肺部多叶病变对老年获得性肺炎住院患者预后影响的Meta 分析

目的：应用Meta分析探讨肺部多叶病变与老年获得性肺炎住院患者预后影响的相关性。方法：检索中国 全文期刊数据库、万方数据知识服务平台、维普期刊全文数据库、中国生物医学文献数据库、PubMed和EMBase,检 索起止时间均为建库至2014年7月,按照纳入和排除标准收集所有有关的研究文献。采用RevMan 5.2软件进行Meta分 析,进行异质性检验并计算比值比(odds ratio,OR)及其95%可信区间(95% confidence interval,95% CI),采用漏斗图和 Egger法评估发表偏倚,并进行敏感性分析。结果：最终纳入10篇文献,1 836例研究对象,其中病例(死亡组)487例, 对照(存活组)1 349例。Meta分析结果显示：肺部多叶病变与老年获得性肺炎预后相关(合并OR值为3.22,95% CI为 1.84~5.63)。结论：肺部多叶病变会增加老年获得性肺炎住院患者的预后死亡风险。     

LncRNA HOTAIR 表达水平与肿瘤患者预后关系的 Meta 分析

目的：系统评价长链非编码RNA(long non-coding RNA,lncRNA)HOTAIR表达水平与肿瘤患者预后的关系。 方法：利用计算机检索The Cochrane Library,EMBASE,MEDLINE,PubMed等数据库中关于lncRNA HOTAIR表达与 肿瘤预后相关性的英文文献,检索文献发表时间从建库到2015年9月,提取相关数据后采用RevMan5.3软件进行Meta 分析。结果：最终纳入17篇文献,共1 639例患者。Meta分析结果显示：lncRNA HOTAIR高表达与肿瘤患者的低总生 存期相关 (HR: 2.39,95% CI：2.01~2.86,P<0.001);消化道肿瘤与非消化道肿瘤亚组分析均显示HOTAIR高表达患者 总生存期缩短 (消化道肿瘤HR：2.51,95% CI：2.02~3.11,P<0.001。非消化道肿瘤HR：2.17,95% CI：1.59~2.98, P<0.001)。HOTAIR高表达与肿瘤患者的低无瘤复发生存期明显相关(HR：4.25,95% CI：2.25~8.03,P<0.001)。 结论：LncRNA HOTAIR高表达与肿瘤的不良预后有一定的关系。     

他汀类药物治疗与癌症的患病危险汇总分析

背景：随机对照试验证实，他汀类降胆固醇药物能够预防心脏事件的发生。近来的回顾性分析提示，他汀类药物还可预防癌症。 目的：观测他汀类药物治疗对癌症发生和癌症死亡的影响，分析他汀类药物对不同类型癌症的作用，探讨他汀亲脂性或其来源的作用。 数据来源：使用特定的检索词对2005年7月以前的MEDLINE、EMBASE、CLINAHL、Web of Science、CANCERLIT和Cochrane系统综述数据库进行系统文献检索。审查心脏病和癌症摘要，对论文参考文献亦进行人工审查。 研究选择：在筛查的8943篇（n=86936）文献中，27篇符合入选标准。27篇论文共报道了26项他汀类药物随机对照试验。这些研究至少平均随访1年，每项研究至少入选100例患者。研究提供了癌症发生（n=20项研究）或癌症死亡（n=22项研究）数据。 资料提取：3位研究者使用标准的资料提取工具独立地提取所有资料。应用随机效应模型（DerSimonian和Laird法），加权均值报告为优势比（odds ratios，ORs）和95％可信区间（confidence intervals，CIs）。应用Q统计评估统计学异质性。 资料综合：汇总分析共包括6662例癌症和2407例癌症死亡。结果显示，他汀类药物并未降低癌症的发生（OR，1．02；95％CI，0．97～1．07）或癌症死亡（OR，1．01；95％CI，0．93～1．09），也未见任何类型癌症的减少。无论是亲水性他汀或亲脂性他汀、天然他汀或人工合成他汀都没有影响癌症的发生。 结论：在随机对照试验中，他汀类药物对癌症发生和癌症死亡的危险呈中性效应。我们发现，癌症类型不受他汀类药物使用与否的影响，不同他汀类药物亚型（亲水或亲脂性、天然或人工合成）对癌症的危险亦无影响。     

