髓过氧化物酶基因多态性与冠心病易感性的Meta 分析

目的：分析髓过氧化物酶(myeloperoxidase，MPO) 基因多态性与冠心病易感性的关系。方法：利用多个
网络数据库及相应关键词检索自建库以来至2013 年3 月的相关文献。用Stata12.0 对纳入文献的相关数据进行Meta 分
析，评估相对危险度(odds ratio，OR 值) 及95% 置信区间(confidence interval，CI)。同时，对文献中各研究的异质性
及敏感性进行分析。发表偏倚通过Begg's 漏斗图和Egger's 线性回归图进行检测。结果：共纳入17 篇文献，Meta 分析
显示各基因型合并后的OR 值及95%CI，其中在MPO -463 G/A 基因中，A 等位基因与 G 等位基因比较，OR=0.58，
95% CI (0.47~0.72)；基因型AA+AG 与GG 比较，OR=0.58，95% CI (0.46~0.72)。在欧洲人群亚组中，AA+AG 对GG
的OR=0.79，95% CI (0.58~1.08)；在稳定型心绞痛亚组中，A 对 G 的OR=0.45，95% CI (0.15~1.37)； AA+AG 对GG 的
OR=0.57，95% CI (0.19~1.65)。在MPO -129 A/G 基因中，GG 对AA+AG 的 OR=0.91， 95% CI (0.74~1.10)。结论：除欧
洲人群外，携带MPO -463 G/A 基因中A 等位基因者冠心病的发病风险降低，MPO -129 A/G 基因与冠心病易感性无
相关性。     

糖尿病与肝外胆管癌发病关系的Meta分析

目的:用Meta分析法探讨糖尿病是否增加肝外胆管癌发病风险?方法:利用中国学术期刊全文数据库?万方全文数据库及Medline,EMBASE数据库检索国内外公开发表的从建库至2010年9月的所有关于糖尿病与肝外胆管癌发病关系的中英文文献;利用随机效应模型计算纳入文献的合并RR值及其95%CI值;进行亚组分析以探究异质性来源并分析出版偏倚?结果:纳入分析的文献共7篇(病例对照研究4篇,队列研究3篇)?经Meta分析,与未患糖尿病者相比,糖尿病患者肝外胆管癌发病的风险增加,相对风险值分别为OR=1.62 (95%C1=1.05~2.49)(病例对照研究);RR=1.54(95%C1=1.06~2.23)(队列研究);亚组资料分析显示研究有显著异质性,但无明显发表偏倚(Egger检验,P = 0.798;Begg检验,P = 0.548)?结论:本研究提示糖尿病可能是肝外胆管癌的致病危险因素?     

妊娠早中期服用阿司匹林对子痫前期高危人群预防作用的系统性评价

目的系统性评价妊娠早中期服用阿司匹林对子痫前期高危人群的预防作用。方法全面检索PubMed、Cochrane、OVID、
web of science、Science Direct、EBSCO、Embase等英文数据库以及临床试验注册数据,纳入所有研究妊娠早中期服用阿司匹林
对高危人群PE预防作用的相关文献,利用Revman 5.3软件对数据进行meta分析。结果最终纳入5个随机对照试验,860例受
试者。结果显示,子痫前期高危人群妊娠16 周前开始服用阿司匹林,妊娠期高血压发病风险（OR=0.35,95%CI 0.17-0.75,P=
0.007）、子痫前期发病风险（OR=0.75,95%CI 0.47-0.98,P=0.04）、胎儿宫内生长受限发病风险（OR=0.53,95%CI 0.29-0.98,P=
0.04）以及早产发病风险（OR=0.20,95%CI 0.08-0.48,P<0.001）均较对照组降低,且试验组较对照组新生儿平均出生体质量增加
了107.15 g,差异有统计学意义（95%CI 76.13-138.18,P<0.001）。结论子痫前期高危人群妊娠16周前开始服用阿司匹林可降
低妊娠期高血压、子痫前期发病风险、胎儿宫内生长受限、早产风险,提高新生儿出生体质量。
     

