含阿米卡星及左氧氟沙星方案治疗耐多药肺结核近期疗效观察

目的　观察和评估含阿米卡星及左氧氟沙星联合化疗方案在耐多药肺结核治疗中的疗效。方法 将 97例耐多药肺结核患者分为治疗组 48例和对照组 49例;化疗方案:治疗组以阿米卡星及左氧氟沙星为主,联合利福喷丁、异烟肼对氨基水杨酸钠、丙硫异烟胺、吡嗪酰胺;对照组用阿米卡星、利副喷丁、异烟肼对氨基水杨酸钠、丙硫异烟胺、吡嗪酰胺,疗程为 21月。结果 共有 93例患者完成化疗疗程。治疗组 46例,痰菌阴转率 87%;对照组 47例,痰菌阴转率 59.6%;痰菌阴转率治疗组明显高于对照组 (P＜0.01).结论 含阿米卡星及左氧氟沙星方案治疗耐多药肺结核有助于痰菌阴转和病变吸收好转,药物不良反应低,值得在临床上推广应用。     

中医功法对高血压干预效果系统评价的再评价

目的再评价中医功法干预高血压病人效果的系统评价。方法计算机检索PubMed、Cochrane Library、EBSCO、Web of Science、知网、万方、维普等数据库,检索时间为建库至2018年12月,收集常用中医功法干预高血压病的系统评价和Meta分析,采用AMSTAR量表及GRADE系统对纳入研究进行方法学质量和证据等级评价。结果本研究共纳入1 0篇系统评价文献。AMSTAR评价结果显示,纳入的系统评价方法学质量普遍不高。GRADE证据质量评价显示,共纳入44个结局指标,仅5个结局指标证据质量为中级,其余均为低级或极低级。结论中医功法干预高血压系统评价方法学质量和结论的证据质量较低,虽然中医功法配合药物或其他治疗高血压疗效确切,且未见明显不良反应,但单纯中医功法是否优于药物或其他常规运动需进一步探讨。     

左氧氟沙星联合奈替米星治疗耐多药肺结核临床疗效观察

目的　观察和评估左氧氟沙星联合奈替米星方案在耐多药肺结核治疗中的疗效。方法 102例耐多药肺结核患者随机分为治疗组52例和对照组50例。治疗组以左氧氟沙星及奈替米星为主,联合力克肺疾、丙硫异烟胺、吡嗪酰胺的化疗方案;对照组以氧氟沙星、力克肺疾、丙硫异烟胺、吡嗪酰胺、乙胺丁醇的化疗方案,疗程为12月。结果 全部102例患者完成化疗疗程。治疗组52例,痰菌阴转率86.5%;对照组50例,痰菌阴转率56.0%;痰菌阴转率治疗组明显高于对照组(P<0.01)。结论 对耐多药肺结核采用3DNZTHV/9DTHV方案,药物不良反应低,近期治疗效果满意,此方案值得在临床上试用。     

含左氧氟沙星方案治疗复治肺结核临床疗效的Meta分析

目的评价含左氧氟沙星方案治疗复治肺结核的临床疗效。 方法计算机检索中国生物医学文献光盘数据库、中国期刊全文数据库、万方数字化期刊、维普中文科技期刊等数据库,检索年限：1994年—2008年。按纳入、排除标准纳入合格的随机对照研究并对其进行质量评价, Meta分析采用RevMan4.2.7软件进行。 结果 共纳入8篇研究,包括791例患者,但这些研究的质量普遍不高。Meta分析结果表明,一线抗结核药加左氧氟沙星在提高痰菌阴转率、促进病灶吸收方面,优于一线抗结核药治疗复治肺结核。其OR和95%CI分别为3.70［2.59,5.27］、3.10［2.25,4.28］。左氧氟沙星方案与单纯一线抗结核药治疗比较,可能促进空洞闭合,其OR和95%CI为2.41［1.50,3.89］,但RR随机（95%CI）为1.63［0.99,2.68］。不良反应方面无统计学差异,其OR和95%CI为0.94［0.58,1.53］。 结论尽管有证据支持左氧氟沙星与一线抗结核药联用在提高痰菌阴转率、促进病灶吸收方面,优于一线抗结核药治疗复治肺结核。由于纳入研究的数量少、潜在的发表偏倚和质量不高,尚不能对其疗效得出肯定性的结论。因此,继续开展高质量、大样本的随机对照试验非常必要。     