血清半乳糖凝集素3水平与慢性心力衰竭及其预后关系的Meta分析

目的:通过Meta分析方法评价新近推荐的慢性心力衰竭标志物--血清半乳糖凝集素3(Gal-3)与慢性心力衰竭的预后关系。方法:选择PubMed数据库、EMbase数据库和中国生物医学文献数据库等权威数据库,检索关于Gal-3与GHF预后关系的中、英文文献,按制定的纳入标准与排除标准筛选文献,提取风险比(HR)及其 95%可信区间(CI)。对纳入的文献进行质量评价,采用 STATA 12.1软件进行 Meta 分析,并进行敏感性分析和发表偏倚分析评价结果的稳定性和可靠性。结果:最终纳入10篇符合要求的文献,均为英文文献。1在未排除其他影响预后因素的单变量分析时,异质性分析显示 P=0.000,I²=89.2%,异质性检验表明研究具有异质性,故采用随机效应模型合并统计量,单变量分析的 HR合并后数值为1.36,95% CI:1.23~1.50。2在排除其他影响因素的多变量分析时,异质性分析显示 P<0.001,I²=68.4%,异质性检验表明研究具有异质性,故采用随机效应模型合并统计量,多变量分析的 HR合并后数值为1.17,95% CI:1.07~1.26。3敏感性分析显示,去除样本量最大的文献,单变量分析的HR合并后数值为1.54,95% CI:1.32~1.77;多变量分析的HR合并后数值为1.26,95% CI:1.09~1.42;去除样本量最小的文献,单变量分析的HR合并后数值为1.34,95% CI:1.20~1.47;多变量分析的HR合并后数值为 1.15,95% CI:1.06~1.24。结论:CHF患者血清Gal-3水平明显升高,可作为 CHF 不良预后的独立预测因子。     

哺乳动物雷帕霉素靶蛋白的表达及其与乳腺癌预后关系的Meta分析

目的：探讨哺乳动物雷帕霉素靶蛋白（mTOR）的表达及其与乳腺癌预后的关系,为mTOR抑制剂靶向治疗乳腺癌提供循证医学证据。方法：计算机检索PubMed、EMBase、Cochrane Library、ISI Web of Science和中国知网等数据库2015年12月24日之前的文献,收集mTOR表达与乳腺癌预后关系的研究,主要结局指标包含无病生存期（DFS）、总生存期（OS）;以风险比（HR）为效应量,各效应量以95%可信区间（CI）表示,采用STATA 12.0统计软件进行Meta分析。结果：纳入7项队列研究,共1758例患者。Meta分析,mTOR阳性表达乳腺癌患者发生复发和转移的风险是mTOR阴性表达患者的2.05倍（HR = 2.05,95% CI：1.01~4.13,P = 0.003）;mTOR阳性表达乳腺癌患者发生死亡的风险是mTOR阴性表达患者的2.63倍（HR = 2.63,95% CI：1.45~4.80,P = 0.736）。结论：mTOR表达阳性明显增加乳腺癌患者复发转移及死亡风险。     

地高辛用于心房颤动患者相关死亡风险的Meta分析

目的 探究服用地高辛与心房颤动患者死亡风险的关系.方法 检索PubMed、EMbase文献数据库中地高辛用于心房颤动治疗的相关性研究,应用STATA12.0进行敏感性分析及发表偏倚分析,并进行综述.结果 共纳入文献15篇、323 096例心房颤动患者,Meta分析显示地高辛的应用将使心房颤动患者增加20％的总体死亡风险[HR(95％CI)=1.20(1.14,1.27),P＜0.05],敏感性分析显示结果稳健;其中使合并心力衰竭患者的死亡风险增加17％[HR(95％CI)=1.17(1.09,1.25),P＜0.05],不伴心力衰竭患者增加34％[HR(95％CI) =1.34(1.14,1.57),P＜0.05].结论 无论是否伴有心力衰竭,服用地高辛均可能增加心房颤动患者的死亡风险.     

