血管内干预可以减少胃变节患者的再出血:一个个体患者数据的元分析
Sagnik Biswas1, Arnav Aggarwal1, Gin-Ho Lo2
1Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
概括
血管内干预措施,如气球封闭逆向静脉横流消灭 (BRTO) 和穿内肝移植系统分流 (TIPS),比内镜注射蓝烯酸盐 (ECI) 更有效地预防肝硬化患者的胃水再出血. 然而,BRTO可能会恶化,而TIPS可能会增加肝脏脑病变的风险.
科学领域:
- 胃肠病学和肝病学
- 干预性放射学 干预性放射学
- 临床试验和元分析
背景情况:
- 肝硬化患者的胃水出血 (GV) 缺乏关于最佳二次预防的共识.
- 目前的治疗选择包括内镜注射 (ECI) 和内血管干预.
研究的目的:
- 为了比较ECI,BRTO和TIPS的疗效和安全性,用于GV出血的二次预防.
- 分析再出血率,整体存活率,,以及肝脏脑病变 (HE).
主要方法:
- 进行了聚合数据元分析 (ADMA) 和个人患者数据元分析 (IPDMA).
- 包括RCT和比较ECI,BRTO和TIPS的观察性研究.
- 倾向性得分匹配用于IPDMA.
主要成果:
- 与ECI相比,BRTO和TIPS显著减少了所有原因的再出血.
- BRTO与风的风险增加有关; TIPS增加了HE的风险.
- 治疗效益最明显的是儿童皮格B级肝硬化患者.
结论:
- 内血管干预 (BRTO,TIPS) 在减少GV再出血方面优于ECI.
- 需要进一步的大规模研究,以标准化结果来确认生存效益和优化治疗选择.
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