静脉血栓栓塞症复发风险预测模型的系统评价

Risk prediction models for Venous Thromboembolism recurrence:a systematic review

目的:系统评价静脉血栓栓塞症复发预测模型,为相关预测模型的构建及临床实践提供参考。方法:全面检索中英文数据库中发表的与静脉血栓栓塞症复发风险预测模型相关的文献,检索时限为从建库至2023年4月1日。由2名研究人员严格按照纳入与排除标准独立筛选文献并提取相关数据,采用偏倚风险评价工具对纳入文献的质量进行评价,并使用RevMan 5.3软件对筛选出的预测因子进行Meta分析。结果:共纳入9篇文献,包括10个静脉血栓栓塞症复发风险预测模型。其中9个是模型开发,1个是模型更新。Meta分析结果显示,男性[OR=1.88,95%CI(1.66,2.13),Z=9.84,P<0.001]、D-二聚体升高[OR=2.13,95%CI(1.51,3.00),Z=4.30,P<0.001]、既往有近端深静脉栓塞病史[OR=1.64,95%CI(1.35,2.00),Z=4.87,P<0.001]和既往有肺血栓栓塞症病史[OR=2.69,95%CI(1.98,3.65),Z=6.36,P<0.001]是静脉血栓栓塞症复发的高危因素。结论:静脉血栓栓塞症复发预测模型仍需继续发展,未来应根据临床实际情况选择或开发一种偏倚风险低、适用性高的预测模型,应用并监测其预测效果。同时,医护人员应重点关注男性、D-二聚体升高、既往有近端深静脉栓塞和肺栓塞病史患者的静脉血栓栓塞症复发情况,有针对性地采取合理的预防措施。

Objective:To systematically evaluate Venous Thromboembolism(VTE)recurrence prediction models and provide reference for the development of related prediction models and clinical practice.Methods:We comprehensively searched Chinese and English databases for studies related to VTE recurrence risk prediction models from inception of databases to April 1,2023.Studies were independently screened,relevant data were extracted by 2 researchers and the quality of the included studies was evaluated using PROBAST.Results:A total of 9 articles were select,including 10 VTE recurrence risk prediction models.Among them,nine are the development of models,one is update of model.Meta-analysis results showed that men[OR=1.88,95%CI(1.66,2.13),Z=9.84,P<0.001],elevated D-dimer[OR=2.13,95%CI(1.51,3.00),Z=4.30,P<0.001],proximal deep vein embolism[OR=1.64,95%CI(1.35,2.00),Z=4.87,P<0.001]and pulmonary embolism[OR=2.69,95%CI(1.98,3.65),Z=6.36,P<0.001]were high risk factors for recurrence of VTE.Conclusion:The prediction model for VTE recurrence still needs to be developed,and in the future,a prediction model with low risk of bias and high applicability should be selected or developed according to the actual clinical situation,and its prediction effect should be monitored.Meanwhile,medical staff should pay attention to those patients who are male,have elevated D-dimer,proximal deep vein embolism,and pulmonary embolism,and take reasonable preventive measures for them to prevent recurrence of VTE.