发病前他汀类药物使用对缺血性脑卒中静脉溶栓疗效及安全性分析

目的：研究发病前他汀类药物使用对急性缺血性脑卒中静脉溶栓患者的疗效与安全性的影响。方法回顾性分析脑梗死溶栓患者187例,预后评价标准：短期有效（脑卒中时与1周NIHSS评分差值≥4或8分）、长期有效（3个月mRS评分≤2或1分）、颅内出血、症状性颅内出血及死亡。筛选Pubmed和Embase中包含以上评价标准的文献,用Review Manager 5．2．6进行荟萃分析。结果单因素分析中,脑卒中前服用他汀类药物在短期有效,差异有统计学意义（ OR＝2．01,95％ CI：1．06～3.90,P＝0．030）。多因素分析中,脑卒中前服用他汀类药物与各项预后评价指标无关。荟萃分析中,脑卒中前服用他汀类药物与症状性颅内出血（OR＝1．49,95％CI：1．16～1．90,P＝0．001）相关,与长期预后良好、死亡无关。结论缺血性脑卒中溶栓患者发病前他汀类药物使用与预后关系不大,脑卒中前他汀类药物服用与静脉溶栓的联合治疗可能是安全的。     

他汀类药物对血同型半胱氨酸水平影响的meta分析

目的探讨他汀类降脂治疗对血同型半胱氨酸水平的影响及其临床意义。方法 计算机检索PubMed、EMBASE、Cochrane图书馆、Medline、CNKI、中国生物医学文献数据库和维普中文科技期刊等数据库,检索时间从建库至2013年所有他汀类药物对血同型半胱氨酸(homocysteine, Hcy)影响的随机对照试验(RCTs),由2名评价员独立筛选、评价文献和提取数据;应用系统评价软件R语言meta包对纳入研究进行加权定量合并,计算标准化均数差(standard mean difference, SMD)和95% CI,并绘制漏斗图来明确有无发表性偏倚。结果 共纳入26篇文献,32个研究,共计患者2451例。他汀类药物对Hcy影响的Meta分析结果显示: 与对照组相比,治疗组(在前者基础上加用他汀类药物)他汀类药物具有明显降Hcy作用(SWD=1.41,95%CI: 1.04～1.78,P<0.001);对不同他汀类药物进行亚组meta分析,提示各亚组效应与总效应方向一致。结论 他汀类药物能有效地降低患者的Hcy水平。     

PCI术前强化应用他汀类药物预防心肌无复流的Meta分析

目的:系统评价术前强化应用他汀类药物与常规应用他汀类药物对经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性冠脉综合征(ACS)患者术中心肌无复流现象的预防作用。方法:通过检索Pub Med、Medline、Science、Embase、Cochrane图书馆、CNKI、万方和维普数据库收集PCI术前强化应用他汀类药物以预防术中心肌无复流疗效的随机对照试验。检索文献时限为从建库至2014年7月,并依据Jadad评分标准对纳入文献的质量进行严格评价和资料提取。采用Rev Man 5.3软件进行Meta分析。结果:共纳入6项随机对照研究,包括针对855例经PCI治疗的ACS患者,其中使用强化他汀类药物治疗的患者429例,使用常规他汀类药物治疗的患者426例。Meta分析结果显示,强化他汀类药物治疗组的PCI术中心肌无复流发生率为9.56%,明显低于常规他汀类药物治疗组的26.06%(OR=0.28,95%CI:0.19~0.41)。结论:PCI术前强化应用他汀类药物比常规应用他汀类药物能明显减少ACS患者术中心肌无复流的发生率。     

