体育锻炼对老年性痴呆干预效果的Meta分析

目的综合分析体育锻炼对老年性痴呆(Alzheimer’s Disease,AD)的干预效果,为改善老年人认知功能,延缓AD病情提供依据。方法收集2001-2011年国内外公开发表的关于体育锻炼对AD干预效果的文献,并用Stata12.0软件对这些文献进行Meta分析。采用卡方值和P值分析各研究结果间的统计学异质性。选用随机效应模型进行合并效应量,并通过OR值及其95%置信区间来衡量干预效果。结果纳入本次Meta分析的文献共有10篇,累计病例数2 804例。综合分析后的OR值及其95%置信区间(95%CI)为:OR=0.48,95%CI(0.33～0.64),结果具有统计学意义。结论经常参加体育锻炼可以改善老年人的认知功能,延缓AD病情的进展。     

农药与阿尔茨海默症关联性研究的Meta分析

目的利用国内外发表的关于农药暴露与阿尔茨海默症(AD)有关的文献,探讨农药暴露是否为AD的危险因素。方法采用Cochrane系统评价方法,根据PICOs原则提出关键词,在CBM、万方、维普、CNKI、PubMed、EMBASE、CENTRAL数据库中检索国内外公开发表的相关文献。利用Endnote X7文献管理软件管理文献,运用Cochrane协作网推荐的NOS偏倚风险评价工具进行文献质量评价,设计表格提取相关信息。分析主要结局指标为阿尔茨海默病例及其农药暴露或血清中农药的含量,采用RevMan 5.3软件进行Meta分析。病例对照研究的效应值为暴露的比值比(OR)以及95%可信区间(95%CI),队列研究的效应值为相对危险度(RR值)及95%CI,根据异质性检验结果选择相应的合并模型。结果最终纳入4篇文章,病例对照研究和队列研究各2篇。纳入的2篇病例对照研究的异质性为无,I2为27%(P=0.24),合并结果为OR=2.41,95%CI(1.47~3.94,P=0.008)。纳入的2篇队列研究的异质性为中度,I2为58%(P=0.12),合并结果为RR为1.75,95%CI(1.22~2.50,P=0.002)。结论目前证据支持农药暴露是阿尔茨海默症的危险因素。     

吸烟与肝癌关系的Meta分析

[目的]采用Meta分析法探讨吸烟与肝癌发病的相关性,为进行人群健康教育和预防决策提供依据。[方法]以肝癌组与对照组人群是否吸烟的OR值为效应指标,根据一致性检验的结果,选择随机效应模型对OR值进行合并并进行偏倚评估。采用GLS法检验吸烟量与OR值的剂量反应关系。[结果]共查到符合要求的国内外文献50篇,病例和对照数分别为10228、22312例。经异质性检验,50项研究结果存在异质性(q=267.75,P﹤0.0001),经过随机效应模型估计,以不吸烟人群为参比组,吸烟人群患肝癌的合并OR值为1.43(95%CI1.25～1.63)。按地域(亚洲、中北美洲、欧洲)合并OR值(95%CI)分别为1.46(1.24～1.72)、1.65(1.29～2.10)和1.14(0.83～1.57),按国别(国内、国外)合并OR值(95%CI)为1.32(1.07～1.63)和1.51(1.28～1.78),按对照选取的人群(正常人、非肝癌病人)合并OR值(95%CI)为1.41(1.21～1.64)和1.44(1.18～1.75),按研究设计的类型(病例对照、巢式病例对照)合并OR值(95%CI)为1.47(1.29～1.68)和1.00(0.54～1.82),OR值较一致。随吸烟量增加,肝癌发生风险在增加,呈现显著剂量反应关系(Z=4.76,P﹤0.0001)。[结论]吸烟是肝癌发病的危险因素。     