力克肺疾、氧氟沙星、卷曲霉素、丙硫异烟胺联合治疗耐多药肺结核的临床观察

目的　分析耐多药肺结核患者采用3LiOCTh/3LiThC₃/6LiOTh方案治疗的临床效果。方法 1994年11月至1997年12月收治的54例同时耐INH、RFP的耐多药肺结核,采用3LiOCTh/3LiOThC₃/6LiOTh方案治疗,疗程中每月进行痰结核菌检查和肝功能检查,疗程的3、6、12个月摄胸片。结果 54例完成疗程时痰菌阴转率87%,随访24个月的痰菌复发率为12.8%,肝功异常率1.9%,无一例因副反应停药。结论 对耐多药肺结核采用3LiOCTh/3LiOThC₃/6LiOTh方案,治疗效果满意,药物副反应轻微,该方案值得在临床中推广应用。     

左氧氟沙星治疗耐多药肺结核近期疗效观察

目的　观察左氧氟沙星对耐多药肺结核的近期疗效。方法 92例耐多药肺结核患者随机分为治疗组 50例和对照组 42例，化疗方案分别是 3HKZThV/18HZTh，3HKZTh/18HZTh，观察两组痰菌阴转、病变吸收和症状改善情况。结果 治疗组 3月和 6月的痰菌阴转率、病变吸收率、症状改善率分别是 40.0%，58.0%；54.0%，72.0%；66.0%，76.0%，对照组分别是 19.0%，35.7%；33.3%，42.9%；38.1%，45.2%，两组之间有显著性差异 (P＜0.05)。结论 左氧氟沙星联合其他化疗药物 3月强化治疗耐多药肺结核效果明显。     

含药凝胶介入治疗耐多药空洞肺结核的初步临床研究

目的　评价经纤支镜灌注含药凝胶治疗耐多药肺结核的临床疗效和安全性。方法 治疗组用纤支镜灌注含药凝胶治疗和抗结核药物治疗,对照组用抗结核药物治疗。观察治疗效果。结果治疗 6月后,治疗组痰菌阴转率 73.1%,病灶治疗有效率 85.4%,空洞治疗有效率 81%,明显高于对照组 51.3%,56.7%和 51.4%(P＜0.05 ),治疗组痰菌阴转时间 36.3d,比对照组 61.8d明显缩短(P＜0.01 )。治疗组无严重不良反应。结论 经纤支镜含药凝胶灌注治疗耐多药肺结核疗效优于单纯药物治疗,是治疗耐多药肺结核病的一种有效、安全的方法。     

针灸治疗原发性高血压病系统评价的再评价

目的汇总当前针灸治疗原发性高血压病的系统评价,评价其方法学偏倚及其证据体质量。方法计算机检索Pubmed、EMbase、The Cochrane library、CBM、CNKI及Wangfang Data等中英文数据库,检索针灸疗法治疗原发性高血压病的系统评价,检索时限从建库到2016年11月。采用系统评价方法学质量评估工具AMSTAR评价纳入的系统评价方法学质量,采用GRADE系统方法学评估纳入的系统评价主要结局指标的证据质量。结果共纳入14个系统评价,7篇是中文文献,7篇是英文文献。对原始研究方法学质量评估使用risk of bias工具的有9篇,使用改良Jadad量表的有4篇,1篇使用改良牛津量表。AMSTAR工具评价结果显示,影响系统评价方法学质量的11个条目中,条目1"是否提供了前期方案",条目3"是否进行了全面的文献检索",条目4"发表状态是否已考虑在纳入标准中"和条目10"是否评估了发表偏倚的可能性"存在的方法学偏倚最大。GRADE系统方法学对主要结局指标进行了证据质量评估,均为低级别或者极低级别。结论当前针灸治疗原发性高血压病有一定疗效,但其证据质量级别较低,临床实际中应用该证据时应当慎重。     

