促进原发性血小板增多症血栓形成因素的Meta分析  

Factors promoting thrombosis in essential thrombocythemia:a Meta-analysis

作　　者：王德好 赵霈 王子卿 杨二鹏 李雨蒙 牛继聪 陈奕 陈科 王明镜[2] 刘为易 吕妍[2] 胡晓梅[2] WANG Dehao;ZHAO Pei;WANG Ziqing;YANG Erpeng;LI Yumeng;NIU Jicong;CHEN Yi;CHEN Ke;WANG Mingjing;LIU Weiyi;LYU Yan;HU Xiaomei(Graduate School of Beijing University of Traditional Chinese Medicine,Beijing 100029,China;不详)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]中国中医科学院西苑医院,北京100091 [3]中国中医科学院,北京100700

出　　处：《中国临床研究》2023年第8期1189-1195,共7页Chinese Journal of Clinical Research

基　　金：国家自然科学基金面上项目(82174360);中国中医科学院科技创新工程重大攻关项目(CI2021A01702)。

摘　　要：目的进一步了解未被预测模型IPSET-thrombosis纳入的促进原发性血小板增多症(ET)血栓形成的因素。方法检索PubMed、Web of Science和The Cochrane Library数据库,对292项研究进行系统评价,并计算不同因素ET患者血栓发生率及相对风险比(RR),同时对结果可信度作推荐评分(RS),结合RR值及RS分析找到ET患者血栓形成的风险因素。结果促进ET血栓形成的危险因素有9个。其中包含IPSET-thrombosis纳入的4个因素:血栓形成史(35.0%,RR=3.30,95%CI:2.30~4.75)、JAK2V617F阳性(21.0%,RR=2.28,95%CI:1.14~4.56)、年龄大于60岁(22.4%,RR=1.95,95%CI:1.17~3.23)、心血管危险因素(CVR)(17.7%,RR=1.90,95%CI:1.08~3.35)。以及IPSET-thrombosis未纳入的5个因素:X染色体失活模式(XCIP)的单克隆型(30.6%,RR=4.49,95%CI:1.58~12.77)、JAK2V617F高负荷(33.9%,RR=3.69,95%CI:1.70~7.99)、白细胞增多(18.7%,RR=3.05,95%CI:1.81~5.13)、MPL突变(22.1%,RR=2.40,95%CI:1.08~5.33)、脾肿大(25.6%,RR=1.76,95%CI:1.29~2.40)。结论除IPSET-thrombosis评分系统纳入的4个血栓危险因素外,XCIP单克隆型、JAK2V617F高负荷、白细胞增多、MPL突变、脾肿大5个因素也是促进ET患者血栓形成的因素。Objective To further understand the factors that promote thrombosis in essential thrombocythemia(ET)that were not included in IPSET-thrombosis(International Prognostic Score of Thrombosis for ET).Methods A systematic evaluation was conducted on 292 studies by retrieving PubMed,Web of Science,and The Cochrane Library.The incidence and relative risk ratio(RR)of thrombosis in ET patients with different risk factors were calculated.The confidence levels for the outcome were analyzed in combination with RR values and recommendation scores(RS)to find the thrombotic risk factors in ET patients.Results Out of 9 risk factors that promoted ET thrombosis,there were 4 factors in IPSET-thrombosis,including history of thrombosis(35.0%,RR=3.30,95%CI:2.30-4.75),JAK2V617F positive(21.0%,RR=2.28,95%CI:1.14-4.56),age over 60 years old(22.4%,RR=1.95,95%CI:1.17-3.23)and cardiovascular risk factors(17.7%,RR=1.90,95%CI:1.08-3.35).The remaining five risk factors,not listed in IPSET-thrombosis,included monoclonal type of ET based on X-chromosome inactivation pattern(XCIP,30.6%,RR=4.49,95%CI:1.58-12.77),high JAK2V617F burden(33.9%,RR=3.69,95%CI:1.70-7.99),leukocytosis(18.7%,RR=3.05,95%CI:1.81-5.13),MPL mutation(22.1%,RR=2.40,95%CI:1.08-5.33)and splenomegaly(25.6%,RR=1.76,95%CI:1.29-2.40).Conclusion Among the risk factors promoting thrombosis in ET patients,five thrombotic risk factors not included in the IPSET-thrombosis have been identified.

关 键 词：原发性血小板增多症 META分析 血栓 JAK2V617F突变 脾肿大 XCIP单克隆型 MPL突变 

分 类 号：R558.3[医药卫生—血液循环系统疾病] R551.3[医药卫生—内科学]