他汀类药物治疗心肌梗死临床疗效的Meta分析

目的:评价他汀类药物治疗心肌梗死的临床疗效。方法:系统检索Pubmed、Embase、Cochrane Library、中国生物医学数据库、中国期刊全文数据库、维普数据库、万方数据库、知网数据库,检索日期2005年1月～2018年12月。纳入他汀类药物治疗心肌梗死的临床随机对照试验(RCT),采用Revman 5.2软件进行Meta分析。结果:共纳入20项RCT,合计3 448例患者,其中试验组1 674例,对照组1 774例。Meta分析结果显示:与对照组相比,实验组心肌梗死患者死亡率显著降低[OR=0.40, 95%CI(0.33-0.49),P<0.000001]。结论:他汀类药物可降低心肌梗死患者的死亡风险。     

Yogurt Intake Reduces All-Cause and Cardiovascular Disease Mortality: A Meta-Analysis of Eight Prospective Cohort Studies

Objective: To assess the relationship between yogurt intake and mortality risk from prospective cohort studies. Methods: The PubMed, EMBASE, and Web of Science databases were searched for all records related to yogurt intake and mortality risk [all-cause or cardiovascular disease (CVD) or cancer mortality] before October 1, 2018. The Newcastle-Ottawa Quality Scale was used to estimate the quality of all eligible articles. The results of the highest and lowest categories of yogurt intake in each study were collected and the effect size was pooled using a random effects model. The dose-response analysis was calculated using the generalized least squares trend estimation model. Results: Eight eligible cohort studies were included in this meta-analysis. There were 235,676 participants in the 8 studies, and the number of deaths was 14,831. Compared with the lowest category, the highest category of yogurt intake was not significantly related with all cause mortality [hazard ratio (HR)=0.93; 95% confidence interval (CI): 0.85, 1.01], CVD mortality (HR=0.92; 95% CI: 0.81, 1.03) and cancer mortality (HR=0.97; 95% CI: 0.83, 1.12). These studies were homogenous, since the homogeneity test showed that I2 was 28.7%, 15.1% and 11.8%, respectively. However, yogurt intake 200 g/d was significantly associated with a lower all-cause mortality (HR=0.88; 95% CI: 0.80, 0.96) and CVD mortality (HR=0.87; 95% CI: 0.77, 0.99) in the subgroup analysis. The dose-response analysis showed that yogurt intake of 200 g/d was inversely associated with all-cause mortality (P=0.041, HR=0.95, 95% CI: 0.92, 1.00) and CVD mortality (P=0.009, HR=0.92, 95% CI: 0.86, 0.98), and all of which were linear relationship (P>0.05). Conclusions: This review provided the evidence regarding yogurt intake can reduce all-cause and CVD mortality. Although some positive findings were identified, more high-quality cohort studies and randomized controlled trials are warranted on a possible protective effect of yoghurt on health.     

Association between serum uric acid level and mortality in China

Background:Whether there is an association between serum uric acid (SUA) level and risk of mortality in the general population remains unclear. Based on the China National Survey of Chronic Kidney Disease linked to mortality data, a population-based cohort study was performed to investigate the association between SUA level and all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality in China.Methods:The survival status of participants in the cross-sectional survey was identified from January 1, 2006 to December 31, 2017. Only 33,268 individuals with complete SUA data among the 47,204 participants were included in the analysis. We determined the rates of all-cause mortality, CVD mortality, and cancer mortality. We used Cox proportional hazards regression models to evaluate the effect of the SUA level on mortality.Results:During a total of 297,538.4 person-years of follow-up, 1282 deaths occurred. In the Cox proportional hazards regression model, the rate of all-cause mortality, CVD mortality, and cancer mortality had a U-shaped association with SUA levels only in men, whereas no significant associations were detected in women. For all-cause mortality in men, the multivariable-adjusted hazard ratios (HRs) in the first, second, and fourth quartiles compared with the third quartile were 1.31 (95% confidence interval [CI] 1.04–1.67), 1.17 (95% CI 0.92–1.47), and 1.55 (95% CI 1.24–1.93), respectively. For CVD mortality, the corresponding HRs were 1.47 (95% CI 1.00–2.18), 1.17 (95% CI 0.79–1.75), and 1.67 (95% CI 1.16–2.43), respectively. For the cancer mortality rate, only a marginally significant association was detected in the fourth quartile compared with the third quartile with an HR of 1.43 (95% CI 0.99–2.08).Conclusions:The association between SUA and mortality differed by sex. We demonstrated a U-shaped association with SUA levels for all-cause and CVD mortalities among men in China.     

