重庆医学
重慶醫學
중경의학
CHONGQING MEDICAL JOURNAL
2014年
33期
4472-4475
,共4页
李俊%司小毛%查斌山%谢文涛%仇鹏%朱化刚
李俊%司小毛%查斌山%謝文濤%仇鵬%硃化剛
리준%사소모%사빈산%사문도%구붕%주화강
M eta分析%髂股静脉%抗凝%置管溶栓%血栓切除术
M eta分析%髂股靜脈%抗凝%置管溶栓%血栓切除術
M eta분석%가고정맥%항응%치관용전%혈전절제술
Meta analysis%iliofemoral deep vein thrombosis%thrombolysis%anticoagulant therapy%thrombectomy
目的:应用Meta分析研究系统抗凝(SA)、置管溶栓(CDT)与血栓切除(ST)治疗急性髂股段血栓形成(AIFDVT)的疗效。方法以“髂股静脉,抗凝,置管溶栓,血栓切除术,随机对照研究”为关键词检索Pubmed、M edline、Elsevier等数据库1984年1月至2014年1月发表的关于SA、ST、CDT临床效果的随机对照研究(RCT),应用Meta分析评价早期血管再通率、深静脉血栓后遗症(PTS)发生率、血管反流(VR)率、管腔堵塞(VO)率等相关指标。结果有10篇随机对照研究纳入此分析,包括626例患者。早期血管再通率:CDT组高于SA组,差异有统计学意义(OR=4.61,95% CI:1.93~10.98,P<0.05);ST组与SA组比较差异无统计学意义(OR=2.54,95% CI:0.49~13.24,P>0.05);术后 PTS发生率:CDT 组低于SA组(OR=0.18,95% CI:0.07~0.43,P<0.05),ST组低于SA组(OR=0.50,95% CI:0.28~0.87,P<0.05);术后 VR发生率:CDT 组与SA组比较(OR=0.54,95% CI:0.29~1.01)、ST组与SA组比较(OR=0.54,95% CI:0.27~1.08),差异均无统计学意义(P>0.05);术后VO发生率:CDT组低于SA组,差异有统计学意义(OR=0.19,95% CI:0.11~0.34,P<0.05),ST 组与SA组比较差异无统计学意义(OR=1.53,95% CI:0.72~3.26,P>0.05)。结论 CDT治疗AIFDVT的早期疗效明显优于传统SA。关于远期疗效, ST、CDT较传统SA均能有效降低PTS发生率,且CDT还能降低血管栓塞的发生率。
目的:應用Meta分析研究繫統抗凝(SA)、置管溶栓(CDT)與血栓切除(ST)治療急性髂股段血栓形成(AIFDVT)的療效。方法以“髂股靜脈,抗凝,置管溶栓,血栓切除術,隨機對照研究”為關鍵詞檢索Pubmed、M edline、Elsevier等數據庫1984年1月至2014年1月髮錶的關于SA、ST、CDT臨床效果的隨機對照研究(RCT),應用Meta分析評價早期血管再通率、深靜脈血栓後遺癥(PTS)髮生率、血管反流(VR)率、管腔堵塞(VO)率等相關指標。結果有10篇隨機對照研究納入此分析,包括626例患者。早期血管再通率:CDT組高于SA組,差異有統計學意義(OR=4.61,95% CI:1.93~10.98,P<0.05);ST組與SA組比較差異無統計學意義(OR=2.54,95% CI:0.49~13.24,P>0.05);術後 PTS髮生率:CDT 組低于SA組(OR=0.18,95% CI:0.07~0.43,P<0.05),ST組低于SA組(OR=0.50,95% CI:0.28~0.87,P<0.05);術後 VR髮生率:CDT 組與SA組比較(OR=0.54,95% CI:0.29~1.01)、ST組與SA組比較(OR=0.54,95% CI:0.27~1.08),差異均無統計學意義(P>0.05);術後VO髮生率:CDT組低于SA組,差異有統計學意義(OR=0.19,95% CI:0.11~0.34,P<0.05),ST 組與SA組比較差異無統計學意義(OR=1.53,95% CI:0.72~3.26,P>0.05)。結論 CDT治療AIFDVT的早期療效明顯優于傳統SA。關于遠期療效, ST、CDT較傳統SA均能有效降低PTS髮生率,且CDT還能降低血管栓塞的髮生率。
목적:응용Meta분석연구계통항응(SA)、치관용전(CDT)여혈전절제(ST)치료급성가고단혈전형성(AIFDVT)적료효。방법이“가고정맥,항응,치관용전,혈전절제술,수궤대조연구”위관건사검색Pubmed、M edline、Elsevier등수거고1984년1월지2014년1월발표적관우SA、ST、CDT림상효과적수궤대조연구(RCT),응용Meta분석평개조기혈관재통솔、심정맥혈전후유증(PTS)발생솔、혈관반류(VR)솔、관강도새(VO)솔등상관지표。결과유10편수궤대조연구납입차분석,포괄626례환자。조기혈관재통솔:CDT조고우SA조,차이유통계학의의(OR=4.61,95% CI:1.93~10.98,P<0.05);ST조여SA조비교차이무통계학의의(OR=2.54,95% CI:0.49~13.24,P>0.05);술후 PTS발생솔:CDT 조저우SA조(OR=0.18,95% CI:0.07~0.43,P<0.05),ST조저우SA조(OR=0.50,95% CI:0.28~0.87,P<0.05);술후 VR발생솔:CDT 조여SA조비교(OR=0.54,95% CI:0.29~1.01)、ST조여SA조비교(OR=0.54,95% CI:0.27~1.08),차이균무통계학의의(P>0.05);술후VO발생솔:CDT조저우SA조,차이유통계학의의(OR=0.19,95% CI:0.11~0.34,P<0.05),ST 조여SA조비교차이무통계학의의(OR=1.53,95% CI:0.72~3.26,P>0.05)。결론 CDT치료AIFDVT적조기료효명현우우전통SA。관우원기료효, ST、CDT교전통SA균능유효강저PTS발생솔,차CDT환능강저혈관전새적발생솔。