微卡辅助治疗耐多药肺结核的临床研究

目的　探讨评价微卡(母牛分枝杆菌菌苗)治疗耐多药肺结核的疗效。方法 60例耐多药肺结核患者按入院先后顺序分为微卡加化疗组即治疗组,与单纯化疗组即对照组。化疗方案均为3PaL₂AKZThV/15PaL₂ZThV。治疗组为病人头3个月每15d肌注微卡(22.5μg),随后的3个月每月肌注1次微卡。观察2组治疗后肺部病灶吸收情况、痰菌阴转情况、症状改善情况、免疫功能变化情况。结果 治疗组与对照组3个月时痰菌阴转率分别为56.6%和26.6%,18个月时为93.3%和73.3%有显著差异(P<0.05);X线吸收率及空洞缩小、闭合率均有明显差异P<0.05;CD4⁺、CD4⁺/CD₈⁺9个月时治疗组与同组治疗前及对照组均有显著差异P<0.05。结论 微卡能调节免疫功能,提高痰菌阴转率,有助于病灶吸收空洞闭合,可作为耐多药肺结核化疗的辅助治疗。     

耐药性肺结核的手术治疗(附36例报告)

目的　探讨耐药肺结核的手术适应症及手术时机。方法 对1990～1997年我院收治的7000肺结核和36例耐药肺结核已手术治疗的病人的手术效果进行回顾分析。结果 36例肺结核病人,临床治愈率94%,痰菌阴转率84%,并发症发生率为13%。结论 对部分耐2～3种药的肺结核病人选择外科治疗仍是可行的,可提高耐药肺结核的治愈率,耐4种以上的肺结核病人术后并发症发生率高,应慎重选择。     

Methodological quality evaluation of systematic reviews or meta-analysis of trastuzumab-based therapy for breast cancer: A systematic review

Background:To evaluate the methodological quality of systematic reviews (SRs) or meta-analysis of trastuzumab-based therapy for breast cancer.Methods:We searched the PubMed, EMBASE, Web of science, Cochrane library, international prospective register of systematic reviews, Chinese BioMedical Literature Database, Wan Fang, China National Knowledge Infrastructure and VIP database for SRs or meta-analysis. The methodological quality of included literatures was appraised by risk of bias in systematic review (ROBIS) tool.Results:Twenty three eligible systematic reviews or meta-analysis were included. Only 2 systematic reviews provided protocol. The most frequently searched databases were PubMed, MEDLINE, EMBASE, and the Cochrane. The two-reviewers model described in the screening for eligible original articles, data extraction, and methodological quality evaluation had 30%, 61%, and 26%, respectively. In methodological quality assessment, 52% SRs or meta-analysis used the Jadad scoring or Cochrane reviewer’ handbook. Research question were well matched to all SRs or meta-analysis in phase 1 and 35% of them evaluated “high” risk bias in study eligibility criteria. The “high” risk of bias in all non-Cochrane SRs or meta-analyses, which involve methods used to identify and/or select studies. And more than half SRs or meta-analysis had a high risk of bias in data collection and study appraisal. More than two-third of SRs or meta-analysis were accomplished with high risk of bias in the synthesis and findings.Conclusions:The study indicated poor methodological and reporting quality of SRs/meta-analysis assessing trastuzumab-based therapy for breast cancer. Registration or publishing the protocol and the reporting followed the PRISMA checklist are recommended in future research.     

中医药治疗胆囊切除术后综合征的Meta分析

目的:以系统评价的方式分析中医药治疗胆囊切除术后综合征(PCS)的临床疗效。方法:系统地回顾了28篇符合纳入标准的随机对照试验文献并进行Meta分析,时间跨度为2004至2018年。OR值以及95%置信区间(CI)由每篇纳入的文献的原始数据中获得,经过计算发现各研究之间存在低异质性。结果:采用中医药的治疗组临床症状缓解率明显高于对照组(OR=5.47,95%CI 4.37~6.85,P<0.01)。结论:中药能有效改善PCS相关症状,相比于单纯西药对症治疗具有一定的优势。     

Effectiveness and safety of acupoint application for chronic obstructive pulmonary disease: A protocol for updated systematic review and meta-analysis

