阿戈美拉汀治疗抑郁症伴睡眠障碍的疗效和安全性的系统评价

目的:基于荟萃分析(Meta分析)方法,系统评价阿戈美拉汀对抑郁症伴睡眠障碍患者的睡眠改善效果及其安全性,为临床治疗提供循证参考。方法:检索PubMed、the Cochrane Library、EMBase、中国知网、万方数据库和维普数据库,纳入从建库至2020年4月公开发表的关于阿戈美拉汀治疗抑郁症伴睡眠障碍患者的中英文文献[研究组患者单独使用阿戈美拉汀口服治疗,对照组患者单独使用5-羟色胺再摄取抑制类抗抑郁药(米氮平、帕罗西汀或艾司西酞普兰等)治疗或阿戈美拉汀联合其他药物治疗],提取汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分和匹茨堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)相关数据,采用Rev Man 5.3软件进行文献质量评价和Meta分析。结果:共纳入8项研究,合计332例患者。Meta分析结果显示,抑郁症伴睡眠障碍患者单独使用阿戈美拉汀治疗后,其HAMD评分(SMD=-5.31,95%CI=-6.28~-4.33,P<0.00001)、PSQI总分(SMD=-3.66,95%CI=-4.16~-3.17,P<0.00001)均较治疗前明显降低,差异均有统计学意义。结论:阿戈美拉汀对抑郁症伴睡眠障碍患者的抑郁症状和失眠症状均有较好的改善作用,但受纳入研究的质量和样本量限制,该结论需大样本、多中心、长时间的随访结果进行验证。     

艾塞那肽降低超重和肥胖患者体质量有效性与安全性的系统评价

目的:系统评价艾塞那肽降低超重和肥胖患者体质量的有效性与安全性,以为临床治疗提供循证参考。方法:计算机检索Cochrane图书馆、Pub Med、Medline、EMBase、中国期刊全文数据库、中国科技期刊数据库和万方数据库,收集艾塞那肽对比安慰剂或其他药物降低超重和肥胖患者体质量的随机对照试验(RCT),提取资料并进行质量评价后,采用Rev Man 5.3.0统计软件进行Meta分析。结果:最终纳入25项RCT,合计5 307例患者。Meta分析结果显示,艾塞那肽组患者体质量显著低于安慰剂组[SMD=-2.06,95%CI(-2.97,-1.15),P<0.001]、胰岛素组[SMD=-3.51,95%CI(-4.52,-2.51),P<0.001]、格列本脲组[SMD=-3.70,95%CI(-4.28,-3.12),P<0.001]、罗格列酮组[SMD=-1.25,95%CI(-1.71,-0.80),P<0.001]和西格列汀组[SMD=-0.71,95%CI(-0.93,-0.48),P<0.001],而与二甲双胍组、他司鲁肽组比较差异无统计学意义。艾塞那肽组患者不良反应发生率显著高于胰岛素组[RR=1.22,95%CI(1.06,1.41),P=0.006],低于他司鲁肽组[RR=0.95,95%CI(0.91,0.99),P=0.02],与安慰剂组、二甲双胍组比较差异无统计学意义。结论:艾塞那肽能有效降低超重和肥胖患者的体质量,但消化系统不良反应较多。受纳入研究方法学质量限制,该结论有待更多高质量、大样本、长期随访的RCT加以验证。     

艾塞那肽治疗2型糖尿病疗效及安全性的Meta分析

目的:评价人胰高血糖素样肽-1(GLP-1)抑制剂艾塞那肽治疗2型糖尿病的疗效及安全性。方法:计算机检索EMBase、PubMed、Coehrane、中国期刊网数据库(CNKI)、万芳数据库(VIP)、中国生物医学文献数据库(CBM)数据库,纳入相关随机对照试验(RCT),对纳入的RCT进行质量评价并提取相关资料。应用RevMan 5.2软件进行Meta分析,计算均数差(MD)、相对风险度(RR)和95%置信区间(CI)。结果:共纳入8个RCT进行分析。Meta分析结果显示:艾塞那肽组在改善2型糖尿病患者糖化血红蛋白和空腹血糖水平方面显著优于安慰剂[MD=-0.86,95%CI(-0.95,-0.77),P<0.01;MD=-1.06,95%CI(-1.52,-0.59),P<0.01]。在不良反应发生率方面,艾塞那肽组发生恶心和呕吐的相对风险度显著增高[RR=3.91,95%CI(2.36,6.47),P<0.01;RR=3.73,95%CI(1.67,8.34),P=0.01]。合用磺酰脲类治疗时,艾塞那肽组发生低血糖的相对风险度较安慰剂显著增高[RR=3.55,95%CI(1.55,8.16),P<0.01];未合用磺酰脲类治疗时,则与安慰剂组无显著性差异[RR=1.03,95%CI(0.74,1.43),P=0.87]。结论:艾塞那肽可显著改善2型糖尿病患者糖化血红蛋白和空腹血糖水平,但恶心和呕吐不良反应发生风险增高,同时与磺酰脲类药物合用可能会增加低血糖风险。     

