单纯抗凝与血管内治疗颅内静脉窦血栓有效性安全性Meta分析

Meta-Analysis of the Effectiveness and Safety of Anticoagulation and Endovascular Treatment for Intracranial Venous Sinus Thrombosis

摘要: 目的：使用Meta分析的方法比较单纯抗凝治疗与血管内治疗颅内静脉窦血栓形成(CVST)的安全性与有效性。方法：检索PubMed、Embase、知网、维普、万方数据库，检索时限从2000年1月1日开始至2023年12月31日。应用RevManV 5.4软件对纳入的文献进行Meta分析。结果：共有7篇符合要求的文献纳入分析，总计CVST患者489人，其中血管内治疗组240人，单纯抗凝治疗组249人。Meta分析结果显示，血管内治疗组治疗后mRS评分低于单纯抗凝治疗(MD = −0.38, 95% CI: −0.46~−0.30, P < 0.05)，但存在中度异质性(I² = 60%, P = 0.02)。治疗后血管再通率血管内治疗组优于单纯抗凝治疗组(OR = 6.55, 95% CI: 2.70~15.90, P < 0.05)，治疗后病死率(OR = 0.86, 95% CI: 0.25~2.96, P = 0.81)及出血事件发生率(OR = 0.34, 95% CI: 0.10~1.16, P = 0.09)均无统计学意义。结论：血管内治疗与单纯抗凝治疗相比能改善CVST患者的临床症状，提高血管再通率，但不影响患者的出血事件发生率及病死率。

Abstract: Objective: To compare the safety and efficacy of intravascular treatment versus anticoagulation alone for cerebral venous sinus thrombosis (CVST) using a Meta-analysis approach. Methods: Digital libraries, including PubMed, Embase, CNKI, Wanfang, and VIP, were searched for relevant studies published from January 1, 2000, to December 31, 2023. The included studies were assessed using RevManV 5.4 software for data extraction and quality evaluation. Results: A total of seven eligible studies involving 489 CVST patients (240 in the intravascular treatment group and 249 in the anticoagulation group) were included in the analysis. The Meta-analysis results showed that post-treatment modified Rankin Scale (mRS) scores were significantly lower in the intravascular treatment group compared to the anticoagulation group (MD = −0.38, 95% CI: −0.46~−0.30, P < 0.05), although there was moderate heterogeneity (I² = 60%, P = 0.02). The rate of vascular re-establishment after treatment was significantly higher in the intravascular treatment group (OR = 6.55, 95% CI: 2.70~15.90, P < 0.05). However, there were no statistically significant differences between the groups in terms of post-treatment mortality (OR = 0.86, 95% CI: 0.25~2.96, P = 0.81) or the incidence of bleeding events (OR = 0.34, 95% CI: 0.10~1.16, P = 0.09). Conclusions: Compared to anticoagulation alone, intravascular treatment improves clinical symptoms and increases the rate of vascular re-establishment in CVST patients without affecting the incidence of bleeding events or mortality rates. These findings highlight the potential benefits of intravascular treatment in enhancing patient outcomes while maintaining safety.