Background:Acute exacerbation is a primary cause of repeated hospitalization and death in chronic obstructive pulmonary disease (COPD) patients. Therefore, how to control the symptoms of COPD at stable stage and reduce the number of acute exacerbation is a hot spot of medical research. Acupoint application (AA) is a significant part of external treatment of traditional Chinese medicine (TCM), Previous researches have reported that AA can be applied to the treatment of COPD. Nevertheless, its effectiveness is still inconclusive. This systematic review (SR) and meta-analysis is designed to appraise its effectiveness and safety for the treatment of patients with COPD.Methods:Eight databases will be systematically retrieved from their inceptions to February 2021. Inclusion criteria are randomized control trials of AA combined with routine western medicine interventions in the treatment of COPD at stable stage. The primary outcomes we focus on comprise clinical effective rate, TCM symptom score, quality of life, dyspnea, exercise capacity, lung function, frequency of acute exacerbation, adverse events. The research screening, data extraction, and risk of bias assessment will be conducted by 2 individuals independently, and divergence will be adjudicated by a third senior investigator. The Stata 13.1 software will be used for meta-analysis. The confidence of evidence will be classified adopting grading of recommendations assessment, development and evaluation (GRADE) algorithm and methodological quality of this SR will be assessed using assessment of multiple systematic reviews-2 (AMSTAR-2) tool.Results:This SR will provide evidence-based medical proof for the treatment of COPD at stable stage by AA combined with conventional western medicine interventions. The findings of this SR will be presented at relevant conferences and submitted for peer-review publication.Conclusions:The findings of this SR will provide up-todated summary proof for evaluating the effectiveness and safety of AA for COPD.Registration number:INPLASY 202140080.     

Traditional Chinese medicine foot bath combined with acupoint massage for the treatment of diabetic peripheral neuropathy: A systematic review and meta‐analysis of 31 RCTs

In this study, we aim to evaluate the efficiency and safety of traditional Chinese medicine foot bath combined with acupoint massage for the treatment of diabetic peripheral neuropathy. A total of eight online databases were searched to collect studies published up to February 2019. Study quality of each included article was evaluated by the Cochrane Collaboration risk of bias tool. Systematic reviews and meta‐analyses were conducted based on the Cochrane systematic review method by using the RevMan 5.3 software. Traditional Chinese medicine foot bath combined with acupoint massage was the main therapy in experimental group. Interventions in control groups include western medicine, oral traditional Chinese medicine, other symptomatic treatment of western medicine, and blank control. Primary outcomes in this study include sensory nerve conduction velocity (SNCV), motor nerve conduction velocity (MNCV), total effective rate, and neuropathic syndrome score. Finally, 31 trials involving 3284 participants were included. The results of systematic reviews and meta‐analyses showed that traditional Chinese medicine foot bath combined with acupoint massage was significantly better compared with the control groups in terms of the total effective rate, SNCV, MNCV, and neuropathic syndrome score. No case of adverse effect was reported. These findings show that traditional Chinese medicine foot bath combined with acupoint massage may be safer and more effective for the treatment of DPN. However, due to the low methodological quality, further research with randomized controlled trials (RCTs) of higher quality is required to prove its efficacy and better evidence for clinical treatment.     

中西医结合治疗HBV相关性慢加急性肝衰竭HBV DNA转阴率的Meta分析

目的:通过Meta分析评价中西医结合治疗HBV相关性慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)HBV DNA转阴率的影响。方法:计算机检索建库至2018年12月31日公开发表的中西医结合治疗HBV相关性慢加急性肝衰竭的随机对照试验(RCT)研究文献,双人独立筛选判定后进行文献质量评价,应用Revman 5.3软件对提取的数据进行Meta分析。结果:纳入文献5篇,共计病例368例。Meta分析结果显示,试验组HBV DNA转阴率与对照组HBV DNA转阴率差异无统计学意义[Z=1.62,RR=1.24,95%CI(0.96,1.62),P=0.10];发表偏倚分析显示纳入文献发表偏倚较小。结论:中西医结合治疗HBV相关性慢加急性肝衰竭在HBV DNA转阴率方面不占优势。     

