妇科恶性肿瘤病人并发静脉血栓栓塞症危险因素的Meta分析

Risk factors of venous thromboembolism in patients with gynecological malignancies: a Meta-analysis

目的:总结妇科恶性肿瘤病人发生静脉血栓栓塞症的危险因素,为临床医护人员及早识别疾病风险人群,以便为进行及时干预提供循证医学的依据。方法:通过计算机检索the Cochrane Library, EMbase, PubMed,中国知网(CNKI)、万方数据库和维普数据库中关于妇科恶性肿瘤病人发生静脉血栓栓塞症危险因素的研究,检索时限为建库至2019年10月31日。由2名评价人员按照标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果:共纳入23篇文献,包括37项危险因素。Meta分析结果显示,年龄[OR=1.06,95%CI(1.09,1.25),P<0.000 1]、体质指数[OR=1.52,95%CI(1.13,2.03),P=0.005]、肿瘤分期[OR=2.11,95%CI(1.27,3.50),P=0.004]、肿瘤直径[OR=3.38,95%CI(1.93,5.91),P<0.000 1]、高血压[OR=2.78,95%CI(1.84,4.19),P<0.000 01]、冠心病[OR=2.28,95%CI(1.51,3.45),P<0.000 01]、慢性合并症数量[OR=2.86,95%CI(1.49,5.50),P<0.002]、住院时间[OR=3.84,95%CI(1.60,9.23),P=0.003]、手术时间[OR=1.33,95%CI(1.09,1.61),P=0.005]、手术方式[OR=10.19,95%CI(1.22,84.86),P=0.03]、CA 125[OR=3.07,95%CI(1.70,5.55),P=0.000 2]及D-二聚体[OR=5.65,95%CI(1.23,26.06),P=0.03]是静脉血栓栓塞症的危险因素。结论:现有证据表明,年龄、体质指数、肿瘤分期、肿瘤直径、高血压、冠心病、慢性合并症数量、住院时间、手术时间、手术方式、CA 125及D-二聚体是妇科恶性肿瘤病人并发静脉血栓栓塞症的危险因素。

Objective:To summarize the risk factors of venous thromboembolism in patients with gynecological malignancies, and provide evidence-based medicine for clinical medical staff to identify the population at risk early for timely intervention.Methods:Studies on the risk factors of VTE in patients with gynecological malignancies were searched from the Cochrane Library, EMbase, PubMed, CNKI,WanFang Database, and VIP databases.The retrieval time was from inception to October 31,2019.After 2 independent reviewers conducted literature screening, data extraction and quality evaluation according to the standards, RevMan 5.3 software was used for Meta-analysis.Results:A total of 23 articles were included, involving 37 risk factors.Meta-analysis results showed that age[OR=1.06,95%CI(1.09,1.25),P<0.000 1],body mass index[OR=1.52,95%CI(1.13,2.03),P=0.005],tumor stage[OR=2.11,95%CI(1.27,3.50),P=0.004],tumor diameter[OR=3.38,95%CI(1.93,5.91),P<0.000 1],hypertension[OR=2.78,95%CI(1.84,4.19),P<0.000 01],coronary heart disease[OR=2.28,95%CI(1.51,3.45),P<0.000 01],number of chronic complications[OR=2.86,95%CI(1.49,5.50),P<0.002],length of hospital stay[OR=3.84,95%CI(1.60,9.23),P=0.003],operation time[OR=1.33,95%CI(1.09,1.61),P=0.005],surgical method[OR=10.19,95%CI(1.22,84.86),P=0.03],CA 125[OR=3.07,95%CI(1.70,5.55),P=0.000 2],and D-dimer[OR=5.65,95%CI(1.23,26.06),P=0.03] were risk factors of venous thromboembolism in patients with gynecological malignancies.Conclusion:Current evidences show that age, body mass index, tumor staging, tumor diameter, hypertension, coronary heart disease, number of chronic complications, length of hospital stay, operation time, surgical method, residual surgical lesions, CA 125 and D-dimer are risk factors of patients with gynecological malignant tumors complicated by VTE.