深静脉血栓患者并发肺栓塞危险因素荟萃分析

A Meta-analysis of the risk factors associated with the occurrence of pulmonary embolism in patients with deep venous thrombosis

目的通过荟萃分析探讨深静脉血栓(DVT)患者并发肺栓塞(PE)的危险因素。方法计算机检索Pubmed、Embase,Cochrane Library.web of science、中国知网.万方数据知识服务中心.维普期刊资源整合服务平台和中国生物医学文献数据库(CBM)已发表的关于DVT患者并发PE危险因素的病例对照研究,检索时限为建库以来至2020年4月15日,两名研究者按照Cochrane系统评价方法及本文纳入和排除标准筛选文献,提取资料并评价质量后,采用Revman 5.3软件进行荟萃分析。结果共纳人15篇病例对照研究,荟萃分析结果显示,右下肢DVT(OR=2.09,95%C11.60-2.73).双下肢DVT(OR=1.96,95%CI 1.27-3.03).近端DVT(OR=1.95,95%CI 1.56~2.43)、静脉血栓栓塞症(VTE)史(OR=1.93,95%CI 1.46-2.54).无明显诱因VTE(OR=2.42,95%CI 1.64-3.59)、外科手术史(OR=2.86.95%CI 2.02-4.04)、恶性肿瘤(OR=2.50,95%CI 1.63~3.83)、心脏疾病(0R=3.22.95%CI 1.85-5.59).冠心病(OR=6.12.95%CI 1.04~36.11)心脏瓣膜病(OR=5.66,95%CI 1.79-17.87)、慢性肺部疾病(OR=1.59,95%CI 1.39-1.81)呼吸道感染(OR=2.07。95%CI 1.29-3.31).糖尿病(OR=3.52,95%CI 1.86-6.67).高C反应蛋白(CRP)(OR=1.04.95%CI 1.02~1.04)合并效应量后差异有统计学意义.简单描述性分析结果显示高D-二聚体是DVT患者并发PE的危险因素.年龄与DVT患者并发PE风险的相关性尚不明确。结论右下股DVT、双下肢DVT、近端DVT、VTE史.无明显诱因VTE、外科手术史.恶性肿瘤、心脏疾病、冠心病、心脏瓣膜病,慢性肺部疾病.呼吸道感染、糖尿病.高D-二聚体和高CRP是DVT患者并发PE相关危险因素.年龄与DVT患者并发PE风险的相关性尚不明确。

Objective To explore the associated risk factors of the occurrence of pulmonary embolism(PE)in patients with deep venous thrombosis(D V T).Methods A systematic literature review of case-control on risk factors of the occurrence of PE in patients with DVP published before April 15th,2020 was made in database o f Pubmed,Embase,Cochrane Library,web of science,CNKI,Wangfang data,CQVIP and CBM.The literature was screened and the data was extracted and assessed by using the Cochrane methods by two investigators and meta-analysis was performed by RevMan 5.3 software.Rusults Finally,15 articles were included.Meta-analysis showed that the right lower limb D VT(0/?=2.09,95%C/1.60-2.73),bilateral lower limb D V T(0/?=1.96,95%C/1.27-3.03),proximal DVT(0/?=1.95,95%C/1.56-2.43),history of VTE(0/?=1.93,95%CI 1.46-2.54),unprovoked VTE(M=2.42,95%C/1.64-3.59),history of surgery(0/?=2.86,95%CI 2.02-4.04),cancer(0/?=2.50,95%C/1.63-3.83),previous heart disease(0/?=3.22,95%C/1.85-5.59),CAD(O R=6.12,95%C/1.04-36.11),valvular heart disease(0/?=5.66,95%C/1.79-17.87),chronic lung disease(0/?=1.59,95%CI 1.39-1.81),respiratory infection(0/?=2.07,95%C/1.29-3.31),diabetes mellitus(OR=3.52,95%C/1.86-6.67),high CRP(0/?=1.04,95%CI 1.02-1.04)were the risk factors of the occurrence of PE in patients with DVP,by the means of descriptive anlysis high D-Dimer was fiound to be the risk factors of the occurrence of PE in patients with DVP while age was not certain.Conclusion The right lower limb DVT,bilateral lower limb DVT,proximal D VT,history of V TE,unprovoked V TE,history o f surgery,cancer,previous heart disease,CAD,valvular heart disease,chronic lung disease,respiratory infection,diabetes mellitus,high CRP and high D-Dimer are the risk factors of the occurrence of PE in patients with DVP while age is not certain.