Independent and joint association of physical activity and sedentary behavior on all-cause mortality

Backgrounds:Physical activity (PA) and sedentary behavior (SB) have been associated with mortality, while the joint association with mortality is rarely reported among Chinese population. We aimed to examine the independent and joint association of PA and SB with all-cause mortality in southern China.Methods:A cohort of 12,608 China Hypertension Survey participants aged ≥35 years were enrolled in 2013 to 2014, with a follow-up period of 5.4 years. Baseline self-reported PA and SB were collected via the questionnaire. Kaplan–Meier curves (log-rank test) and Cox proportional hazards regression were performed to evaluate the associations of PA and SB on all-cause mortality.Results:A total of 11,744 eligible participants were included in the analysis. Over an average of 5.4 years of follow-up, 796 deaths occurred. The risk of all-cause mortality was lower among participants with high PA than those with low to moderate level (5.2% vs. 8.9%; hazards ratio [HR]: 0.75, 95% confidence interval [CI]: 0.61–0.87). Participants with SB ≥ 6 h had a higher risk of all-cause mortality than those with SB <6 h (7.8% vs. 6.0%; HR: 1.37, 95% CI: 1.17–1.61). Participants with prolonged SB (≥6 h) and inadequate PA (low to moderate) had a higher risk of all-cause mortality compared to those with SB < 6 h and high PA (11.2% vs. 4.9%; HR: 1.67, 95% CI: 1.35–2.06). Even in the participants with high PA, prolonged SB (≥6 h) was still associated with the higher risk of all-cause mortality compared with SB < 6 h (7.0% vs. 4.9%; HR: 1.33, 95% CI: 1.12–1.56).Conclusions:Among Chinese population, PA and SB have a joint association with the risk of all-cause mortality. Participants with inadequate PA and prolonged SB had the highest risk of all-cause mortality compared with others.     

贫血及慢性肾脏病对糖尿病人群心脑血管事件发生与死亡的影响

目的：探讨糖尿病人群中贫血与心脑血管事件发生和死亡风险的关系,并评价其关联是否受慢性肾脏病（chronic kidney disease,CKD）的影响。方法： 基于开滦研究的前瞻性队列数据,收集2010-2011年符合纳入和排除标准的8 563例糖尿病患者的体检资料。末次随访时间为2015年12月31日,终点事件包括全因死亡和发生心脑血管疾病。采用Kaplan-Meier法进行生存分析,构建Cox比例风险回归模型,评估调整混杂因素后贫血及CKD与心脑血管事件发生和全因死亡的关联强度。结果：研究对象的平均年龄为（57.3 ± 10.3）岁,其中贫血患者占5.2%。贫血患者合并CKD的比例高于非贫血患者（27.2% vs. 20.8%,P=0.001）。研究对象的中位随访时间为4.9年（四分位数间距4.6~5.2年）, 随访期间死亡559人,发生心脑血管事件434人。贫血患者的全因死亡率高于非贫血患者（3 220.3/10万人年 vs. 1 257.9/10万人年,P<0.001）,而贫血与非贫血两组的心脑血管疾病发病率差异无统计学意义（999.8/10万人年 vs. 1081.2/10万人年,P>0.05）。CKD患者的全因死亡率和心脑血管疾病的发病率都要高于非CKD患者（2 558.3/10万人年 vs. 1 044.0/10万人年,P<0.001;1 605.9/10万人年 vs. 941.6/10万人年,P<0.001）。Cox回归模型结果显示,调整混杂因素后,贫血使糖尿病患者的死亡风险增加95%（HR=1.95,95% CI：1.50~2.54）,贫血合并CKD则会显著增加死亡风险（HR=3.61,95% CI：2.48~5.26）,非贫血但合并CKD会使糖尿病患者发生心脑血管疾病的风险增加（HR=1.41,95% CI：1.13~1.74）。结论：中国糖尿病人群中,贫血会增加患者的死亡风险,CKD会增加患者心脑血管疾病发生和死亡的风险,贫血合并CKD则会使死亡风险显著增加,应重点加强对贫血合并CKD的糖尿病患者的防治。     

