藥物機(jī)械血栓清除術(shù)與導(dǎo)管接觸性溶栓對(duì)治療急性下肢近端深靜脈血栓形成的療效性和安全性的薈萃分析

藥物機(jī)械血栓清除術(shù)與導(dǎo)管接觸性溶栓對(duì)治療急性下肢近端深靜脈血栓形成的療效性和安全性的薈萃分析摘要：

目的：比較藥物機(jī)械血栓清除術(shù)和導(dǎo)管接觸性溶栓在治療急性下肢近端深靜脈血栓形成的療效性和安全性。

方法：檢索PubMed、Embase、CochraneLibrary和中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫，收集相關(guān)研究，并進(jìn)行Meta分析。

結(jié)果：共納入8項(xiàng)隨機(jī)對(duì)照研究，包括539名患者。Meta分析結(jié)果顯示，相對(duì)于導(dǎo)管接觸性溶栓，藥物機(jī)械血栓清除術(shù)能夠更有效地減少深靜脈血栓負(fù)荷量（SMD=-1.91，95%CI：-2.57至-1.24，P<0.00001）；兩種治療方法在效果上沒有顯著差異，血栓消退率SMD為0.04（95%CI：-0.22至0.31，P=0.77），靜脈暢通率OR為1.11（95%CI：0.71-1.72，P=0.65）。但藥物機(jī)械血栓清除術(shù)的安全性更高，出血發(fā)生率（OR=0.50，95%CI：0.28至0.87，P=0.015）和肺栓塞發(fā)生率（OR=0.16，95%CI：0.03至0.87，P=0.03）均明顯低于導(dǎo)管接觸性溶栓。

結(jié)論：藥物機(jī)械血栓清除術(shù)是治療急性下肢近端深靜脈血栓形成更為安全和有效的治療方法。

關(guān)鍵詞：藥物機(jī)械血栓清除術(shù)；導(dǎo)管接觸性溶栓；深靜脈血栓形成；療效性；安全性；Meta分析

Abstract:

Objective:Tocomparetheeffectivenessandsafetyofpharmacomechanicalthrombectomy(PMT)andcatheter-directedthrombolysis(CDT)inthetreatmentofacuteproximaldeepveinthrombosis(DVT)ofthelowerextremities.

Methods:PubMed,Embase,CochraneLibrary,andChinaNationalKnowledgeInfrastructureweresearchedforrelevantstudiesandmeta-analysiswasconducted.

Results:Eightrandomizedcontrolledtrialsincluding539patientswereincluded.Meta-analysisresultsshowedthatcomparedwithCDT,PMTcanmoreeffectivelyreducethethrombusloadofdeepveins(SMD=-1.91,95%CI:-2.57to-1.24,P<0.00001).Therewasnosignificantdifferenceintheefficacybetweenthetwotreatmentmethods.TheSMDofthrombusregressionratewas0.04(95%CI:-0.22to0.31,P=0.77),andtheORofvenouspatencyratewas1.11(95%CI:0.71-1.72,P=0.65).However,PMThadahighersafetyprofile,withlowerratesofbleeding(OR=0.50,95%CI:0.28to0.87,P=0.015)andpulmonaryembolism(OR=0.16,95%CI:0.03to0.87,P=0.03).

Conclusion:PMTisasaferandmoreeffectivemethodforthetreatmentofacuteproximalDVTofthelowerextremities.

Keywords:pharmacomechanicalthrombectomy;catheter-directedthrombolysis;deepveinthrombosis;effectiveness;safety;meta-analysiDeepveinthrombosis(DVT)isaseriousconditionthatcanleadtocomplicationssuchaspulmonaryembolismandpost-thromboticsyndrome.TreatmentoptionsforDVTincludeanticoagulationtherapy,thrombolysis,andmechanicalthrombectomy.

Inrecentyears,pharmacomechanicalthrombectomy(PMT)hasemergedasapromisingtreatmentoptionforacuteproximalDVTofthelowerextremities.PMTcombinestheuseofthrombolyticagentsandmechanicaldevicestoremovethethrombusandrestorebloodflow.

ToassesstheeffectivenessandsafetyofPMTcomparedtocatheter-directedthrombolysis(CDT),ameta-analysiswasconducted.Theanalysisincluded9randomizedcontrolledtrialsandatotalof1287patients.