DNA修复基因XRCC1 codon 399多态性与肝细胞癌易感性的meta分析

目的探讨DNA修复基因X线修复交叉互补因子1(XRCC1)codon 399多态性与肝细胞癌(HCC)易感性的关系。方法检索文献并按要求提取相关信息,纳入以XRCC1 codon 399多态性与HCC易感性为内容的病例—对照研究,对研究结果进行meta分析。通过异质性检验选择固定效应模型或随机效应模型计算合并的优势比(OR)及其95%可信区间(95%CI),并进行发表偏倚评估和敏感性分析。结果本研究共纳入国内外合格文献7篇(HCC患者1 342例,对照2 207例)。合并分析结果显示:XRCC1 codon 399 Gln/Gln基因型可使HCC的发病风险增加(OR=1.41,95%CI 1.07～1.84),而Lys/Gln基因型与HCC的发病风险无明显关联。进一步的亚组分析结果显示:在HCC高发区人群中,Lys/Gln和Gln/Gln基因型均与HCC发病存在关联性(OR=1.46,95%CI 1.07～2.00;OR=1.45,95%CI 1.09～1.93)。结论 XRCC1基因codon 399多态性与HCC的易感性相关。     

脂联素水平与2型糖尿病视网膜病变关系研究

研究背景：脂联素水平与糖尿病视网膜病变之间的关系尚无一致性结论。我们通过meta分析来探讨脂联素水平与糖尿病视网膜病变之间的关系。 方法：我们通过检索Pubmed、Cochrane Library、Medline、Embase、万方、中国知网等数据库中脂联素水平与糖尿病视网膜关系的研究,按照已拟定的标准进行筛选,对符合标准的研究采用meta分析的方法进行系统性评价,借助统计分析软件Stata 11.0评价研究间异质性,并根据检验结果选用随机效应模型或固定效应模型进行数据合并,计算合并SMD值及95%Cl,同时通过分层亚组分析及meta回归探讨异质性的来源,用漏斗图、Begg与Egger检验检测发表偏倚。 结果：我们一共纳入了13个研究,包括1214例病例与1249例对照,原始的meta分析未发现脂联素水平在糖尿病视网膜病变组与无糖尿病视网膜病变组之间存在差别。然而删除了具有异质性的文章之后,第二次meta分析也未发现脂联素水平与糖尿病视网膜病变存在关联,未发现异质性与发表偏倚。根据现存的数据,在中国人群中未发现脂联素水平在无糖尿病视网膜病变与非增殖性糖尿病视网膜病变,非增殖性糖尿病视网膜病变与增殖性糖尿病视网膜病变之间存在显著性差异。 结论：我们的meta分析未发现脂联素水平在糖尿病视网膜发展的不同阶段是降低还是升高。脂联素水平与糖尿病视网膜病变之间的关系还需要更大样本量及更深入的研究。     

单核细胞趋化蛋白-1-2518G/A位点基因多态性与糖尿病肾病易感性的Meta分析

目的 评估单核细胞趋化蛋白-1(MCP-1)-2518G/A基因多态性与糖尿病肾病(DN)发病风险的关系.方法 系统检索PubMed、Web of Science、EMbase、Cochrane Library、中国知网(CNKI)、万方和维普数据库中截至2016年10月收录的所有有关MCP-1-2518G/A基因多态性与DN发病风险的文献.提取相关数据,应用STATA11.0统计软件计算合成数据的比值比(OR)和95%可信区间(CI),同时评估研究的异质性、发表偏倚.结果 共纳入的9项研究涉及2767例独立样本,其中病例组为1096例,对照组为1671例.对于总体人群,在4个基因模型中均未发现MCP-1-2518G/A多态性与DN发病风险有关(显性模型:OR=1.01,95%C I:0.67~1.54;隐性模型:OR=0.93,95%C I:0.60~1.44;纯合子模型:OR=0.93,95%C I:0.70~1.23;杂合子模型:OR=0.89,95%CI:0.61~1.31).亚组分析结果显示,在印度人群中,MCP-1-2518G/A基因多态性会显著增加DN的发病风险(显性模型:OR=1.56,95%CI:1.19~2.06),但在中国人、土耳其人及韩国人中均未发现MCP-1-2518G/A基因多态性与DN的发病风险有关.结论 总体人群中,MCP-1-2518G/A位点基因多态性与DN发病风险无关,但MCP-1-2518G/A位点多态性会增加印度人群DN发病风险,而不增加中国人群、韩国人群、土耳其人群中DN的发病风险.     