短时中等强度有氧运动对我国学龄儿童执行功能影响的Meta分析

目的通过对相关研究文献进行Meta分析,探讨短时中等强度有氧运动对我国学龄儿童执行功能的影响。方法以执行功能、小学生、儿童、有氧运动、运动干预、实验研究为主题词或关键词,检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库、Pub Med、以及OVID检索平台,最终纳入8篇符合研究需要的文献。结果 8篇研究文献具有高度的同质性,采用固定效应模型进行分析。抑制控制子功能的合并效应值WMD=20.89,95%CI:17.65~24.13,Z=12.63,P0.01;记忆刷新子功能的合并效应值WMD=197.21,95%CI:172.15~222.28,Z=15.42,P0.01;注意转换子功能WMD=136.20,95%CI:116.24~156.15,Z=13.37,P0.01。结论短时中等强度有氧运动对我国学龄儿童执行功能的提升效果非常明显。     

体外受精-胚胎移植与自然受孕新生儿畸形的Meta分析

目的 应用Meta分析探讨体外受精-胚胎移植受孕与自然受孕新生儿畸形情况,为今关键词"in vitro fertilization","in vitro主题词和后的辅助生殖技术安全性研究提供依据.方法 应用fertilization and embryo transfer","congenital malformations"和体外受精-胚胎移植、先天畸形等,检索1999年至2007年ISI Web of Knowledge、Medline、CNKI等医学数据库发表的相关文献,并追查参考文献.采用Stata10.0软件进行Meta分析.结果 纳入8篇文献,无异质性(Q=3.57,P=0.83).体外受精-胚胎移植受孕者新生儿总畸形率高于自然受孕者,合并RR值为1.34(95%CI:1.26～1.43,Z=8.67,P=0.00).累积Meta分析提示,随着样本含量的增加估计值越精确.Egger检验提示无发表偏倚(P=0.21).对新生儿畸形进行分组,体外受精-胚胎移植受孕者新生儿心脏畸形率高于自然受孕者,合并RR值为1.48(95%CI:1.25～1.76,Z=4.53,P=0.00).结论 体外受精-胚胎移植受孕者新生儿总畸形率高于自然受孕者,新生儿心脏畸形率也高于自然受孕者.     

绝经前后中国女性BMI与乳腺癌发病关系的剂量-反应meta分析

目的探讨不同绝经状态下中国女性BMI与乳腺癌发病的关系。方法计算机检索Pub Med、EMBASE、万方数据库、维普数据库、中国期刊全文数据库(CNKI),收集国内外2000年1月至2017年2月公开发表的关于中国女性不同体质指数(BMI)分组与乳腺癌发病关系的研究文献。应用Stata12.0进行Meta分析,在总体效应关系存在的基础上,进行线性和非线性模型拟合,若未发现剂量反应关系,再进一步探讨不同BMI对乳腺癌发病的截断效应,采用Begg's检验评估发表偏倚。结果共纳入8篇文献,共103 141人。绝经前组合并后的效应量RR值为1.10(95%CI:0.95~1.27),绝经后组合并后的效应量RR值为1.52(95%CI:1.31~1.75),绝经前、后均未发现剂量-反应关系(X~2=1.95,PLinearity=0.16;=2.02,PNonlinearity=0.57)。相对于参照组(18.5 kg/m~2BMI≤24kg/m~2),绝经后超重人群(24kg/m~2BMI≤28kg/m~2)其乳腺癌发病风险RR值为1.33(95%CI:1.10~1.60),肥胖人群(BMI28 kg/m~2)为1.83(95%CI:1.46~2.29)。Begg's检验的Z=0.82,P=0.41,所纳入分析的文献不存在发表偏倚。结论在中国,BMI升高可增加绝经后女性乳腺癌的发病风险,而在绝经前女性人群中尚未发现此关联。     

妊娠期被动吸烟与出生缺陷关系的Meta分析

目的探讨孕期被动吸烟与出生缺陷的关系。方法运用计算机检索1980年至2010年4月国内外关于孕期被动吸烟与出生缺陷关系的研究文献,采用Cochrane协作网提供的RevMan5.0分析软件对入选的文献进行异质性检验,经Meta分析计算合并效应OR值及其95%CI。结果国内外25篇文献入选。森林图显示纳入文献是异质的(χ2=243.98,P0.000 01),采用随机效应模型计算孕期被动吸烟与出生缺陷关联性的合并效应的OR值为1.70,95%CI:1.34~2.15。其中,国内和国外不同研究人群合并效应的OR值分别为3.62(95%CI:1.71~7.68)和1.28(95%CI:1.04~1.57)。结论孕期被动吸烟可能会增加出生缺陷发生风险。     