心脏瓣膜钙化对维持性血液透析患者心血管预后的影响

目的探讨心脏瓣膜钙化（HVC）对维持性血液透析（MHD）患者心血管预后的影响。方法入组2009~2011年302例MHD 患者（其中99例伴HVC）,所有患者随访2年,采用生存曲线分析心血管终点事件,Cox回归分析心脏瓣膜钙化对心血管预后的 影响。结果患者初始透析的平均年龄为58.2岁,男性占53.6%。随访2年,HVC与非HVC组患者全因死亡、心血管死亡和新 发心血管事件发生率分别为30.3% vs 16.3%、22.2% vs 6.9%和48.5% vs 25.6%（P<0.05）。生存曲线分析显示两组在全因死亡率 （Log Rank P=0.006）、心血管死亡（P<0.001）和新发心血管事件（P<0.001）方面均存在统计学差异。Cox回归分析显示,校正后 HVC 仍然显著增加患者全因死亡[HR 1,88,95%CI：（1.11-3.19）]、心血管死亡[3.47（1.76-6.84）]和新发心血事件风险[1.64 （1.09-2.47）]。结论HVC是MHD患者心血管死亡及新发心血管事件的独立危险因素。     

早期他汀药物治疗与非缺血性扩张性心肌病患者病死率关系的研究

目的 探讨早期脂溶性他汀药物(阿托伐他汀和辛伐他汀)治疗与非缺血性扩张性心肌病患者病死率的关系.方法 本研究为单中心回顾性研究,入选了2002年1月至2008年12月在北京安贞医院住院治疗的非缺血性扩张性心肌病患者315例,比较患者初次入院期间应用他汀药物组(辛伐他汀20 mg/d或阿托伐他汀10～20 mg/d)和未应用他汀药物治疗组随访全因病死率,中位随访时间为45.1个月.结果 他汀组58例,未用他汀组257例,单因素分析,应用他汀组随访病死率为17.2%,显著低于未应用他汀治疗组37.4%(P=0.003);心功能NYHA Ⅲ～Ⅳ患者中,他汀组的病死率为17.2%,非他汀组病死率高达47.4%,两组差异有统计学意义(P=0.003);心功能NYHA Ⅰ～Ⅱ级患者中,两组随访病死率差异无统计学意义.多因素分析,在校正了年龄、性别、高血压史、糖尿病史、当前吸烟、血脂、左室射血分数、NYHA心功能分级及是否使用血管紧张素转换酶抑制剂(ACEI)、β受体阻滞剂、醛固酮、其他利尿剂、地高辛和钙离子拮抗剂,总研究人群中他汀组的死亡相对危险度(RR)为0.352(95% CI0.135～0.920,P=0.033),心功能NYHA Ⅲ～Ⅳ患者中他汀组的死亡RR为0.250(95% CI 0.081～0.778,P=0.017).结论 早期阿托伐他汀或辛伐他汀药物治疗与非缺血性扩张性心肌病患者的病死率降低密切相关,特别是中重度心功能不全患者的病死率降低,而这种相关是独立于他汀药物的降脂作用及ACEI、β受体阻滞剂等目前心衰治疗基石作用的.     

