肝硬化患者抗凝治疗有效性和安全性的meta分析  

Efficacy and safety of anticoagulant therapy in patients with cirrhosis:A meta-analysis

作　　者：苏芮 王存凯 王鼎鑫[1] 蔡聪会 张建[1] 侯洪涛[1] 白云[1] Su Rui;Wang Cunkai;Wang Dingxin;Cai Conghui;Zhang Jian;Hou Hongtao;Bai Yun(Department of Geriatric Gastroenterology,Hebei General Hospital,Shijiazhuang 050071,China;Graduate Academy,Hebei Medical University,Shijiazhuang 050017,China)

机构地区：[1]河北省人民医院老年消化科,河北石家庄050071 [2]河北医科大学研究生学院,河北石家庄050017

出　　处：《临床荟萃》2025年第4期293-303,共11页Clinical Focus

基　　金：河北省政府资助医学人才项目肝硬化门脉高压出血与血栓危险因素及门脉血栓机制研究(20220017)。

摘　　要：目的探讨抗凝治疗和预防性抗凝治疗在肝硬化伴或不伴门静脉血栓(portal vein thrombosis,PVT)患者中的有效性和安全性。方法根据文献检索策略,分别在Pubmed、Cochrane、Embase、Web of Science、知网、万方、维普数据库进行检索,并检索相关参考文献进行文献补充。逐一筛选检索到的文献,并对纳入文献进行质量评价及数据提取,采用Revman5.3和Stata14.0软件进行meta分析。结果总共检索到3423篇文献,按照纳入与排除标准进行文献筛选,最终纳入23篇文献。在肝硬化合并PVT患者中:抗凝治疗组PVT再通率明显高于未抗凝组(OR=3.39,95%CI:2.59-4.44,P<0.001),且未增加不良事件。直接口服抗凝药(direct oral anticoagulants,DOAC)的PVT再通率高于传统抗凝药(OR=39.49,95%CI:9.65-161.68,P<0.001),且大出血发生率低于传统抗凝药(OR=0.35,95%CI:0.13-0.97,P=0.04)。在肝硬化不合并PVT患者中:预防性抗凝组PVT形成率低于不抗凝组(OR=0.15,95%CI:0.05-0.43,P<0.001),两组出血发生率差异无统计学意义(OR=1.96,95%CI:0.72-5.30,P=0.19),预防性抗凝组全因死亡率低于不抗凝组(OR=0.51,95%CI:0.43-0.60,P<0.001)。结论抗凝治疗可以治疗或预防肝硬化患者门静脉血栓形成,是一种相对安全的治疗方法。Objective To investigate the efficacy and safety of anticoagulant therapy and prophylactic anticoagulant therapy in cirrhosis patients with or without portal vein thrombosis(PVT).Methods Literature searchs were conducted using PubMed,Cochrane,Embase,Web of Science,CNKI,Wanfang,and VIP databases,and relevant references were also reviewed.The included literatures were assessed for quality and data extraction.A meta-analysis was conducted using Revman5.3 and Stata14.0.Results Twenty-three eligible articles were included in 3423 retrieved articles.In patients with cirrhosis and PVT,the PVT recanalization rate in the anticoagulant therapy group was significantly higher than that of the non-anticoagulant group(OR=3.39,95%CI:2.59-4.44,P<0.001),without an increase in adverse events.The PVT recanalization rate of direct oral anticoagulants(DOAC)was significantly higher than that of traditional anticoagulants(OR=39.49,95%CI:9.65-161.68,P<0.001),and the rate of major bleeding was significantly lower than that of traditional anticoagulants(OR=0.35,95%CI:0.13-0.97,P=0.04).In patients with cirrhosis without PVT,the rate of PVT formation in the prophylactic anticoagulation group was significantly lower than that of non-anticoagulant group(OR=0.15,95%CI:0.05-0.43,P<0.001),with no difference of bleeding between groups(OR=1.96,95%CI:0.72-5.30,P=0.19),but the all-cause mortality rate in the prophylactic anticoagulation group was significantly lower(OR=0.51,95%CI:0.43-0.60,P<0.001).Conclusion Anticoagulant therapy can treat or prevent PVT in patients with cirrhosis and is a relatively safe treatment.

关 键 词：肝硬化 抗凝 预防性抗凝 门静脉血栓 META分析 

分 类 号：R575.2[医药卫生—消化系统]