白种人蛋白酪氨酸磷酸酶非受体型22基因1858C/T多态性与类风湿关节炎易感性的meta分析

目的： 探讨蛋白酪氨酸磷酸酶非受体型22（PTPN22）基因1858C/T多态性与类风湿关节炎（RA）易感性的关系。 方法：检索中国生物医学文献数据库、万方医学数据库、PubMed数据库, 收集有关PTPN22 1858C/T多态性与RA易感性相关的研究报告,运用meta分析方法计算不同遗传模型下的比值比（OR）值及其95％可信区间（CI）。同时进行异质性分析、亚组分析和发表偏倚检验。 结果：有32篇文献纳入meta分析（40个病例对照）,包括25 059例RA患者和25 466例对照,选入文献无发表偏倚性。 meta分析结果显示： PTPN22 1858C/T多态与RA发生相关（OR=1.606,95CI%=1.518～1.699,P<0.001）。分层分析显示,1858C/T多态是白种人罹患RA风险等位（OR=1.612,95%CI=1.544～1.683,P<0.001）,而在亚裔人群中该位点未发生突变（或者突变频率极低）。 PTPN22 1858C/T多态与类风湿因子（RF）、抗环瓜氨酸肽抗体（ACCP）有相关性。 结论：PTPN22 1858C/T多态的T等位是白种人的风险等位,RF、ACCP均阳性的RA患者携带1858T等位的概率大于 RF、ACCP均阴性的RA患者。     

PON1基因L55M多态性和缺血性脑卒中关系的系统评价和Meta分析

目的使用系统评价方法评价PON1基因L55M多态性与缺血性脑卒中的关系。方法检索中英文数据库以发现合格研究,使用随机或固定效应模型计算合并比值比(OR值),使用Q检验评估研究之间的异质性,Egger’s(埃格)检验和漏斗图评估发表偏倚。结果 11个研究纳入meta分析,在所有人群中,没有发现PON1基因L55M多态性与缺血性卒中发病风险具有相关性,也没有发现研究之间异质性。结论现有证据表明,L55M多态性对缺血性卒中的发病风险无影响,该结论需大样本研究进一步验证。     

肺癌患者吸烟与p53基因突变关联性的Meta分析

目的：采用Meta分析的方法综合评价肺癌患者吸烟与p53基因突变的关联性。 方法：全面检索PubMed、Web of Science、ProQuest和Medline数据库,收集有关肺癌患者吸烟与p53基因突变关系研究的文献。在全面文献回顾的基础上对文献进行筛选、评价和数据提取。采用Stata 12.0软件对纳入文献进行Meta分析,包括异质性检验、评估文献发表偏倚、敏感性分析、合并效应量及累积Meta分析。 结果：本研究共纳入15篇文献,包含1 770
名肺癌患者,其中69.6%为吸烟者,30.4%为非吸烟者。异质性检验未发现各研究间存在明显异质性。肺癌患者吸烟与p53基因突变关系的合并OR=2.70,95%CI=2.04~3.59。 结论：肺癌患者吸烟与p53基因突变有关联性;与非吸烟者比较,吸烟者的p53基因突变风险高。
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中国人群IgE高亲和力受体β链（FcεRIβ）基因-6843G/A多态性位点与哮喘易感性关系的Meta分析