Objective To compare the clinical efficacy of catheter directed thrombolysis(CDT ) ,thrombectomy(ST ) and system‐atic anticoagulant(SA) in treating acute iliofemoral deep vein thrombosis(AIFDVT ) of lower limb using Meta analysis method . Methods The systematic review was initialted by electronic literature searches (PUBMED ,MEDLINE ,ELSEVIER ,etc .) for stud‐ies comparing catheter directed thrombolysis ,thrombectomy and systematic anticoagulant clinical effects published from January 1984 to January 2014 based on the keyword such as "iliofemoral deep vein thrombosis;thrombolysis;anticoagulant therapy ;throm‐bectomy ;RCTs;Meta analysis".A Meta analysis was conducted to estimate early vein patency ,post thrombotic syndrome(PTS) , venous reflux(VR) rate ,venous obstruction(VO) rate ,etc .Results Ten RCTs were included in this analysis ,including 626 pa‐tients .The early vein patency rate was higher in the CDT group and the difference was statistically significant(OR=4 .61 ,95% CI 1 .93-10 .98 ,P<0 .05);there was no statistically difference between ST and SA group(OR= 2 .54 ,95% CI 0 .49 -13 .24 ,P>0 .05) .The post thrombotic syndrome rate was less both in the CDT group(OR=0 .18 ,95% CI 0 .07 -0 .43 ,P< 0 .05) and ST group(OR=0 .50 ,95% CI 0 .28 -0 .87 ,P< 0 .05);the difference was statistically significant .The difference of the venous reflux rate was not statistically significant in both two groups .The venous obstruction rate was less in the CDT group(OR=0 .19 ,95% CI 0 .11-0 .34 ,P<0 .05) and the difference was statistically significant ;while the difference was not statistically significant between ST and SA group (OR=1 .53 ,95% CI 0 .72-3 .26 ,P>0 .05) .Conclusion For acute iliofemoral deep vein thrombosis(AIFDVT) , short term (< 7 d) outcomes of catheter directed thrombolysis was better than anticoagulant therapy ,but thrombolysis brought more bleeding .In long term(>6 m) outcomes ,the post thrombotic syndrome rate was less both in the thrombolysis group and the thrombectomy ,and catheter directed thrombolysis could diminish the vein obstruction rate .