下腔静脉滤器预防肺栓塞的系统评价和Meta分析

摘要

Objective To systematically evaluate the effects of vena cava filters for the prevention of pulmonary embolism. Methods Chinese Conference Data, Chinese Biomedical Database, Cochrane Central Register of Controlled Trials, Pubmed, English Medical Current Contents were searched up to March 2009, and the studies as references of eligible articles were also searched. Controlled clinical trials (CCTs) and randomised controlled trials (RCTs) that examined the efficacy of vena cava filters in preventing PE were selected. Data collection and literature evaluation were performed by two reviewers independently. RevMan4. 2. 8 was used for statistical analysis. Results 7 trials met all eligible criteria. Results of Meta - analysis showed that compared with the control group, the occurrence of pulmonary embolism in short term and long term, the total mortality and mortality correlated with pulmonary embolism in short term in the vena cava filters group decreased, and difference was shown statistically in two groups. The Odds Rate were OR =0. 14, 95% CI[0. 05, 0. 37] , P < 0.0001; OR=0.34, 95% CI[0. 19, 0.62], P= 0.0004; OR =0.52, 95% CI[0. 32, 0.82], P = 0. 005 ; OR = 0. 10, 95% CI[ 0. 01, 0. 78 ] , P = 0. 03 , respectively. Nevertheless, vena cava filters had no effect on the total mortality in long term, OR = 0. 92, 95% CI [ 0. 68 , 1. 22 ] , P = 0. 52, and the occurrence of deep vein thrombosis increased, OR = 1. 68, 95% CI [ 1. 17, 2. 39] , P = 0. 004. Conclusion Vena cava filters reduced the occurrence of pulmonary embolism, the total mortality and mortality correlated with pulmonary embolism in short term. Nevertheless, vena cava filters had no effect on the total mortality in long term, and increased the occurrence of deep - vein thrombosis Further study are needed to come to the affirmative conclusion due to the localization of the study.%目的 系统评价下腔静脉滤器预防肺栓塞的疗效.方法 系统检索CNKI、CBM、Cochrane Central Register of Controlled Trials、PubMed数据库、西文生物医学数据库,检索时间截止到2010年3月,并查阅各个研究中引用的参考文献来补充.纳入研究IVCF预防PE疗效的随机对照试验和临床对照试验.由两人独立提取数据及文献评价.应用RevMan 4.2.8软件进行统计学分析.结果 共纳入7篇文献.Meta分析结果显示,下腔静脉滤器组的近期PE发生率[OR=0.14,95%CI(0.05,0.37),P<0.0001]、远期PE发生率[OR=0.34,95% CI(0.19,0.62),P=0.0004]、近期总死亡率[OR=0.52,95%CI(0.32,0.82),P=0.005]和近期PE相关死亡率[OR=0.10,95%CI(0.01,0.78),P=0.03]低于对照组,两组间差异有统计学意义.下腔静脉滤器对远期总死亡率无影响[OR=0.92,95%CI(0.68,1.22),P=0.52],且增加远期DVT发生率[OR=1.68,95% CI(1.17,2.39),P=0.004].结论 Meta分析结果显示下腔静脉滤器可以降低PE发生率和近期死亡率,对远期死亡率无影响,且增加远期DVT的发生.但由于本研究的局限性此结论还有待于今后高质量研究的证实.