坎格列净治疗2型糖尿病疗效与安全性的系统评价

目的:系统评价坎格列净治疗2型糖尿病的疗效与安全性,以为临床治疗提供循证参考。方法:计算机检索Cochrane图书馆、Pub Med、EMBase、中国生物医学文献数据库、万方数据库,收集坎格列净(试验组)对比安慰剂(对照组)治疗2型糖尿病的随机对照试验(RCT),提取资料并评价质量后,采用Rev Man 5.2统计软件进行Meta分析。结果:共纳入7项RCT,合计2 188例患者。Meta分析结果显示,试验组患者糖化血红蛋白(Hb A1c)水平[WMD=-0.82,95%CI(-0.99,-0.65),P<0.001]、Hb A1c<7%的患者比例[RR=2.51,95%CI(1.98,3.19),P<0.001]、空腹血糖水平[WMD=-32.91,95%CI(-39.65,-26.17),P<0.001]显著优于对照组。生殖道感染发生率显著高于对照组[RR=3.76,95%CI(2.23,6.35),P<0.001];而低血糖发生率[RR=1.13,95%CI(0.40,3.20),P=0.81]、尿路感染发生率[RR=1.19,95%CI(0.82,1.73),P=0.36]与对照组比较,差异无统计学意义。结论:坎格列净治疗2型糖尿病安全、有效,临床使用时应注意预防患者生殖道感染。受纳入研究方法学限制,该结论尚需大样本、多中心的RCT进一步验证。     

西地那非治疗新生儿持续性肺动脉高压的系统评价

目的:系统评价西地那非治疗新生儿持续性肺动脉高压(PPHN)的临床疗效,为临床提供循证参考。方法:计算机检索Pub Med、Cochrane图书馆、EMBase(Ovid)、中国生物医学文献数据库、中国期刊全文数据库、万方数据库和中文科技期刊数据库,收集西地那非(试验组)对比基础治疗或安慰剂治疗PPHN的随机对照试验(RCT),对符合纳入标准的临床研究进行资料提取,并参考Cochrane系统评价员手册5.1.0进行质量评价,然后采用Rev Man 5.1统计软件进行Meta分析。结果:共纳入6项RCT,合计210例患儿。Meta分析结果显示,与安慰剂比较,西地那非治疗PPHN可以显著降低患儿的病死率[RR=0.16,95%CI(0.05,0.45),P<0.001]和氧合指数[2 h后:MD=-12.80,95%CI(-20.11,-5.49),P<0.001;24 h后:MD=-19.41,95%CI(-24.81,-14.00),P<0.001],差异均有统计学意义;与基础治疗比较,西地那非治疗PPHN可以显著降低患儿肺动脉压[2 h后:MD=-22.36,95%CI(-24.89,-19.83),P<0.001;24 h后:MD=-29.43,95%CI(-31.12,-27.74),P<0.001],差异均有统计学意义,但对病死率无显著影响[RR=0.64,95%CI(0.30,1.39),P=0.26]。结论:西地那非治疗PPHN疗效较好,可以显著降低患儿的氧合指数、肺动脉压和病死率。     