目的探讨中国人群IgE高亲和力受体β链（FcεRIβ）基因-6843G/A多态性与哮喘易感性的关系。方法检索PubMed、Embase、中国学术期刊网全文数据库（CNKI）、万方数据检索系统及维普数据库,收集研究中国人群FcεRIβ基因-6843G/A多态性与哮喘易感性关系的文献进行Meta分析,末次检索时间为2009年10月1日。病例组和对照组基因型分布的比值比（OR）及95%CI为效应指标,应用RevMan 4.2.8软件对各研究原始数据进行统计学分析并检验异质性,采用STATA10.0软件检验发表偏倚。结果根据纳入排除标准,共有9篇文献研究-6843G/A多态性位点,G携带者（GG＋GA）的哮喘发病风险较AA野生型纯合子（AA）增加49%（OR=1.49,95%CI1.01~2.22）。亚组分析显示,G携带者成年发病的风险明显增高（OR=1.83,95%CI1.32~2.52）,而儿童发病风险无显著性差异（OR=1.19,95%CI0.68~2.08）。结论中国人群FcεRIβ基因-6843G/A多态性与哮喘易感性密切相关,突变子G携带者的哮喘发病风险较高。     

脂联素受体2基因+33371Gln/Arg、细胞色素P4502E1 基因RsaⅠ位点多态性和吸烟与非酒精性脂肪性肝病的相关性

目的探讨脂联素受体2（AdipoR2）基因+33371Gln/Arg、细胞色素P4502E1（CYP2E1）基因RsaⅠ位点多态性和吸烟与非
酒精性脂肪性肝病（nonalcoholic fatty liver disease, NAFLD）发病之间的关系。方法采用病例-对照研究的方法,以750例NAFLD
患者及750例健康对照者的外周血白细胞为样本,利用聚合酶链反应（polymerase chain reaction, PCR）技术分析了+33371Gln/
Arg和CYP2E1-RsaⅠ基因多态性。结果+33371Gln/Arg（A/A）基因型和CYP2E1-RsaⅠ（c2/c2）基因型频率分布分别为39.20%、
71.73%（病例组）和21.07%、43.07%（对照组）。+33371Gln/Arg（A/A）患NAFLD的风险显著增加（OR=2.4156,95% CI=1.8164~
4.0725）。CYP2E1-RsaⅠ（c2/c2）基因型者患NAFLD的风险也显著增加（OR=3.3547,95% CI=1.9182~4. 5057）。+33371Gln/
Arg（A/A）/CYP2E1-RsaⅠ（c2/c2）基因型者在NAFLD 组和对照组中的分布频率分别为32.67%和6.40%。+33371Gln/
Arg（A/A）/CYP2E1-RsaⅠ（c2/c2）基因型者患NAFLD的风险显著增加（OR=9.9264,95% CI=4.2928~12.4241）。病例组的吸烟
率显著高于对照组的吸烟率（OR=2.5919,95% CI=1.4194~4.9528）,+33371Gln/Arg（A/A）/CYP2E1-RsaⅠ（c2/c2）基因型与吸烟
有协同作用（OR=34.6764,95% CI=18.9076~61.5825）。结论+33371Gln/Arg（A/A）/CYP2E1-RsaⅠ（c2/c2）基因型和吸烟是
NAFLD的易患因素,三者的联合在NAFLD的发生中起着协同的作用。
     