The effectiveness and safety of Chinese herbal formulas on skin photoaging: A protocol for systematic review and meta-analysis

Background:Skin photoaging (SP) is a complex and complicated process of skin characteristic changes caused by excessive sunlight. Wrinkles, looseness, coarseness, and increase or loss of pigment are the main clinical manifestations of the disease. The pathogenesis of SP mainly involving oxidative stress, inflammatory reaction, immune dysregulation and DNA damage, and so on. In recent years, traditional Chinese medicine, as an significant form of complementary and alternative medicine, has attracted the more and more attention within the field of health care and indicated a desirable effect on SP. Chinese herbal formula (CHF) is an essential part of traditional Chinese medicine interventions, and the number of clinical trails on SP treated by CHFs have shown a growing trend. Therefore, we developed this systematic review and meta-analysis protocol to assess the effectiveness and safety of CHFs in the therapy of SP, so as to provide reliable evidence-based evidence for clinical decision-making.Methods:A overall literature retrieval will be carried out in 9 electronic journal database. We will include randomized controlled trials (RCTs) on CHFs alone or combined with routine western medicine measures in the treatment of SP. The outcomes we focused on are consists of symptom score (skin relaxation, telangiectasia, pore coarseness, pigmentation, etc), total effective rate, and adverse reactions. Meta-analysis will be performed using Stata 13.0 software. Literature retrieval and screening, data extraction, risk of bias assessment of RCTs, evidence confidence rating by grading of recommendations assessment, development, and evaluation method and methodological quality assessment of systematic review by assessment of multiple systematic reviews-2 will be conducted independently by 2 reviewers, and disagreements will be resolved through discussion or judged by a third senior reviewer.Results:This systematic review and meta-analysis will pool the proof of RCTs on SP treated by CHFs alone or combined with conventional western medicine treatments. The findings of this study will be presented at relevant conferences and submitted to peer-reviewed journals for publication.Conclusion:We expect that the results of this systematic review will provide comprehensive and reliable evidence for clinicians and policy makers.Registration number:INPLASY 2020120005     

Effectiveness and safety of Chinese herbal formula combined with western medicine for ankylosing spondylitis: A protocol for systematic review and meta-analysis

Background:Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease of the spine, which mainly invades the sacroiliac joint, spine, and large joints near the trunk, leading to fibrous and skeletal ankylosis and deformity, and can cause damage to the eyes, lung, cardiovascular, kidney and other organs. Chinese herbal formulas (CHF) is an important interventions of Traditional Chinese Medicine (TCM), and CHFs combined with western medicine are widely used in clinical practice to treat AS.Methods:Eight databases will be systematically retrieved from their inceptions to March 2021. Only randomized controlled trials (RCTs) of CHFs combined with western medicine for AS treatment will meet the inclusion criteria. The primary outcomes we focus on include clinical effectiveness rate, TCM syndrome score, TCM symptom score, Bath ankylosing spondylitis disease activity index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), chest expansion, nocturnal spinal pain, adverse reactions, erythrocyte sedimentation rate (ESR), and C protein response (CRP). The research screening, data extraction, and risk of bias assessment will be performed independently by 2 researchers, and divergence will be solved by a third researcher. Revman 5.3 software will be used for meta-analysis. The confidence of evidence will be graded using grading of recommendations assessment, development, and evaluation (GRADE) algorithm and methodological quality will be assessed adopting risk of bias in systematic reviews (ROBIS).Results:This systematic review (SR) will provide evidence-based medical evidence for AS therapy by CHF combined with western medicine and we will submit the findings of this SR for peer-review publication.Conclusions:This SR will provide latest and updated summary proof for assessing the effectiveness and safety of CHF combined with western medicine for AS.Registration number:INPLASY 202150089.     