高危型人乳头瘤病毒感染与不良妊娠结局之间关系的Meta分析

目的探讨高危型人乳头瘤病毒(HPV)感染是否会导致不良的妊娠结局(包括早产、胎膜早破、子痫前期、流产及胎儿宫内生长发育受限),为指导临床提供循证医学证据。方法通过计算机检索Pubmed、Embase、Ovid-Medline数据库中最早可用的查找至2017年12月19日前关于高危型HPV感染与妊娠结局关系的英文文献,由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后采用stata 12.0软件进行Meta分析。结果共纳入12篇文献,其中11篇队列研究,1篇病例对照研究。Meta分析的结果:以流产为结局指标合并效应量结果为1.65[95%CI(1.14,2.39)],以胎膜早破为结局指标的研究合并RR为1.80[95%CI(1.24,2.61)],早产为结局指标的效应量结果是1.61[95%CI(1.36,1.90)],均有统计学意义(P0.05)。关于子痫前期结局,检测部位为宫颈组织的亚组的合并RR为1.74[95%CI(1.31,2.31)],两组差异有统计学意义(P0.05);检测部位为胎盘组织的亚组的合并RR为1.73[95%CI(0.83,3.60)],两组差异无统计学意义(P0.05)。致胎儿宫内生长发育受限的合并RR为1.34[95%CI(1.06,1.69)],两组差异有统计学意义(P0.05)。结论高危型HPV感染会增加不良妊娠结局发生的风险,有效的预防高危型HPV感染对于减少不良妊娠结局有重要作用。     

不同运动强度对儿童青少年工作记忆影响的Meta分析

通过Meta分析对国内外相关文献进行研究,系统评价不同运动强度对儿童青少年人群工作记忆的影响,为今后学校心理卫生和体育教学领域的相关研究提供循证学参考.方法 以“中等强度体育活动”“高强度体育活动”“工作记忆”“认知功能”“moderate physical activity”“vigorous physical activity”“moderate intensity exercise" "high intensity exercise”“acute physical activity”“chronic physical activity”“working memory”“cognitive function”“cognition”等关键词检索国内外七大数据库,检索时间为2019年9月.采用PICOS模式进行文献筛选,共纳入40篇相关研究文献,文献Jadad评分较高,运用随机效应模型进行Meta分析.结果 中等强度体育活动对学龄儿童工作记忆影响的合并效应值WMD=136.98,Z=21.77,95%CI=124.65~ 149.31;青少年组的合并效应值WMD=95.78,Z=9.08,95%CI=75.11~116.46;总效应值WMD=126.17,Z=23.35,95%CI=115.58~136.76(P值均<0.01).高强度体育活动对学龄儿童工作记忆影响的合并效应值WMD=-6.05,Z=0.38,95%CI=-37.15~25.06(P=0.70);青少年组的合并效应值WMD=8.51,Z=0.60,95%CI=-19.12~36.13(P=0.55);总效应值WMD=2.09,Z=0.20,95%CI=-18.57~22.74(P=0.84).结论 中等强度体育活动对儿童青少年的工作记忆能力具有一定的提升和改善作用,高强度体育活动对儿童青少年的工作记忆能力没有积极影响.在运用体育活动手段对儿童青少年进行工作记忆提升训练时,应将强度控制在中等强度才能达到促进工作记忆能力的效果.     

健康教育干预对预防护士锐器伤效果的Meta分析

目的：综合评价我国护士锐器伤健康教育的干预效果,为护士制定相应的预防干预措施提供依据。方法通过计算机检索 PubMed、EMBASE、中国知网全文数据库(CNKI)、万方数据库和中国维普全文数据库(VIP),搜索1994—2014年期间有关护士锐器伤健康教育干预效果研究的文献,使用 Stata 12.0对入选的研究进行 Meta分析。结果纳入的研究存在异质性(χ2=18.78,P =0.005),使用随机效用模型合并后的 RR 值为0.51(Z =6.82,P <0.001)。Meta 异质来源分析发现,研究所在国家为异质性产生的主要来源。进行亚组分析结果显示,国内的6项研究无异质性(χ2=2.73,P =0.742),使用固定效用模型合并后的 RR 值为0.54(Z =15.01,P <0.001)；泰国1项研究无异质性,效用 RR 值为0.16。结论开展护士锐器伤防护的健康教育能有效预防锐器伤的发生且效果较好。     

