中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
34期
2419-2425
,共7页
肺栓塞%危险因素%Meta分析%复发
肺栓塞%危險因素%Meta分析%複髮
폐전새%위험인소%Meta분석%복발
Pulmonary embolism%Risk factors%Meta-analysis%Recurrence
目的 应用荟萃分析系统评价肺血栓栓塞症(PTE)发生再栓塞的相关危险因素.方法 系统检索中国期刊全文数据库、中国生物医学数据库、PubMed数据库、西文生物医学数据库1995年1月至2011年5月公开发表的关于PTE再栓塞相关危险因素的研究论文,并查阅各个研究中引用的参考文献来补充.观察性研究(队列研究和病例对照研究)参照文献关于观察性研究方法学质量评估的建议进行评价；随机对照研究利用Jadad量表进行评价.应用Cochrane协作网提供的RevMan 5.1软件,进行一致性检验,使用固定效应模型及随机效应模型进行合并,计算相对危险度(RR)及其95％ CI.结果 纳入42篇文献,共计36909例PTE伴或不伴深静脉血栓患者.再栓塞的相关危险因素为D-二聚体水平升高[1.77( 1.34 ～2.36),P=0.000]、特发性PTE[1.82( 1.61～2.05),P=0.000]、右室功能不全(RVD)[持续性RVD比RVD恢复:8.71(2.38～31.91),P=0.001；持续性RVD比未发生RVD:2.45( 1.26 ～4.76),P=0.008]、抗凝疗程不足[1.73(1.32～2.28),P=0.000]、凝血酶生成潜力升高[1.89( 1.39～ 2.56),P=0.000]、凝血因子Ⅷ升高[1.96(1.40 ～2.74),P=0.000]、抗磷脂抗体阳性[5.64(4.09 ～7.77),P=0.000]、抗凝血酶缺陷[2.45(1.26 ～4.76),P=0.008]、男性[1.47 (1.06～2.03),P=0.020].多种相关危险因素并存时再栓塞风险大于单一因素.结论 D-二聚体水平升高、特发性PTE等多种因素均为再栓塞发生的危险因素,再栓塞患者常有多种危险因素并存.
目的 應用薈萃分析繫統評價肺血栓栓塞癥(PTE)髮生再栓塞的相關危險因素.方法 繫統檢索中國期刊全文數據庫、中國生物醫學數據庫、PubMed數據庫、西文生物醫學數據庫1995年1月至2011年5月公開髮錶的關于PTE再栓塞相關危險因素的研究論文,併查閱各箇研究中引用的參攷文獻來補充.觀察性研究(隊列研究和病例對照研究)參照文獻關于觀察性研究方法學質量評估的建議進行評價；隨機對照研究利用Jadad量錶進行評價.應用Cochrane協作網提供的RevMan 5.1軟件,進行一緻性檢驗,使用固定效應模型及隨機效應模型進行閤併,計算相對危險度(RR)及其95％ CI.結果 納入42篇文獻,共計36909例PTE伴或不伴深靜脈血栓患者.再栓塞的相關危險因素為D-二聚體水平升高[1.77( 1.34 ～2.36),P=0.000]、特髮性PTE[1.82( 1.61～2.05),P=0.000]、右室功能不全(RVD)[持續性RVD比RVD恢複:8.71(2.38～31.91),P=0.001；持續性RVD比未髮生RVD:2.45( 1.26 ～4.76),P=0.008]、抗凝療程不足[1.73(1.32～2.28),P=0.000]、凝血酶生成潛力升高[1.89( 1.39～ 2.56),P=0.000]、凝血因子Ⅷ升高[1.96(1.40 ～2.74),P=0.000]、抗燐脂抗體暘性[5.64(4.09 ～7.77),P=0.000]、抗凝血酶缺陷[2.45(1.26 ～4.76),P=0.008]、男性[1.47 (1.06～2.03),P=0.020].多種相關危險因素併存時再栓塞風險大于單一因素.結論 D-二聚體水平升高、特髮性PTE等多種因素均為再栓塞髮生的危險因素,再栓塞患者常有多種危險因素併存.
