肝硬化合并门静脉血栓患者抗凝治疗有效性及安全性的Meta分析

Efficacy and Safety of Anticoagulation Therapy for Portal Vein Thrombosis in Liver Cirrhosis:A Meta-analysis

目的:系统评价肝硬化合并门静脉血栓(PVT)患者抗凝治疗的有效性及安全性。方法:计算机检索CNKI、WanFang Data、PubMed、EMbase、Web of Science、the Cochrane Library数据库,搜集有关肝硬化合并PVT抗凝治疗的临床研究文献,检索时限均为建库至2022年1月31日,由两名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果:共纳入10篇文献,均为队列研究,累计745例患者。Meta分析结果显示,采用抗凝治疗的肝硬化合并PVT患者门静脉总再通率明显高于未抗凝患者[OR=6.06,95%CI(4.24,8.67),P<0.000 01]。安全性方面,抗凝患者的静脉曲张出血率低于未抗凝患者[OR=0.22,95%CI(0.08,0.60),P=0.003],而两组患者的非静脉曲张出血率差异无统计学意义[OR=2.63,95%CI(0.98,7.03),P=0.78]。结论:现有证据表明,与未经抗凝治疗比较,肝硬化合并PVT患者接受抗凝治疗可以提高门静脉血管再通率,且具有良好的安全性。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。

Objective:To systematically review the efficacy and safety of anticoagulation therapy for portal vein thrombosis(PVT) in liver cirrhosis.Methods:CNKI,WanFang Data,PubMed,EMbase,Web of Science,the Cochrane Library were electronically searched to collect articles reported clinical trials on anticoagulation therapy for PVT in liver cirrhosis from inception to January 31 st,2022.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then,meta-analysis was performed by using RevMan 5.4 software.Results:A total of 10 cohort studies involving 745 patients were included.The results of meta-analysis showed that,the PVT patients received anticoagulation therapy achieved a higher complete recanalization rate than the non-anticoagulation group(OR=6.06,95%CI 4.24 to 8.67,P<0.000 01).In terms of safety,the rate of variceal bleeding in the anticoagulation group was lower than that in the non-anticoagulation group(OR=0.22,95%CI 0.08 to 0.60,P=0.003),while no significant difference existed in the rate of variceal bleeding(OR=2.63,95%CI 0.98 to 7.03,P=0.78) between the two groups.Conclusion:Current evidence shows that the use of anticoagulation therapy in cirrhotic patients with PVT,with significant rates of vein recanalization compared to controls without increasing bleeding risk.Due to limited quality and quantity of the included studies,more high quality studies are required to verify the above conclusions.