代谢紊乱与肝硬化门静脉血栓形成风险：系统评价和荟萃分析。
Metabolic Disorders and Risk of Portal Vein Thrombosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis.
机构信息
Department of Gastroenterology, The Third People's Hospital of Chendu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China.
出版信息
Turk J Gastroenterol. 2022 Jul;33(7):541-553. doi: 10.5152/tjg.2022.211022.
Portal vein thrombosis is considered to be an indicator of worse outcomes in patients with hepatic cirrhosis. More and more evidence shows that metabolic disorders are noticeable pro-thrombotic factors. However, whether or not metabolic disorders increase the risk of cirrhotic portal vein thrombosis is controversial. We aim to quantify the magnitude of the association between metabolic disorders and the risk of cirrhotic portal vein thrombosis. Databases were searched for papers to identify studies in which metabolic disorders were compared in liver cirrhosis with or without portal vein thrombosis. Based on data from the eligible studies, metabolic disorders related to portal vein thrombosis included diabetes mellitus, nonalcoholic fatty liver disease, hypercholesterolemia, and body mass index. Pooled adjusted odds ratios with 95% CIs were calculated. Data for 22 studies with a total of 57 371 portal vein thrombosis cases and 3 979 015 participants were included. Statistically significant pooled odds ratios for portal vein thrombosis were obtained for diabetes mel- litus (odds ratio 1.80, 95% CI 1.42-2.28), nonalcoholic fatty liver disease (odds ratio 1.61, 95% CI 1.34-1.95), and hypercholesterolemia (odds ratio 3.59, 95% CI 1.83-7.03). Body mass index was likely irrelevant with cirrhotic portal vein thrombosis (odds ratio 1.01, 95% CI 0.87-1.17), both in overall and subgroup meta-analyses. Significant heterogeneities among studies were observed, except for the hypercholesterolemia group. Metabolic disorders, such as diabetes mellitus, nonalcoholic fatty liver disease, and hypercholesterolemia, increased the risk of portal vein thrombosis in cirrhotic patients by 1.80-fold, 1.61-fold, and 3.59-fold, respectively. Body mass index did not appear to be a risk predictor of cirrhotic portal vein thrombosis. Further, well-designed clinical and mechanistic studies are required to strengthen the arguments, especially in obese patients.
门静脉血栓形成被认为是肝硬化患者预后不良的指标。越来越多的证据表明，代谢紊乱是明显的促血栓形成因素。然而，代谢紊乱是否会增加肝硬化门静脉血栓形成的风险仍存在争议。我们旨在量化代谢紊乱与肝硬化门静脉血栓形成风险之间的关联程度。检索数据库以寻找比较肝硬化伴或不伴门静脉血栓形成患者代谢紊乱的研究。根据合格研究的数据，与门静脉血栓形成相关的代谢紊乱包括糖尿病、非酒精性脂肪肝、高胆固醇血症和体重指数。计算合并调整后比值比（OR）及其 95%置信区间（CI）。共纳入 22 项研究，总计 57371 例门静脉血栓形成病例和 3979015 名参与者。结果显示，糖尿病（OR 1.80，95%CI 1.42-2.28）、非酒精性脂肪肝（OR 1.61，95%CI 1.34-1.95）和高胆固醇血症（OR 3.59，95%CI 1.83-7.03）与门静脉血栓形成的统计学显著合并 OR。体重指数与肝硬化门静脉血栓形成的相关性可能不显著（OR 1.01，95%CI 0.87-1.17），在总体和亚组荟萃分析中均如此。除高胆固醇血症组外，研究间存在显著异质性。代谢紊乱，如糖尿病、非酒精性脂肪肝和高胆固醇血症，分别使肝硬化患者门静脉血栓形成的风险增加 1.80 倍、1.61 倍和 3.59 倍。体重指数似乎不是肝硬化门静脉血栓形成的风险预测因子。此外，需要进行精心设计的临床和机制研究来加强论证，尤其是在肥胖患者中。
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