 vs. 1/70,OR=1.53,95% CI（0.25,9.24）,P=0.65], but the minor complications and total complications of CDT group were higher than those of AC group, [11/68 vs. 2/70,OR=5.48,95% CI（1.33,22.51）,P=0.02] and [13/68 vs. 3/70,OR=3.55,95% CI（1.20,10.45）,P=0.02]. Conclusions CDT is a positively effective way to treat early IFVT. Application of CDT in patients without contraindications to its use can have good therapeutic effect.