Meta-analysis on relationship between gastrointestinal bleeding before TIPS and hepatic encephalopathy after TIPS

doi:10.3760/cma.j.issn.1007-1245.2023.16.004

Abstract

Abstract:

Objective　To explore the relationship between gastrointestinal bleeding before transjugular intrahepatic portosystemic shunt (TIPS) and postoperative hepatic encephalopathy (HE) after TIPS by meta-analysis. Methods　The databases, PubMed , Embase, Cochrane, and Web of Science, were searched, and the literatures from the establishment of the databases to October 2022 were screened. RevMan 5.3 and Stata 16 were used to analyze the data. Results Nine English literatures with 2 063 patients were included, including 1 341 patients with bleeding and 1 341 patients without bleeding. The results of overall analysis were not statistically significant (P>0.05; OR=0.84, 95%CI 0.68-1.04). After 2016, the cumulative OR value showed a trend of moving to the left (the trend was stable). Subgroup analysis further confirmed that the proportion of HE after TIPS in the patients with gastrointestinal bleeding before TIPS decreased significantly after 2017 (P<0.05; OR=0.66, 95%CI 0.47-0.93). Conclusions　After 2016, the cumulative OR of HE in patients with gastrointestinal bleeding before TIPS continues to improve; the promotion of TIPS guidelines may be an important reason.

Key words:

Hepatic encephalopathy, Transjugular intrahepatic portosystemic shunt, Preoperative gastrointestinal bleeding, Meta-analysis, , Guidelines

摘要：

目的　通过meta分析探讨经颈静脉肝内门体分流术（transjugular intrahepatic portosystemic shunt，TIPS）术前消化道出血与术后肝性脑病（hepatic encephalopathy，HE）的关系。方法　检索数据库（PubMed、Embase、Cochrane、Web of Science）并筛选建库至2022年10月的文献，采用RevMan 5.3及Stata 16分析数据。结果　纳入9篇英文文献，2 063例患者，出血组1 341例，无出血组722例。总体分析结果差异无统计学意义（P>0.05；OR=0.84，95%CI 0.68～1.04）；2016年之后，累积OR值呈向左移动的趋势（趋势稳定）；亚组分析进一步证实，2017年之后TIPS术前消化道出血的患者术后发生HE的比例明显减低（P<0.05；OR=0.66，95%CI 0.47～0.93）。结论　2016年之后，TIPS术前消化道出血患者术后发生HE的累积OR值持续向好，TIPS相关指南的推广可能是其重要原因。

关键词:

肝性脑病, 经颈静脉肝内门体分流术, 术前消化道出血, meta分析, 指南

Wang Fengyan, Wang Shengguo, Gu Shanshan, Han Zhihao.

Meta-analysis on relationship between gastrointestinal bleeding before TIPS and hepatic encephalopathy after TIPS [J]. International Medicine and Health Guidance News, 2023, 29(16): 2235-2239.

王凤燕王胜果谷姗姗韩志浩.

TIPS术前消化道出血与术后肝性脑病关系meta分析 [J]. 国际医药卫生导报, 2023, 29(16): 2235-2239.

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