Assessment of the potential effect of incremental increases in folic acid intake on neural tube defects in Australia and New Zealand

OBJECTIVE: To estimate the number of neural tube defects that could be prevented in Australia and New Zealand by increasing levels of folic acid intake. METHODS: Available data on prevalence of neural tube defects in Australia and New Zealand, folic acid supplement use and serum folate were used in a published model to estimate the number of neural tube defects that could be prevented in Australia and New Zealand for increments of folic acid intake from 0.1 mg daily to 1 mg daily. RESULTS: An increase of 0.2 mg folic acid per day was estimated to result in the prevention of 49 (95% CI 27-84) neural tube defects per year in Australia and 11 (95% CI 6-18) in New Zealand. A separate estimation for Indigenous Australians found that 0.2 mg of folic acid daily could prevent 7 (95% CI 4-11) neural tube defects in Indigenous infants per year. CONCLUSIONS: These data should be useful in considering primary preventive strategies for neural tube defects, including the possible introduction of mandatory fortification of food with folic acid. The estimates are imprecise because of limitations in the data used in the model. IMPLICATIONS: More representative and precise data on neural tube defects, serum folate levels and use of folic acid supplements from all Australian States and New Zealand are needed to refine the output from the model and to provide a baseline assessment of folate status against which to measure the effects of any future interventions to prevent neural tube defects.     

维生素A与维生素E增强叶酸防畸效果的研究

为观察维生素A与维生素E能否增强叶酸的防畸效果 ,采用环磷酰胺致大鼠胎鼠发育畸形作为动物模型 ,孕鼠在孕期分别补充叶酸和叶酸 +维生素A +维生素E ,观察其防畸效果。结果显示孕鼠不补充叶酸和维生素、单独补充叶酸和联合补充叶酸、维生素A和维生素E使胎鼠脑膨出率分别为 87 2 7%、42 0 3%和 30 0 8% (P <0 0 1)。联合补充组与单独补充叶酸组相比 ,脑膨出率降低更为明显 (P <0 0 5 ) ,上枕骨骨化程度明显提高 (P <0 0 1) ,胎鼠平均体重增加 (P <0 0 5 )。结果提示叶酸、维生素A、维生素E有明显促进胚胎发育及拮抗环磷酰胺的致畸作用 ,且叶酸与维生素A、维生素E联合应用的作用明显优于单独补充叶酸     

Effect of folic acid fortification on the incidence of neural tube defects

Amarin ZO, Obeidat AZ. Effect of folic acid fortification on the incidence of neural tube defects. Paediatric and Perinatal Epidemiology 2010. In a few countries enriched cereal grains have been fortified with folic acid to reduce the incidence of neural tube defects. The objective of this study was to analyse the effect of folic acid fortified foods on the incidence of neural tube defects in live newborns at Princess Badea Teaching Hospital, in the north of Jordan, before and after the national food fortification with folic acid was implemented. For the 7‐year period from 1 January 2000 to 31 December 2006, we retrospectively extracted the total number of births at Princess Badea Hospital, as well as the number of pregnancies affected by spina bifida and anencephaly, per 1000 births during the periods before (2000–01), during (2002–04) and after (2005–06) folic acid fortification of grain products, was implemented. Neural tube defects were defined in accordance with the International Classification of Diseases, 10th revision (ICD‐10): anencephaly, encephalocele and spina bifida. A total of 78 subjects with neural tube defects were recorded among 61 447 births during the study period. The incidence of neural tube defects decreased from 1.85 per 1000 births before fortification [95% confidence interval (CI) 1.2, 2.4] to 1.07 per 1000 births during the fortification period [95% CI 0.7, 1.5], and 0.95 after full fortification [95% CI 0.5, 1.5], a 49% reduction. The difference between incidence of neural tube defects in the periods before and after food fortification with folic acid was statistically significant. We conclude that food fortification with folic acid was associated with a significant reduction in the rate of neural tube defects in north Jordan.     

