Ahn Sanghyun, Mo Hyejin, Han Ahram, Min Sang-Il, Min Seung-Kee, Ha Jongwon, Lee Chang-Hyun, Jang Myoung-Jin, Jung In Mok
Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Ann Vasc Surg. 2019 Oct;60:415-423.e4. doi: 10.1016/j.avsg.2019.02.022. Epub 2019 May 8.
Conservative treatment is feasible in most patients with spontaneous isolated dissection of the superior mesenteric artery (SID-SMA). However, the role of antiplatelet agents and anticoagulants is not well defined in either symptomatic or asymptomatic SID-SMA. This study aimed to conduct a meta-analysis, including a single-arm study, comparing the resolution rate of conservative management with versus without antithrombotics for symptomatic and asymptomatic SID-SMA.
A systematic search of electronic databases, including PubMed, EMBASE, and Cochrane Library, on August 22nd, 2018, was performed to identify studies concerning SID-SMA. Meta-analyses were conducted to determine the primary resolution rate, long-term aneurysmal change for symptomatic SID-SMA, and any event for asymptomatic SID-SMA. We calculated pooled risk ratios and 95% confidence intervals (CIs) using random-effects model in studies with two arms and in studies with two arms or a single arm.
We included data from 35 articles involving 727 patients with SID-SMA (symptomatic 693, asymptomatic 134). No significant differences were observed in the successful resolution rate between conservative management with and without antithrombotics (random-effects model, risk ratio [RR] 0.96; 95% CI, 0.87-1.05]). The pooled resolution rate from combining single-arm studies was 91% (95% CI, 85-95) and 95% (95% CI, 88-100) in conservative management with and without antithrombotic, respectively, which was not statistically significant (RR, 0.97; 95% CI, 0.91-1.02). The pooled morphologic progression rate from combining single-arm studies was 3% (95% CI, 0-8) and 11% (95% CI, 2-26) in conservative management with and without antithrombotics, respectively, which was not statistically significant (RR, 0.44; 95% CI, 0.12-1.64). The adverse event was 0% for both groups for asymptomatic SID-SMA.
Additional antithrombotic therapy for both symptomatic and asymptomatic SID-SMA did not benefit the outcomes. We do not recommend the use of antithrombotics for SID-SMA, unless further evidence shows any beneficial effect.
对于大多数自发性孤立性肠系膜上动脉夹层（SID-SMA）患者，保守治疗是可行的。然而，抗血小板药物和抗凝剂在有症状或无症状的SID-SMA中的作用尚未明确界定。本研究旨在进行一项荟萃分析，包括一项单臂研究，比较有症状和无症状SID-SMA在使用与不使用抗血栓药物的情况下保守治疗的缓解率。
于2018年8月22日对电子数据库（包括PubMed、EMBASE和Cochrane图书馆）进行系统检索，以识别有关SID-SMA的研究。进行荟萃分析以确定主要缓解率、有症状SID-SMA的长期动脉瘤变化以及无症状SID-SMA的任何事件。在双臂研究以及双臂或单臂研究中，我们使用随机效应模型计算合并风险比和95%置信区间（CI）。
我们纳入了35篇文章的数据，涉及727例SID-SMA患者（有症状693例，无症状134例）。在使用与不使用抗血栓药物的保守治疗之间，成功缓解率未观察到显著差异（随机效应模型，风险比[RR]0.96；95%CI，0.87 - 1.05）。在使用和不使用抗血栓药物的保守治疗中，单臂研究合并后的缓解率分别为91%（95%CI，85 - 95）和95%（95%CI，88 - 100），差异无统计学意义（RR，0.97；95%CI，0.91 - 1.02）。在使用和不使用抗血栓药物的保守治疗中，单臂研究合并后的形态学进展率分别为3%（95%CI，0 - 8）和11%（95%CI，2 - 26），差异无统计学意义（RR，0.44；95%CI，0.12 - 1.64）。无症状SID-SMA两组的不良事件均为0%。
对有症状和无症状的SID-SMA进行额外的抗血栓治疗对结局并无益处。除非有进一步证据显示有益效果，否则我们不建议对SID-SMA使用抗血栓药物。
