低分子肝素防治肝硬化及其脾切除术后门静脉栓塞的系统评价和Meta分析

Clinical effect of low-molecular-weight heparin in prevention and treatment of liver cirrhosis and portal vein thrombosis after splenectomy： a systematic review and meta-analysis

目的评价低分子肝素治疗肝硬化门静脉栓塞疗效及早期应用低分子肝素预防脾切除术后门静脉系血栓形成的价值。方法检索PubMed、Google Scholar、中国知网、万方、重庆维普数据库，并辅以手工检索和互联网检索灰色文献，纳入符合标准的文献，并进行系统评价和Meta分析。结果共纳入12组随机对照试验，共计1397例，其中低分子肝素组723例，对照组674例。对以上试验进行Meta分析，结果显示，早期应用低分子肝素干预病例的血栓形成率较对照组低（OR 0．37，95％可信区间0．28-0．48，P〈0．001）。三项应用低分子肝素治疗门静脉栓塞的随机临床测试结果显示，应用低分子肝素病例的血栓再通率较对照组高（OR 25．08，95％可信区间1．74-14．84，P〈0．001）。结论早期应用低分子肝素干预可降低脾切除术后门静脉系血栓形成率，应用低分子肝素治疗门静脉栓塞可提高血管再通率。

Objective To investigate the clinical effect of low-molecular-weight heparin （LMWH） in the treatment of liver cirrhosis and portal vein thrombosis and the value of early application of LMWH in the prevention of portal vein thrombosis after splenectomy. Methods The databases of PubMed, Google Scholar, CNKI, Wanfang Data, and VIP were searched, and manual searching and interact searching were used to retrieve grey literature. The articles which met the inclusion criteria were included, and a systematic review and meta- analysis was performed. Results A total of 12 randomized controlled trials were included, with 1397 patients enrolled, among whom 723 were enrolled in the LMWH group and 674 were enrolled in the control group. A meta-analysis was performed for the trials above, and the results showed that the patients with early application of LMWH had a lower rate of thrombosis compared with those in the control group （OR = 0.37, 95% CI 0.28-0.48, P 〈 0.001）. The results of three randomized trials with the application of LMWH in the treatment of portal vein embolism showed that the patients treated with LMWH had a higher rate of recanalization of thrombus than those in the control group （OR = 5.08, 95% CI 1.74-14.84, P 〈 0.001）. Conclusion Early application of LMWH can reduce the rate of portal vein thrombosis after splenectomy, and LMWH for the treatment of portal vein embolism can increase the rate of recanalization of thrombus.