목적 응용회췌분석계통평개폐혈전전새증(PTE)발생재전새적상관위험인소.방법 계통검색중국기간전문수거고、중국생물의학수거고、PubMed수거고、서문생물의학수거고1995년1월지2011년5월공개발표적관우PTE재전새상관위험인소적연구논문,병사열각개연구중인용적삼고문헌래보충.관찰성연구(대렬연구화병례대조연구)삼조문헌관우관찰성연구방법학질량평고적건의진행평개；수궤대조연구이용Jadad량표진행평개.응용Cochrane협작망제공적RevMan 5.1연건,진행일치성검험,사용고정효응모형급수궤효응모형진행합병,계산상대위험도(RR)급기95％ CI.결과 납입42편문헌,공계36909례PTE반혹불반심정맥혈전환자.재전새적상관위험인소위D-이취체수평승고[1.77( 1.34 ～2.36),P=0.000]、특발성PTE[1.82( 1.61～2.05),P=0.000]、우실공능불전(RVD)[지속성RVD비RVD회복:8.71(2.38～31.91),P=0.001；지속성RVD비미발생RVD:2.45( 1.26 ～4.76),P=0.008]、항응료정불족[1.73(1.32～2.28),P=0.000]、응혈매생성잠력승고[1.89( 1.39～ 2.56),P=0.000]、응혈인자Ⅷ승고[1.96(1.40 ～2.74),P=0.000]、항린지항체양성[5.64(4.09 ～7.77),P=0.000]、항응혈매결함[2.45(1.26 ～4.76),P=0.008]、남성[1.47 (1.06～2.03),P=0.020].다충상관위험인소병존시재전새풍험대우단일인소.결론 D-이취체수평승고、특발성PTE등다충인소균위재전새발생적위험인소,재전새환자상유다충위험인소병존.
Objective To evaluate the risk factors of recurrent pulmonary thromboembolism (PTE) through Meta-analysis.Methods Chinese Journal Full-text Database, Chinese Biomedical Database,PubMed and Foreign Medical Journal Full-Text Service were searched for the paper relating to the risk factors of recurrent PTE from January 1995 to May 2011. And the references of these studies were also examined.Observational studies (cohort & case control) were assessed according to the method of quality assessment suggested within the references. Randomized control trials (RCTs) were assessed by the Jadad scale.Software RevMan 5.1 was used to examin the heterogeneity of trials.The fixed or random effect model was pooled to calculate the risk ratio (RR).And the results were expressed by RR (95％ CI).Results Fortytwo trials including 36 909 cases of PTE and/or deep vein thrombosis were analyzed. And the following factors were relative to recurrence:elevated D-dimer ( 1.77 ( 1.34 - 2.36 ),P =0.000 ),idiopathic PTE (1.82(1.61 -2.05),P =0.000),right ventricular dysfunction (RVD) (persistent RVD vs RVD regression (8.71 (2.38 - 31.91 ),P =0.001 ) ; persistent RVD vs non-RVD (2.45 ( 1.26 - 4.76),P =0.008),short anticoagulation duration ( 1.73 ( 1.32 - 2.28),P =0.000),increased endogenous thrombin generation capacity ( 1.89 ( 1.39 - 2.56 ),P =0.000 ),elevated factor Ⅷ ( 1.96 ( 1.40 - 2.74 ),P =0.000),positive antiphospholipid antibodies (5.64 (4.09 - 7.77 ),P =0.000),anti-thrombin defect (2.45(1.26-4.76),P=0.008) and males (1.47(1.06-2.03),P=0.020),etc.When multiple factors co-existed,the risk of recurrence became more obvious.Conclusions Elevated D-dimer,idiopathic PTE and many other factors may influence the recurrence of pulmonary embolism. And most recurrent patients have two or more factors.
