导管溶栓与系统溶栓治疗急性下肢深静脉血栓形成的Meta分析

Catheter-directed thrombolysis versus systemic thrombolysis for acute lower extremity deep venous thrombosis: a Meta-analysis

目的 比较导管接触性溶栓（CDT）和系统溶栓（ST）治疗急性下肢深静脉血栓形成（DVT）的疗效,为选择最佳的溶栓方法提供理论依据。方法 在Pub Med、Embase、中国知网、维普和万方等数据库中检索CDT与ST治疗急性DVT对比研究的相关文献,发表时间截止至2016年7月。按照钮卡斯-渥太华量表（NOS）对纳入的研究进行质量评价。应用Revman5.0软件进行数据合并与发表偏倚检测。运用固定或随机效应模型对各个因素进行合并分析。结果 共纳入13篇随机对照研究。Meta分析结果显示,CDT组的大腿消肿率高于ST组（WMD=12.01,95%CI 8.58-15.43;P〈0.01）;CDT组的小腿消肿率高于ST组（WMD=12.88,95%CI 9.60-16.11;P〈0.01）;CDT组的溶栓率高于ST组（WMD=15.24,95%CI 11.99-18.50;P〈0.01）;CDT组的出血并发症率明显低于ST组（OR=0.50,95%CI0.31-0.80;P〈0.01）;术后半年CDT组的深静脉血栓形成后遗症（PTS）发生率明显低于ST组（OR=0.40,95%CI 0.25-0.63;P〈0.01）。结论 相比于ST,CDT消肿效率及溶栓率更高,并发症和PTS发生率明显降低。

Objective To investigate curative effects of catheter-directed thrombolysis （CDT） and systemic thrombolysis （ST） for acute lower extremity deep venous thrombosis （DVT） by means of evidence based medicine and to provide a theoretical basis for selecting the best way for thrombolysis. Methods The fixed-effects or random-effects model was performed on the studies about CDT and ST for DVT published up to July 2016 by searching PubMed, Embase, CNKI, YIP and Wanfang Data. Results A total of 13 randomized controlled trials were included in the meta-analysis. Thigh swelling reduction rate of CDT group was significantly higher than that of ST group （WMD = 12.01,95%CI 8.58 -15 .43; P〈0.01）; Leg swelling reduction rate of CDT group was significantly higher than ST group （WMD=12.88,95 % CI： 9.60 - 16.11; P〈0.01）; Thrombolysis rate of CDT group was significantly higher than that of ST group （WMD = 15.24, 95%CI ： 11.99- 18.50; P〈0.01） ; Bleeding complication rate of CDT group was significantly lower than that of ST group （OR=0.50,95%CI： 0.31 - 0.80; P〈0.01）; Incidence of post-thrombotic syndrome （PTS） in CDT group was significantly lower than that in ST group （OR =0.40, 95%CI： 0.25- 0.63; P〈0 .0 1）. Conclusion The treatment of CDT has good clinical effects and high safety for acute DVT. As compared to ST, CDT has higher rates of swelling reduction and thrombolysis, and lower rates of complication and PTS.