Folic acid supplements in pregnancy and birth outcome: re-analysis of a large randomised controlled trial and update of Cochrane review

Periconceptual folic acid prevents neural tube defects. The effect of folic acid taken throughout pregnancy is unclear, however. We re-analysed data from a large randomised controlled trial performed between 1966 and 1967 and combined the results with those from trials included in a Cochrane review. A total of 2928 women were randomised: 1977 were allocated to placebo, 466 to folic acid 200 microg/day and 485 to folic acid 5 mg/day. Folic acid supplementation was not associated with any difference in mean birthweight, placental weight or gestational age. When combined with trials in the Cochrane review folic acid at high doses was associated with reduced risk of low birthweight (pooled relative risk 0.73 [95% CI 0.53, 0.99]). We found no conclusive evidence of benefit for folic acid supplementation in pregnant women given from time of booking onwards.     

岳阳市育龄女性增补叶酸预防神经管缺陷的效果分析

目的分析岳阳市育龄女性增补叶酸预防神经管缺陷的效果,为以后的临床工作提供参考依据。方法选取2017年4月1日-2018年3月31日在岳阳市助产机构住院流产及分娩的64 276例育龄女性作为研究对象,根据治疗方式分为观察组(54 086例,规律服用叶酸)和对照组(10 190例,未规律服用叶酸)。比较两组神经管畸形发生率。结果观察组和对照组出生缺陷、围生儿出生缺陷、神经管畸形发生率比较差异均有统计学意义(均P<0. 05)。结论岳阳市增补叶酸预防神经管畸形发生的效果显著,但仍有提升空间,在未来工作中可通过优化健康宣教、干预出生缺陷发生的相关因素而降低神经管畸形发生率。     

叶酸配伍大豆异黄酮对大鼠神经管畸形的影响

目的研究不同剂量叶酸配伍大豆异黄酮对神经管畸形孕鼠体内过氧化状态的影响。方法采用正交设计方案来观察叶酸和大豆异黄酮在不同的配伍干预下对环磷酰胺致神经管畸形(脑膨出为主)的孕鼠体内重要的抗氧化物质谷胱甘肽及其酶以及一些与抗氧化相关元素水平的影响。将100只鼠龄25～3个月的孕鼠随机分为对照组、模型组、配伍干预组和单独干预组。孕20d时,处理孕鼠并进行血中谷胱甘肽、谷胱甘肽过氧化物酶及元素硒、锰、铁抗氧化相关指标的检测;剖腹取出胎鼠,统计其畸形发生率。结果叶酸配伍大豆异黄酮的交互作用对血中谷胱甘肽、谷胱甘肽过氧化物酶及元素硒、锰、铁等抗氧化相关指标的水平均产生了影响,且两者之间的配伍关系对抗氧化相关指标的影响随配伍的不同而表现不同。研究结果显示,叶酸07mg/kg配伍大豆异黄酮160mg/kg的干预效果最佳;与叶酸或大豆异黄酮的2倍剂量(叶酸14mg/kg、大豆异黄酮320mg/kg)进行单独干预比较,结果显示配伍干预效果要优于单独干预效果。结论叶酸是预防神经管畸形发生的主要因素,而大豆异黄酮加强了体内抗氧化能力,有可能增强叶酸的保护作用而使神经管畸形的发生率下降,而增强效果的发挥依赖于最佳配伍的选择。     

Folic acid supplements and fortification affect the risk for neural tube defects,vascular disease and cancer: evolving science

Folic acid supplements reduce the risk of neural tube defects and may be associated with reduced risk for vascular disease and cancer. Research data from both observational and controlled intervention studies provide strong support for the existing public health policies related to folic acid and neural tube defects. However, educational efforts to promote daily intake of folic acid supplements by women of reproductive age have not, in most cases, resulted in increased supplement use. In contrast, food fortification appears to be associated with a reduction in neural tube defects in the United States and Canada but is not practiced universally. The potential for folic acid supplements to reduce the incidence and severity of vascular disease and cancer is the focus of major research efforts including ongoing intervention studies.     

