Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis.
Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis.
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DOI：
10.1186/s12959-018-0179-z
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发表时间：
2018
影响因子：
3.1
通讯作者：
Bigna JJ
中科院分区：
文献类型：
--
作者：
Noubiap JJ;Temgoua MN;Tankeu R;Tochie JN;Wonkam A;Bigna JJ
在全球范围内，镰状细胞病(SCD)是最常见的血红蛋白病之一。它被认为是一个公共健康问题，会导致血管闭塞、血瘀症和凝血系统的慢性激活，导致血管闭塞危机和静脉血栓栓塞症(VTE)，后者可能是致命的。虽然当代的观察性研究表明SCD或镰刀状(SCT)与VTE之间存在关系，但缺乏关于这种可能的相关性的总结或荟萃分析数据。因此，我们建议总结关于SCD、SCT和VTE之间关系的现有证据，包括深静脉血栓形成(DVT)和肺血栓(PE)。我们检索了PubMed和Scope us，以确定所有关于SCD或SCT与成人或儿童VTE、DVT或PE的相关性的横断面、队列和病例对照研究，从研究开始到2017年4月25日。为了衡量SCD或SCT与VTE、DVT或PE之间的关联性，使用随机效应方法进行荟萃分析，以汇集风险估计的加权优势比(OR)。在最初从书目数据库中确定的313条记录中，有10项研究符合条件，因此纳入了荟萃分析。与非SCD患者相比，SCD患者合并VTE(合并OR4.4，95%CI2.6~7.5，p <； 0.001)、DVT(合并OR1.1，95%CI1.1~1.2，p <； 0.001)和PE(合并OR3.7，95%CI3.6~3.8，p <； 0.001)的风险显著增加。与无SCD的孕妇相比，有SCD的孕妇发生静脉血栓(OR33.2，95%CI9.7~113.4，p <； 0.001)和DVT(OR30.7，95%CI1.6~578.2，p= 0.02)的风险更高。与成年SCT患者相比，SCD成人患者发生静脉血栓栓塞症的风险更高(合并OR3.1，95%CI1.8-5.3，p <； 0.001)，尤其是SCD孕妇或产后妇女(OR20.3，95%CI4.1-102，p = 0.0003)。成人SCD患者发生PE的风险也高于SCT患者(OR3.1，95%CCI1.7-5.9，p = 0.0004)。与对照组(合并OR1.7，95%CI1.3-2.2，p <； 0.0001)相比，SCT患者发生静脉血栓栓塞症的风险更高，但在孕妇或产后妇女中(OR0.9，95%CI0.3-2.9，p = 0.863)。与对照组相比，SCT组发生PE的风险较高(合并OR2.1，95%CI1.2~3.8，p = 0.012)，但与DVT无关(合并OR1.2，95%CI0.9~1.7，p = 0.157)。与普通人群相比，SCD患者，特别是孕妇或产后妇女，患VTE的风险可能更高。SCT也可能增加VTE的风险。然而，目前可用的数据不足以得出明确的结论。对于SCD、SCT和VTE之间的关系，还需要进一步的更大规模的研究来提供明确的结论。本文的在线版本(10.1186/s12959-0180179-z)包含向授权用户提供的补充材料。
Globally, sickle cell disease (SCD) is one of the most common haemoglobinopathy. Considered a public health problem, it leads to vessel occlusion, blood stasis and chronic activation of the coagulation system responsible for vaso-occlussive crises and venous thromboembolism (VTE) which may be fatal. Although contemporary observational studies suggest a relationship between SCD or sickle trait (SCT) and VTE, there is lack of a summary or meta-analysis data on this possible correlation. Hence, we propose to summarize the available evidence on the association between SCD, SCT and VTE including deep vein thrombosis (DVT) and pulmonary embolism (PE). We searched PubMed and Scopus to identify all cross-sectional, cohort and case-control studies reporting on the association between SCD or SCT and VTE, DVT or PE in adults or children from inception to April 25, 2017. For measuring association between SCD or SCT and VTE, DVT, or PE, a meta-analysis using the random-effects method was performed to pool weighted odds ratios (OR) of risk estimates. From 313 records initially identified from bibliographic databases, 10 studies were eligible and therefore included the meta-analysis. SCD patients had significantly higher risk for VTE (pooled OR 4.4, 95%CI 2.6–7.5, p < 0.001), DVT (OR 1.1, 95% CI 1.1–1.2, p < 0.001) and PE (pooled OR 3.7, 95% CI 3.6–3.8, p < 0.001) as compared to non SCD-adults. A higher risk of VTE (OR 33.2, 95% CI 9.7–113.4, p < 0.001) and DVT (OR 30.7, 95% CI 1.6–578.2, p = 0.02) was found in pregnant or postpartum women with SCD as compared to their counterparts without SCD. Compared to adults with SCT, the risk of VTE was higher in adults with SCD (pooled OR 3.1, 95% CI 1.8–5.3, p < 0.001), and specifically in SCD pregnant or postpartum women (OR 20.3, 95% CI 4.1–102, p = 0.0003). The risk of PE was also higher in adults with SCD (OR 3.1, 95% CCI 1.7–5.9, p = 0.0004) as compared to those with SCT. The risk of VTE was higher in individuals with SCT compared to controls (pooled OR 1.7, 95% CI 1.3–2.2, p < 0.0001), but not in pregnant or postpartum women (OR 0.9, 95% CI 0.3–2.9, p = 0.863). Compared to controls, SCT was associated with a higher risk of PE (pooled OR 2.1, 95% CI 1.2–3.8, p = 0.012) but not of DVT (pooled OR 1.2, 95% CI 0.9–1.7, p = 0.157). Individuals with SCD, especially pregnant or postpartum women, might have a higher risk of VTE compared to the general population. SCT might also increases the risk of VTE. However, currently available data are not sufficient to allow a definite conclusion. Further larger studies are needed to provide a definitive conclusion on the association between SCD, SCT and VTE. The online version of this article (10.1186/s12959-018-0179-z) contains supplementary material, which is available to authorized users.
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影响因子：
2.9
作者：
Little, Iain;Vinogradova, Yana;Qureshi, Nadeem
通讯作者：
Qureshi, Nadeem
影响因子：
2
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通讯作者：
Sterne, Jonathan A. C.
影响因子：
2.2
作者：
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影响因子：
4
作者：
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通讯作者：
Lanzkron S
影响因子：
3.4
作者：
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通讯作者：
STUART, J