颅内静脉窦血栓介入与抗凝效果及安全性的Meta分析

Meta-analysis of efficacy and safety of interventional treatment and anticoagulant therapy for intracranial venous sinus thrombosis

目的运用询证医学的概念,采用Meta分析的方法评价静脉内局部溶栓、机械性碎栓和静脉窦内球囊扩张以及支架置入术等介入治疗方法和抗凝治疗方法的安全性和有效性,以期找出在CVST患者的治疗过程中能取得好的治疗效果并能减少相关并发症及后遗症的治疗方法。方法中文以CNKI、维普和万方数据库作为文献的主要来源,发表年限1990-01-01至2015-07-01,检索词设置为"颅内静脉窦血栓""抗凝治疗物""介入治疗""溶栓治疗",英文以Pub Med和MEDLINE数据库为文献检索的主要来源,检索词为"cerebral venous sinus thrombosis""anticoagulant therapy""interventional therapy""thrombolytic therapy",发表年限为1990-01-01至2015-07-01。所有符合纳入标准的文献仔细阅读全文以及参考文献,并查找相关的参考文献。纳入文献的全文均为中文或英文,由相同单位或个人针对相同对象所做的研究且不同的期刊都有报道时,纳入其最新和最完整的报道。结果共检索出467篇中文文献和1 035篇英文文献,经筛选纳入本次Meta分析的文献共4篇,颅内静脉窦血栓患者累计261例,对照组累计207例,在5个研究结果中,疗效合并灵敏度为0.73(0.69,0.76),合并特异性为0.95(0.91,0.98),比值比为126.67(34.53,464.70),综合受试者工作特性曲线下面积AUC为0.973 3,标准误为0.044 3。结论介入治疗比单纯抗凝治疗的有效人数多,抗凝溶栓的综合治疗效果更明显,一定程度上代表了多部分的研究结果。而抗凝溶栓治疗的各个方法中,接触性置管溶栓的有效人数比周围静脉溶栓的人数多且效果十分明显。

Objective To conduct a comprehensive analysis of the current relevant experimental research data in this study,and to use a meta-analysis method to evaluate intravenous local thrombolysis,mechanical thrombolysis,and sinusoid balloon expansion and stent placement.The safety and efficacy of interventional treatment such as surgery and anticoagulant therapy should be sought in order to find out how to achieve good therapeutic effect and reduce treatment-related complications and sequelae in CVST patients.Methods CNKI,VIP,and Wanfang database were the main sources of the literature in Chinese.The publication period was between 1990-01-01 and 2015-07-01.The search terms were set to ＂cranial venous sinus thrombosis＂, ＂Anticoagulant therapy＂, ＂Interventional treatment＂, ＂Treatment for thrombolysis＂;Pub Med and MEDLINE databases are the main sources of literature search in English,and the search terms are ＂cerebral venous sinus thrombosis＂, ＂Anticoagulant therapy＂, ＂promoting therapy＂, ＂thrombolytic therapy,＂ published years 1990-01-01 to 2015-07-01.All documents that meet the inclusion criteria are carefully read the full text and references,and find relevant references.The full texts of the included documents are either Chinese or English.When the same entity or individual conducts research on the same subject and different periodicals report it,the latest and most complete report is included.Results A total of 467 Chinese articles and 1 035 English articles were retrieved.A total of 4 articles were included in the meta-analysis.There were 261 patients with intracranial venous sinus thrombosis and 207 patients in the control group.Among 5 studies,The combined sensitivity of efficacy was 0.73（0.69,0.76）;the combined specificity was 0.95（0.91,0.98）;the odds ratio was 126.67（34.53,464.70）;the area under the AUC was 0.973 3 with a standard error of 0.044 3.Conclusion Interventional treatment is more effective than anticoagulant therapy.The comprehensive treatment effect of anticoagulation and thrombolysis is more obvious.To a certain extent,it represents a multi-part study.In the various methods of anticoagulation and thrombolytic therapy,the effective number of thrombolytics for contact catheterization is greater than that for peripheral vein thrombolysis.