胆汁淤积性肝病儿童维生素K缺乏性出血：系统回顾和荟萃分析

IF 3.4 3区医学 Q2 HEMATOLOGY

Research and Practice in Thrombosis and Haemostasis Pub Date : 2025-03-01 DOI:10.1016/j.rpth.2025.102847

Anusak Sakwit , Pongpak Pongphitcha , Patcharee Komvilaisak , Masayuki Ochiai , Daijiro Takahashi , Shutaro Suga , Ampaiwan Chuansumrit , Marisol Betensky , Stephen P. Pereira , Amber Afzal , C. Heleen van Ommen , Neil Goldenberg , Sasivimol Rattanasiri , Nongnuch Sirachainan

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引用次数: 0

摘要

维生素K缺乏症（VKD）在胆汁淤积性肝病影响高达23%的儿科患者。虽然已经提出了几种维生素K （VK）预防方案，但最佳治疗策略仍未确定。该研究旨在确定对胆汁淤积性肝病儿童最有效的VK预防。我们对18岁患有胆汁淤积性肝病的儿童的研究进行了系统回顾，这些儿童在VK预防后报告了VKD或维生素K缺乏性出血（VKDB）的结果。这些文章来自PubMed、Scopus和Embase。进行了一项荟萃分析，以确定VKD的患病率以及每种预防方案在预防VKD/VKDB方面的功效。该研究已在PROSPERO上注册（CRD 42021270048）。在889篇文章中，选择了37篇（2篇比较研究，6篇非比较研究，29篇病例报告/系列）。比较研究的结果表明，肠外VKD的发生率低于口服VK。非比较研究的荟萃分析显示，维生素K缺失- ii诱导的高凝血酶原组VKD患病率为56% (95% CI, 45%-68%；I2 = 0.0%；H2 = 1.0；Q检验：χ2 = 1.93；P = 0.38)，凝血异常检查中VKD的发生率为10% (95% CI, 5%-14%；I2 = 0%, h2 = 1.0；Q检验：χ2 = 0.82；P = .66)。在3种给药途径中，病例报告/系列分析显示，胆汁淤积症婴儿VKDB的中位发病时间最早为口服(44.5 d；IQR, 13.0-240.0天)与肌内注射(86.0天；IQR, 36.0-120.0)和静脉注射途径和静脉注射(97.0天；IQR, 74.0-120.0天)VK预防。确定儿童胆汁淤积性肝病VK给药最佳途径的现有研究有限。该综述的结果表明，在预防胆汁淤积症儿童的VKD/VKDB方面，肠外注射VK比口服VK有明显的优势。

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Vitamin K deficiency bleeding in children with cholestatic liver disease: a systematic review and meta-analysis

Vitamin K deficiency (VKD) in cholestatic liver disease affects up to 23% of pediatric patients. While several vitamin K (VK) prophylaxis regimens have been proposed, optimal therapeutic strategies remain undefined. The study aimed to identify the most effective VK prophylaxis for children with cholestatic liver disease. We conducted a systematic review of articles focusing on studies of children aged <18 years with cholestatic liver disease who reported outcomes of either VKD or vitamin K deficiency bleeding (VKDB) after VK prophylaxis. The articles were sourced from PubMed, Scopus, and Embase. A meta-analysis was performed to determine the prevalence of VKD and the efficacy of each prophylactic protocol in preventing VKD/VKDB. The study was registered on PROSPERO (CRD 42021270048). Of the 889 articles, 37 were selected (2 comparative studies, 6 noncomparative studies, and 29 case reports/series). The results from the comparative studies indicated a lower incidence of VKD in the parenteral than that in the oral VK. The meta-analysis of the noncomparative studies showed the prevalence of VKD in high prothrombin induced by vitamin K absence-II group was 56% (95% CI, 45%-68%; I² = 0.0%; H² = 1.0; Q test: χ² = 1.93; P = .38) and a prevalence of VKD in abnormal coagulation test was 10% (95% CI, 5%-14%; I² = 0%, H² = 1.0; Q test: χ² = 0.82; P = .66), respectively. Among the 3 administrative routes, the analysis from case reports/series showed the median onset of VKDB in cholestatic infants was the earliest in the oral (44.5 days; IQR, 13.0-240.0 days) compared with intramuscular (86.0 days; IQR, 36.0-120.0) and intravenous routes and intravenous (97.0 days; IQR, 74.0-120.0 days) VK prophylaxis. Available studies to determine the optimal route of VK administration in children with cholestatic liver disease were limited. The result from the review indicated that parenteral VK demonstrated a noticeable advantage over oral VK for VKD/VKDB prevention in cholestatic children.

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