覆膜支架TIPS与标准治疗对肝硬化静脉曲张再出血2级预防的Meta分析

Covered TIPS versus standard therapy for secondary prophylaxis of variceal bleeding in liver cirrhosis:A Meta-analysis

[目的]分析覆膜支架颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)对肝硬化静脉曲张出血2级预防的价值。[方法]检索PubMed,Embase,Cochrane Library,中国知网,万方数据库,维普中文数据库。提取符合条件文献的数据,采用Review Manger 5.3软件对再出血、死亡、肝性脑病、腹水新发或加重和原位肝移植的结果进行Meta分析,检索截止日期为2021-10-24。[结果]共纳入随机对照试验7篇,共涉及524例患者,其中覆膜支架TIPS组283例,内镜+非选择性β受体阻滞剂组(标准治疗组)241例。Meta分析结果显示:覆膜TIPS支架组再出血风险低于标准治疗组(RR=0.32,95%CI=0.23~0.45,P<0.00001),死亡风险低于标准治疗组(RR=0.60,95%CI=0.46~0.78,P=0.0001),腹水新发或加重风险低于标准治疗组(RR=0.44,95%CI=0.28~0.70,P=0.0005),在发生肝性脑病(RR=1.09,95%CI=0.85~1.41,P=0.49)和原位肝移植(RR=1.09,95%CI=0.46~2.57,P=0.84)结果上,2组比较差异无统计学意义。[结论]长期结果来看,覆膜支架TIPS比标准治疗更优越,将来有望在肝硬化静脉曲张出血的2级预防中占据更重要的地位。

[Objective]To analyze the value of transjugular intrahepatic portosystemic shunt(TIPS)in the secondary prevention of varicose hemorrhage in cirrhosis.[Methods]We searched PubMed,Embase,Cochrane Library,CNKI,Wan Fang and VIP databases.Meta analysis conducted by Review Manger 5.3 data on rebleeding,mortality,hepatic encephalopathy,new or worsening ascites,and liver transplantation.Deadline was October 24 th in 2021.[Results]Seven randomize control trials were included,which were enrolled 524 patients,283 patients were in covered TIPS and 241 patients were treated by endoscopy combined with nonselective β-blockers(standard therapy).The lower risks were observed in the group of covered TIPS than standard therapy in rebleeding(RR= 0.32,95%CI= 0.23-0.45,P<0.00001),mortality(RR=0.60,95%CI=0.46-0.78,P=0.0001)and new or worsening ascites(RR=0.44,95%CI=0.28-0.70,P=0.0005).But there were no significant difference between two groups in both hepatic encephalopathy(RR=1.09,95%CI=0.85-1.41,P=0.49)and liver transplantation(RR=1.09,95%CI=0.46-2.57,P=0.84).[Conclusion]Covered TIPS was better therapeutic method than standard therapy,which will play a more important role in secondary prophylaxis.