Congenital heart defects and abnormal maternal biomarkers of methionine and homocysteine metabolism

BACKGROUND: It is well established that folic acid prevents neural tube defects. Although the mechanisms remain unclear, multivitamins containing folic acid may also protect against other birth defects, including congenital heart defects. OBJECTIVE: Our goal was to establish a maternal metabolic risk profile for nonsyndromic congenital heart defects that would enhance current preventive strategies. DESIGN: Using a case-control design, we measured biomarkers of the folate-dependent methionine and homocysteine pathway among a population-based sample of women whose pregnancies were affected by congenital heart defects (224 case subjects) or unaffected by any birth defect (90 control subjects). Plasma concentrations of folic acid, homocysteine, methionine, S-adenosylmethionine (SAM), S-adenosylhomocysteine (SAH), vitamin B-12, and adenosine were compared, with control for lifestyle and sociodemographic variables. RESULTS: After covariate adjustment, case subjects had higher mean concentrations of homocysteine (P < 0.001) and SAH (P < 0.001) and lower mean concentrations of methionine (P = 0.019) and SAM (P = 0.014) than did control subjects. Vitamin B-12, folic acid, and adenosine concentrations did not differ significantly between case and control subjects. Homocysteine, SAH, and methionine were identified as the most important biomarkers predictive of case or control status. CONCLUSIONS: The basis for the observed abnormal metabolic profile among women whose pregnancies were affected by congenital heart defects cannot be defined without further analysis of relevant genetic and environmental factors. Nevertheless, a metabolic profile that is predictive of congenital heart defect risk would help to refine current nutritional intervention strategies to reduce risk and may provide mechanistic clues for further experimental studies.     

影响育龄妇女叶酸增补的因素

出生缺陷已经成为影响新生儿健康和生命的主要疾病 ,神经管畸形及多种出生缺陷的发生与妇女孕早期叶酸缺乏有关 ,孕期前后增补叶酸可以降低胎儿多种出生缺陷的危险性。叶酸增补形式中最方便、经济而有效的是服用叶酸增补剂 ,但由于多种因素影响 ,育龄妇女叶酸增补剂服用率较低。可能影响育龄妇女叶酸增补的因素包括人口、经济及社会学特征 ,生理、心理事件 ,对叶酸的知识、态度和信念 ,以及行为干预等几个方面。     

Folic acid supplementation for pregnant women in Hungary

INTRODUCTION: Neural tube defects are common major congenital anomalies. Folic acid supplementation has been shown to reduce the incidence of neural tube defects. In 2003, incidence of neuroblastoma has decreased with 60% in Canada as a result of enriched cereal grain flours with synthetic folic acid. The aim of this study was to investigate the effect of the practice of the folic acid intake by pregnant women (based on the Hungarian recommendation) to the incidence of neural tube defects and neuroblastoma. METHODS: The practice of folic acid supplementation was examined by questionnaires filled according to the documentation of health visitors. The data were worked up by computer. The incidence of neural tube defect was obtained from the data of the Hungarian Congenital Anomalies Registry, however, the data of National Health Insurance Company are also given. The incidence of neuroblastoma was the data of the Hungarian Pediatric Tumor Registry. Regular folic acid intake has been recommended to pregnant women in Hungary, since the eighties of the last century. An official protocol had been released by the Obstetric and Gynecologic Professional Board in 1997. In this paper, the authors report the Hungarian pregnant women's folic acid intake in years of 2001, 2002 and 2003. These years were chosen, because according to the data of the Hungarian Pediatric Cancer Registry 45% of the neuroblastoma cases are less than 1 year old, and 45% of them are 1-5 years old at the time of diagnosis. The authors succeeded to collect the data from 95% of the pregnant women during these years (271,748 women). RESULTS: Based on the statistical analysis of the collected data, 69% of the pregnant women were regularly taking folic acid products in Hungary, however, the dose of the daily intake was below 5 mg. 93% of the pregnant women started the folic acid intake after their 7th weeks of pregnancy The incidence of neural tube defects was constant, and the incidence of neuroblastoma slightly increased during the above mentioned period. CONCLUSIONS: This work highlighted that, the folic acid intake to prevent neural tube defects was started too late, because the formation of neural tube is finished on 28. day of pregnancy. 85% of the pregnant women used less amount of folic acid than 5 mg/day. The increasing number of planned pregnancies would allow to start folic acid intake earlier. However, based on international experience, the enrichment of cereal grain flours with synthetic folic acid could provide optimal results.