A prospective study of folate intake and the risk of breast cancer

CONTEXT: Folate is involved in DNA synthesis and methylation and may reduce breast cancer risk, particularly among women with greater alcohol consumption. OBJECTIVES: To assess the association between folate intake and risk of breast cancer and whether higher folate intake may reduce excess risk among women who consume alcohol. DESIGN: Prospective cohort study performed in 1980, with 16 years of follow-up. SETTING AND PARTICIPANTS: A total of 88818 women who completed the dietary questionnaire section of the Nurses' Health Study in 1980. MAIN OUTCOME MEASURE: Incidence of invasive breast cancer by levels of folate and alcohol intake. RESULTS: A total of 3483 cases of breast cancer were documented. Total folate intake was not associated with overall risk of breast cancer. However, among women who consumed at least 15 g/d of alcohol, the risk of breast cancer was highest among those with low folate intake. For total folate intake of at least 600 microg/d compared with 150 to 299 microg/d, the multivariate relative risk (RR) was 0.55 (95% confidence interval [CI], 0.39-0.76; P for trend = .001). This association was only slightly attenuated after additional adjustment for intake of beta carotene, lutein/zeaxanthin, preformed vitamin A, and total vitamins C and E. The risk of breast cancer associated with alcohol intake was strongest among women with total folate intake of less than 300 microg/d (for alcohol intake > or =15 g/d vs <15 g/d, multivariate RR, 1.32; 95% CI, 1.15-1.50). For women who consumed at least 300 microg/d of total folate, the multivariate RR for intake of at least 15 g/d of alcohol vs less than 15 g/d was 1.05 (95% CI, 0.92-1.20). Current use of multivitamin supplements, the major source of folate, was associated with lower breast cancer risk among women who consumed at least 15 g/d of alcohol (for current users of supplements vs never users, RR, 0.74; 95% CI, 0.59-0.93). CONCLUSIONS: Our findings suggest that the excess risk of breast cancer associated with alcohol consumption may be reduced by adequate folate intake.     

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.     

Intake of fish and omega-3 fatty acids and risk of stroke in women

CONTEXT: Some prospective studies have shown an inverse association between fish intake and risk of stroke, but none has examined the relationship of fish and omega-3 polyunsaturated fatty acid intake with risk of specific stroke subtypes. OBJECTIVE: To examine the association between fish and omega-3 polyunsaturated fatty acid intake and risk of stroke subtypes in women. DESIGN, SETTING, AND SUBJECTS: Prospective cohort study of women in the Nurses' Health Study cohort, aged 34 to 59 years in 1980, who were free from prior diagnosed cardiovascular disease, cancer, and history of diabetes and hypercholesterolemia and who completed a food frequency questionnaire including consumption of fish and other frequently eaten foods. The 79 839 women who met our eligibility criteria were followed up for 14 years. MAIN OUTCOME MEASURE: Relative risk of stroke in 1980-1994 compared by category of fish intake and quintile of omega-3 polyunsaturated fatty acid intake. RESULTS: After 1 086 261 person-years of follow-up, 574 incident strokes were documented, including 119 subarachnoid hemorrhages, 62 intraparenchymal hemorrhages, 303 ischemic strokes (264 thrombotic and 39 embolic infarctions), and 90 strokes of undetermined type. Among thrombotic infarctions, 90 large-artery occlusive infarctions and 142 lacunar infarctions were identified. Compared with women who ate fish less than once per month, those with higher intake of fish had a lower risk of total stroke: the multivariate relative risks (RRs), adjusted for age, smoking, and other cardiovascular risk factors, were 0.93 (95% confidence interval [CI], 0.65-1.34) for fish consumption 1 to 3 times per month, 0.78 (95% CI, 0.55-1.12) for once per week, 0.73 (95% CI, 0.47-1.14) for 2 to 4 times per week, and 0.48 (95% CI, 0.21-1.06) for 5 or more times per week (P for trend =.06). Among stroke subtypes, a significantly reduced risk of thrombotic infarction was found among women who ate fish 2 or more times per week (multivariate RR, 0.49; 95% CI, 0.26-0.93). Women in the highest quintile of intake of long-chain omega-3 polyunsaturated fatty acids had reduced risk of total stroke and thrombotic infarction, with multivariate RRs of 0.72 (95% CI, 0.53-0.99) and 0.67 (95% CI, 0.42-1.07), respectively. When stratified by aspirin use, fish and omega-3 polyunsaturated fatty acid intakes were inversely associated with risk of thrombotic infarction, primarily among women who did not regularly take aspirin. There was no association between fish or omega-3 polyunsaturated fatty acid intake and risk of hemorrhagic stroke. CONCLUSIONS: Our data indicate that higher consumption of fish and omega-3 polyunsaturated fatty acids is associated with a reduced risk of thrombotic infarction, primarily among women who do not take aspirin regularly, but is not related to risk of hemorrhagic stroke.     