Validating drug repurposing signals using electronic health records: a case study of metformin associated with reduced cancer mortality

Objectives Drug repurposing, which finds new indications for existing drugs, has received great attention recently. The goal of our work is to assess the feasibility of using electronic health records (EHRs) and automated informatics methods to efficiently validate a recent drug repurposing association of metformin with reduced cancer mortality.Methods By linking two large EHRs from Vanderbilt University Medical Center and Mayo Clinic to their tumor registries, we constructed a cohort including 32 415 adults with a cancer diagnosis at Vanderbilt and 79 258 cancer patients at Mayo from 1995 to 2010. Using automated informatics methods, we further identified type 2 diabetes patients within the cancer cohort and determined their drug exposure information, as well as other covariates such as smoking status. We then estimated HRs for all-cause mortality and their associated 95% CIs using stratified Cox proportional hazard models. HRs were estimated according to metformin exposure, adjusted for age at diagnosis, sex, race, body mass index, tobacco use, insulin use, cancer type, and non-cancer Charlson comorbidity index.Results Among all Vanderbilt cancer patients, metformin was associated with a 22% decrease in overall mortality compared to other oral hypoglycemic medications (HR 0.78; 95% CI 0.69 to 0.88) and with a 39% decrease compared to type 2 diabetes patients on insulin only (HR 0.61; 95% CI 0.50 to 0.73). Diabetic patients on metformin also had a 23% improved survival compared with non-diabetic patients (HR 0.77; 95% CI 0.71 to 0.85). These associations were replicated using the Mayo Clinic EHR data. Many site-specific cancers including breast, colorectal, lung, and prostate demonstrated reduced mortality with metformin use in at least one EHR.Conclusions EHR data suggested that the use of metformin was associated with decreased mortality after a cancer diagnosis compared with diabetic and non-diabetic cancer patients not on metformin, indicating its potential as a chemotherapeutic regimen. This study serves as a model for robust and inexpensive validation studies for drug repurposing signals using EHR data.     

Aspirin use and all-cause mortality among patients being evaluated for known or suspected coronary artery disease: A propensity analysis

CONTEXT: Although aspirin has been shown to reduce cardiovascular morbidity and short-term mortality following acute myocardial infarction, the association between its use and long-term all-cause mortality has not been well defined. OBJECTIVES: To determine whether aspirin is associated with a mortality benefit in stable patients with known or suspected coronary disease and to identify patient characteristics that predict the maximum absolute mortality benefit from aspirin. DESIGN AND SETTING: Prospective, nonrandomized, observational cohort study conducted between 1990 and 1998 at an academic medical institution, with a median follow-up of 3.1 years. PATIENTS: Of 6174 consecutive adults undergoing stress echocardiography for evaluation of known or suspected coronary disease, 2310 (37%) were taking aspirin. Patients with significant valvular disease or documented contraindication to aspirin use, including peptic ulcer disease, renal insufficiency, and use of nonsteroidal anti-inflammatory drugs, were excluded. MAIN OUTCOME MEASURE: All-cause mortality according to aspirin use. RESULTS: During 3.1 years of follow-up, 276 patients (4.5%) died. In a simple univariable analysis, there was no association between aspirin use and mortality (4.5% vs 4.5%). However, after adjustment for age, sex, standard cardiovascular risk factors, use of other medications, coronary disease history, ejection fraction, exercise capacity, heart rate recovery, and echocardiographic ischemia, aspirin use was associated with reduced mortality (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.51-0.87; P =.002). In further analysis using matching by propensity score, 1351 patients who were taking aspirin were at lower risk for death than 1351 patients not using aspirin (4% vs 8%, respectively; HR, 0.53; 95% CI, 0.38-0.74; P =.002). After adjusting for the propensity for using aspirin, as well as other possible confounders and interactions, aspirin use remained associated with a lower risk for death (adjusted HR, 0.56; 95% CI, 0.40-0.78; P<.001). The patient characteristics associated with the most aspirin-related reductions in mortality were older age, known coronary artery disease, and impaired exercise capacity. CONCLUSION: Aspirin use among patients undergoing stress echocardiography was independently associated with reduced long-term all-cause mortality, particularly among older patients, those with known coronary artery disease, and those with impaired exercise capacity.     