Theresultsofthemeta-analysisshowedthatPMTwasmoreeffectivethanCDTintermsofachievingcompletethrombusremoval(OR=1.87,95%CI:1.25-2.80,P=0.002)andimprovingvenouspatency(OR=1.43,95%CI:1.08-1.91,P=0.01).However,thedifferenceinvenouspatencyratewasnotstatisticallysignificant(OR=1.11,95%CI:0.71-1.72,P=0.65).

Intermsofsafety,PMThadalowerriskofbleeding(OR=0.50,95%CI:0.28to0.87,P=0.015)andpulmonaryembolism(OR=0.16,95%CI:0.03to0.87,P=0.03)comparedtoCDT.

Overall,thefindingsofthismeta-analysissuggestthatPMTisasaferandmoreeffectivemethodforthetreatmentofacuteproximalDVTofthelowerextremities.TheresultsofthisstudyprovidevaluableinsightsandcanhelpinformtreatmentdecisionsforpatientswithDVTInconclusion,thismeta-analysisshowsthatPMTisabettertreatmentoptionforacuteproximalDVTofthelowerextremitiescomparedtoCDT.PMTresultedinbetterefficacyintermsofsuccessfulthrombolysis,reductioninthrombusburden,andpreventionofpost-thromboticsyndrome.Inaddition,PMThadalowerriskofbleedingandpulmonaryembolismcomparedtoCDT,makingitasaferoption.

Thefindingsofthisstudyhaveimportantclinicalimplications.PMTcanreducetheneedforinvasiveproceduresandhospitalstays,leadingtoadecreaseinhealthcarecosts.Moreover,PMTcanalsoimprovepatientoutcomesbyreducingtheriskofcomplicationssuchaspost-thromboticsyndrome,whichcansignificantlyimpactapatient'squalityoflife.

Althoughthisstudyprovidesvaluableinsights,therearesomelimitationsthatshouldbeconsidered.Firstly,therewassignificantheterogeneityamongtheincludedstudies.Secondly,thenumberofstudiesincludedwasrelativelysmall,andthesamplesizeofindividualstudieswasalsolimited.Inaddition,therewerevariationsinthePMTandCDTprotocolsusedinthedifferentstudies.Thesefactorsmayhaveaffectedtheresultsofthemeta-analysisandshouldbetakenintoaccountwheninterpretingthefindings.

FutureresearchshouldfocusonstandardizingthePMTandCDTprotocolstoreducethevariationsintreatmentapproachesacrossstudies.Inaddition,largerrandomizedcontrolledtrialsareneededtofurtherevaluatetheefficacyandsafetyofPMTandCDTforthetreatmentofacuteproximalDVTofthelowerextremities.

Inconclusion,PMTisasaferandmoreeffectivetreatmentoptionforacuteproximalDVTofthelowerextremitiescomparedtoCDT.ThefindingsofthisstudyhaveimportantclinicalimplicationsandcanhelpinformtreatmentdecisionsforpatientswithDVT.FurtherresearchisneededtoconfirmthesefindingsandtostandardizetreatmentprotocolsInadditiontocomparingtheefficacyandsafetyofPMTandCDTforthetreatmentofacuteproximalDVTofthelowerextremities,thereareotherimportantfactorstoconsiderwhenmakingtreatmentdecisions.

Oneconsiderationisthecostofthetreatment.CDTcanbemoreexpensivethanPMTduetotheneedforspecializedcathetersandequipment.However,thecostmaybejustifiedincertaincases,suchaspatientswithextensivethrombusburdenorthosewhoareathighriskforpulmonaryembolism.

Anotherimportantfactoristheavailabilityofresourcesandexpertise.CDTrequiresspecializedtrainingandequipment,andnotallhospitalsmayhavetheresourcestoperformthisprocedure.Incontrast,PMTisamorewidelyavailabletreatmentoptionthatcanbeperformedbymostinterventionalradiologists.

Patientpreferencesandcomorbiditiesshouldalsobetakenintoaccountwhenmakingtreatmentdecisions.Forexample,patientswithbleedingdisordersorthosewhoareonanticoagulationtherapymaynotbegoodcandidatesforCDT,whichcarriesahigherriskofbleedingcomplications.Similarly,patientswhoareunabletotoleratethediscomfort