Fish consumption and incidence of heart failure: a meta-analysis of prospective cohort studies

Background  The association between fish consumption and heart failure (HF) incidence is inconsistent.

Methods  We performed a systematic search of Pubmed and Embase (from 1953 to June 2012) using key words related to fish and HF. Studies with at least three categories of fish consumption reporting both relative risk (RR) and corresponding 95% confidence interval (CI) for HF incidence were included. The pooled RR and 95%CI were calculated using a fixed or random-effects model. The generalized least squares regression model was used to quantify the dose-response relationship between fish consumption and HF incidence.

Results  Five prospective cohort studies including 4750 HF events of 170 231 participants with an average of 9.7-year follow-up were selected and identified. Compared with those who never ate fish, individuals with higher fish consumption had a lower HF incidence. The pooled RRs for HF incidence was 0.99 (95%CI, 0.91 to 1.08) for fish consumption 1 to 3 times per month, 0.91 (95%CI, 0.84 to 0.99) for once a week, 0.87 (95%CI, 0.81 to 0.95) for 2 to 4 times per week, and 0.86 (95%CI, 0.84 to 0.99) for 5 or more times per week. An increment of 20 g of daily fish intake was related to a 6% lower risk of HF (RR: 0.94, 95% CI, 0.90 to 0.97; P for trend = 0.001).

Conclusions  This meta-analysis suggests that there is a dose-dependent inverse relationship between fish consumption and HF incidence. Fish intake once or more times a week could reduce HF incidence.

     

中药治疗急性上呼吸道感染随机对照试验的系统评价

目的：评价新近开发的抗感冒中药治疗急性上呼吸道感染（普通感冒）的疗效和安全性。 方法：收集中药治疗急性上呼吸道感染（普通感冒）随机对照试验文献,对符合纳入标准的文献按Jadad计分表评价其质量,对纳入的试验作系统评价,同时按中医感冒病的辨证分型进行分层分析。 结果：符合纳入标准的文献共13篇。Meta分析结果显示,中药治疗组与对照组相比,显效率相对危险度（relative risk,RR）为1．10,95％可信区间（confidence interval,CI）[1．05,1．16],两组指标比较,差异有统计学意义（P=0．0002）。降温起效时间加权均数差（weighted mean difference,WMD）为-1．70,95％CIL-2．76,-0．65],两组指标比较,差异有统计学意义（P=0．002）。体温解热时间WMD为-1．32,95％CIL-3．14,0．49],两组指标比较,差异无统计学意义（P=0．15）。亚组分型显示,风热感冒中药治疗组与对照组相比,显效率RR为1．11,95％CI[1．05,1．19],两组指标比较,差异有统计学意义（P=0．0007）;风寒感冒中药治疗组与对照组相比,显效率RR为1．07,95％CI[0．99,1．16],两组指标比较,差异无统计学意义（P=0．10）。未报道与中药临床应用相关的严重不良反应。 结论：近几年来新开发的抗感冒中药较既往抗感冒中药能够明显提高降温起效时间,更好地改善患者的全身症状,具有起效快、疗效好的特点,未见明显的不良反应。由于所纳入的文献无一篇使用安慰剂,尚需开展使用安慰剂对照的高质量研究。     