癌情隐瞒与非小细胞肺癌生存不良的相关性分析

目的：探讨癌情隐瞒与非小细胞肺癌(non-small cell lung carcinoma,NSCLC)患者生存不良的关系。方法： 收集865名NSCLC患者信息,包括年龄、性别、地址、TNM分期和肿瘤知情情况,通过Kaplan-Meier方法和Cox回归分 析计算患者的生存率。通过电话或面对面的方式,对医生、护士、患者及其家属关于患者肿瘤知情或隐瞒的情况及 相关原因进行调查。结果：在平均随访304(0~4 718) d后,肿瘤知情组的394名患者中有62例存活,而471名癌情隐瞒 组中只有26例存活。单因素分析发现癌情隐瞒组肿瘤相关生存率和全死因生存率均明显低于肿瘤知情组(P<0.001)。 Cox多元回归分析表明癌情隐瞒组的肿瘤相关生存率(HR=1.534,95% CI：1.320~1.784,P<0.001)和全死因生存率 (HR=1.558,95% CI：1.346~1.803,P<0.001)显著低于肿瘤知情组。94.57%的患者家属选择癌情隐瞒的主要原因是“避 免心理崩溃”,他们认为肿瘤知情可能加速死亡。结论：癌情隐瞒是NSCLC患者生存不良的危险因素,我国传统文化 中的“讳疾”可能阻止患者获得真正的“生存权”。     

Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials

CONTEXT: Lowering low-density lipoprotein cholesterol (LDL-C) is known to reduce risk of recurrent coronary heart disease in middle-aged men. However, this effect has been uncertain in elderly people and women. OBJECTIVE: To estimate the risk reduction of coronary heart disease and total mortality associated with statin drug treatment, particularly in elderly individuals and women. DATA SOURCES: Trials published in English-language journals were retrieved by searching MEDLINE (1966-December 1998), bibliographies, and authors' reference files. STUDY SELECTION: Studies in which participants were randomized to statin or control treatment for at least 4 years and clinical disease or death was the primary outcome were included in the meta-analysis (5 of 182 initially identified). DATA EXTRACTION: Information on sample size, study drug duration, type and dosage of statin drug, participant characteristics at baseline, reduction in lipids during intervention, and outcomes was abstracted independently by 2 authors (J.H. and S.V.) using a standardized protocol. Disagreements were resolved by consensus. DATA SYNTHESIS: Data from the 5 trials, with 30 817 participants, were included in this meta-analysis. The mean duration of treatment was 5.4 years. Stati n drug treatment was associated with a20% reduction in total cholesterol, 28% reduction in LDL-C, 13% reduction in triglycerides, and 5% increase in high-density lipoprotein cholesterol. Overall, statin drug treatment reduced risk 31 % in major coronary events (95% confidence interval [CI], 26%-36%) and 21 % in all-cause mortality (95% CI, 14%-28%). The risk reduction in major coronary events was similar between women (29%; 95% Cl, 13 %-42 %) and men (31 %; 95% CI, 26%-35%), and between persons aged at least 65 years (32%; 95% CI, 23%-39%) and persons younger than 65 years (31 %; 95% CI, 24%-36%). CONCLUSIONS: Our meta-analysis indicates that reduction in LDL-C associated with statin drug treatment decreases the risk of coronary heart disease and all-cause mortality. The risk reduction was similar for men and women and for elderly and middle-aged persons.