中国耐多药结核病发病危险因素的Meta分析

目的 系统评价中国发生耐多药结核病(MDR-TB)的主要危险因素并进行分析,为我国提供有效预防MDR-TB的措施,达到病因预防(一级预防)的目的。方法 时间限定为2005年1月至2019年5月,在英文数据库(PubMed、Embase、Web of Science、Cochrane Library)和中文数据库(中国知网、万方、中国生物医学文献服务系统与维普)检索中国耐多药结核病发病危险因素的相关论文,经过对论文的筛选、提取资料和质量评价后进行Meta分析。结果 根据检索结果、入选及排除标准,共纳入55篇论文,通过Meta分析,发现MDR-TB相关的危险因素有9种。结果显示外省户籍人口(OR=1.92;95%CI=1.48~2.51)、家庭收入低下(OR=2.12;95%CI=1.72~2.63)、患者分类为复治患者(OR=6.28;95%CI=4.72~8.36)、既往有抗结核药物治疗史(OR=5.73;95%CI=4.56~7.20)、既往抗结核药物治疗史次数≥2次(OR=4.41;95%CI=3.35~5.80)、药物不良反应(OR=4.89;95%CI=2.48~9.62)、中断治疗(OR=3.59;95%CI=2.02~6.38)、肺部空洞(OR=1.56;95%CI=1.25~1.93)和吸烟(OR=1.59;95%CI=1.12~2.25)与MDR-TB的发病密切相关。结论 中国MDR-TB的发病危险因素可能为外地人口、家庭收入低下、复治患者、既往抗结核治疗史、既往抗结核治疗史次数≥2次、药物不良反应、中断治疗、肺部空洞和吸烟史。     

Clinical efficacy and safety of Shuxuetong injection for acute myocardial infarction: A protocol for systematic review and meta-analysis

Background:Shuxuetong injection (SXT) is a Chinese medicine injection and has been widely used for the treatment of acute myocardial infarction (AMI) in Asia. However, whether SXT has a definite efficacy and safety is poorly understood. The aim of our study was to clarify the effect of SXT on clinical symptoms alliavation and survival in AMI patients.Methods:A systematic reviews of SXT combined with conventional therapy treating AMI will be searched in 8 electronic databases including PubMed, Cochrane Library, Embase, Wanfang Database, China Biology Medicine (CBM), Google Scholar, Chinese Scientific Journal Database (VIP), and China National Knowledge Infrastructure (CNKI), from inception to December 2020. The literature will extracted by 2 researchers independently and the methodological quality of the included study will be evaluated. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to evaluate the evidence quality of the included literature. RevMan software (version 5.3) will be applied for the original research data synthesis.Results:The results of our study will be published in a peer reviewed journal.Conclusion:Our meta-analysis will provide the latest evidence to determine whether SXT is an effective intervention for AMI patients.     

中西医联合与单纯西医治疗结核病所致药物性肝损伤的对比分析(2000—2019年文献复习)

目的 通过搜集文献分析中西医联合治疗结核病所致药物性肝损伤的发生情况,为临床合理用药提供参考。方法 通过计算机检索2000年1月至2019年7月国内外数据库(中国知网、万方数据知识服务平台、维普网、PubMed)公开发表的中西医联合治疗结核病的相关文献,纳入原发病为结核病,试验组为中西医联合抗结核药物治疗方案,对照组为西医抗结核药物治疗方案,文献中有肝损伤病例报告,肝损伤患者原发疾病、用药方法与剂量等资料的文献。通过阅读摘要和全文剔除不符合要求(非临床试验研究、文献回顾性研究、综述等)的文献、文献信息提供不完整或出现错误,以及质量较低或数据可信度差的文献,最终纳入22篇文献。采用SPSS 23.0软件对数据进行统计学分析,计数资料的比较采用χ ²检验,以P<0.05为差异有统计学意义。结果 纳入的22篇文献中,结核病患者2561例。试验组的肝损伤发生率[12.05%(156/1295)]明显低于对照组[24.33%(308/1266)](χ ²=65.096,P<0.001)。其中试验组的初治方案、复治方案、耐药结核病方案患者肝损伤的发生率[分别为10.65%(23/216)、4.35%(3/69)、10.86%(19/175)]明显低于对照组[分别为25.12%(54/215)、13.04%(9/69)、26.75%(42/157)](χ ²=15.371,P<0.001;χ ²=3.286,P=0.070;χ ²=13.940,P<0.001)。 结论 与单纯西医抗结核药物治疗方案相比,中西医联合治疗方案能在一定程度上减少抗结核药物治疗所致药物性肝损伤的发生。