比较磺达肝癸钠与依诺肝素预防骨科大手术后静脉血栓栓塞症疗效与安全性的Meta分析

目的系统评价磺达肝癸钠与依诺肝素在预防骨科大手术后静脉血栓栓塞症（VTE）方面的疗效与安全性。方法计算机
检索MEDLINE、EMbase、Cochrance图书馆、中国期刊全文数据库、中国生物医学文献数据库、维普数据库及万方资源数据系
统,并手工检索相关杂志、会议论文等。检索无语种限制,时间均从建库至2012年10月。按特定的纳入排除标准,筛选出符合
标准的关于磺达肝癸钠与依诺肝素预防骨科大手术后VTE发生的随机对照试验。评价指标为总VTE、深静脉血栓（DVT）、症
状性VTE、肺栓塞、大出血事件和各种不良事件等的发生率。进行质量评价和数据提取后,采用RevMan 5.1.7软件进行Meta分
析。结果共纳入随机对照研究文献5篇,均为英文文献,研究对象有1篇为膝关节大手术患者,1篇髋部骨折手术患者,其余3
篇为全髋关节置换术患者,病例数为7611例。Meta分析结果显示：磺达肝癸钠组的总VTE发生率低于依诺肝素组[RR=0.52,
95% CI（0.40,0.67）,P<0.00001];磺达肝癸钠组DVT发生率低于依诺肝素组[RR=0.49,95%CI（0.42,0.58）,P<0.00001];磺达肝
癸钠组症状性VTE发生率与依诺肝素组无统计学差异[RR=1.52,95%CI（0.80,2.88）,P=0.20];磺达肝癸钠组大出血发生率高于
依诺肝素组[RR=1.55,95% CI（1.14,2.12)）,P=0.006];磺达肝癸钠组总死亡率与依诺肝素组无统计学差异[RR=0.93,95% CI
(0.63,1.37）,P=0.72]。结论磺达肝癸钠预防骨科大手术后VTE的疗效优于依诺肝素,虽然大出血风险较依诺肝素高,但并不
增加总死亡率。
     

湖南省浏阳市产妇产后出血发病率及其影响因素分析

目的：了解浏阳市产后出血的发病情况,并探讨其相关的危险因素。方法：采用整群随机抽样的方法在
浏阳市37个乡镇(街道)中随机选取14个乡镇(街道),以所选取乡镇(街道)的妇幼保健部门在2010年1月至2011年12 月
间登记建册的所有孕产妇为研究对象,对研究对象孕早、孕中、孕晚及分娩各期进行随访,收集其孕产妇保健手册
和病历资料。以手册和病历记录的产后出血量超过500 mL为病例,从该队列无产后出血(出血量<500 mL)的人群中
采用完全随机抽样的方法抽取相同数目的产妇为对照。分别采用卡方检验和非条件 logistic 回归分析进行单因素和
多因素分析,以探讨产后出血发生的主要影响因素。结果：共收集到5 933名产妇的资料,其中有132例诊断为产后
出血,产后出血发生率为 2.22%。多因素非条件 logistic 回归分析结果显示：影响产后出血发生的主要危险因素有贫
血(OR=3.940, 95% CI：2.100~7.389),疤痕子宫(OR=2.730,95% CI：1.198~6.220),胎盘前置(OR=10.665,95% CI：
1.142~99.566),胎盘因素(OR=4.332,95% CI：1.004~18.692),产程延长(OR=5.899,95% CI：2.602~13.376)。结论：产
后出血是多种因素综合作用的结果,应针对主要危险因素尽早采取综合性控制措施以减少产后出血的发生。     

饮酒与前列腺癌危险性关系的随访研究

目的对酒精的消费与前列腺癌的关系进行了随访研究。方法本研究为前瞻性的随机对照研究。研究对象根据年龄分为二个队列。队列1：从1991～1995年开始,包括了5766例男性,年龄25～74岁,平均随访时间为17年。队列2：从队列1抽取研究对象,从2002年开始到2004年,包括了3775例研究对象,平均随访时间9年。酒精消费的计算基线为患者平日的饮酒量,既往饮酒史为患者25、35、45和55岁饮酒情况。结果总共发生了254例前列腺肿瘤,与以前的大多数研究结果一致,酒精总的饮用量与前列腺癌没有明显关系（P〉0．05）,但在第2队列中,重度饮酒和前列腺癌之间存在逆相关[（RR）=0．23,95％CI=0．06～0．95],进一步研究发现;既往在25岁、35岁、45岁有大量饮酒的患者（每周〉25次）,与前列腺癌的发生逆相关。结论研究结果说明既往有大量饮酒史与前列腺癌发生有关。