噻奈普汀与氟西汀对照治疗抑郁症患者的系统评价

目的 系统评价噻奈普汀与氟西汀治疗抑郁症的疗效和安全性。方法 计算机检索中国期刊全文数据库、维普全文数据库、万方数据库、PubMed、Medline、EMBase中关于噻奈普汀与氟西汀治疗抑郁症的随机对照试验(RCT),对纳入的RCT采用Cochrane系统评价的方法进行评价,采用RevMan 5.0统计软件进行Meta分析。结果 共纳入5项研究,合计942例患者,meta分析结果显示,噻奈普汀组患者有效率[OR=1.25,95%CI(0.93,1.66),P=0.13]与氟西汀组比较差异无统计学意义;在不良反应发生率方面,2组比较差异有统计学意义[OR=0.53,95%CI(0.36~0.77),P<0.001]。结论 噻奈普汀与氟西汀治疗抑郁症疗效相当,不良反应少。但该结论尚需高质量、设计严谨的RCT进一步证实。     

参麦注射液辅助治疗冠心病心绞痛疗效与安全性的系统评价

目的:系统评价参麦注射液辅助治疗冠心病心绞痛的疗效和安全性,为临床提供循证参考。方法:计算机检索中国期刊全文数据库、万方数据库、中文科技期刊数据库、PubMed,收集参麦注射液联合常规方案(试验组)对比单用常规方案(对照组)治疗冠心病心绞痛的随机对照试验(RCT),提取资料并根据Cochrane系统评价员手册5.1.0评价质量,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入25项RCT,合计2 093例患者。Meta分析结果显示,试验组患者临床总有效率[RR=1.31,95%CI(1.25,1.37),P<0.001]和心电图总有效率[RR=1.42,95%CI(1.31,1.54),P<0.001]均显著高于对照组,差异均有统计学意义。亚组分析结果显示,在高剂量(>40 mL/d)和低剂量(≤40 mL/d)亚组中,试验组患者临床总有效率[高剂量:RR=1.26,95%CI(1.19,1.34),P<0.001;低剂量:RR=1.36,95%CI(1.27,1.45),P<0.001]和心电图总有效率[高剂量:RR=1.39,95%CI(1.22,1.60),P<0.001;低剂量:RR=1.43,95%CI(1.30,1.58),P<0.001]均显著高于对照组,差异均有统计学意义。两组患者不良反应发生率比较,差异无统计学意义[RR=0.66,95%CI(0.32,1.40),P=0.28]。结论:参麦注射液辅助治疗冠心病心绞痛疗效与安全性均较好,建议临床从低剂量开始使用。     

铜绿假单胞菌制剂治疗恶性胸腔积液疗效和安全性的Meta分析

目的:系统评价铜绿假单胞菌制剂(PAI)治疗恶性胸腔积液的疗效和安全性,以为临床提供循证参考。方法:计算机检索Cochrane Library、PubMed、EMBase、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库和万方数据库中关于PAI治疗恶性胸腔积液的随机对照试验(RCT),对纳入的RCT采用Cochrane协作网提供的Rev Man 5.2.9统计软件进行Meta分析。结果:共纳入9项RCT,合计546例患者。Meta分析结果显示,试验组患者完全缓解率[RR=1.65,95%CI(1.25,2.17),P<0.000]、部分缓解率[RR=1.49,95%CI(1.20,1.85),P<0.000]、稳定率[RR=0.42,95%CI(0.30,0.58),P<0.000]、进展率[RR=0.35,95%CI(0.19,0.64),P<0.000]均显著优于对照组,两组比较差异有统计学意义。亚组分析显示,两组患者不良反应发生率比较差异无统计学意义[RR=1.15,95%CI(0.91,1.46),P>0.05;RR=0.61,95%CI(0.32,1.17),P>0.05]。结论:PAI治疗恶性胸腔积液可以提高临床疗效,降低不良反应发生率,但该结论仍需要高质量、大样本的RCT进一步来验证。     

康艾注射液辅助放疗治疗恶性肿瘤疗效和安全性的系统评价

目的:系统评价康艾注射液辅助放疗治疗恶性肿瘤的有效性和安全性,以为临床治疗提供循证参考。方法:计算机检索Cochrane图书馆、Pub Med、中国期刊全文数据库、中文科技期刊数据库和万方数据库,收集康艾注射液联合放疗(试验组)对比单纯放疗(对照组)治疗恶性肿瘤的随机对照试验(RCT),提取资料并评价质量后,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入13项RCT,合计1 107例患者。Meta分析结果显示,试验组患者治疗有效率[RR=1.20,95%CI(1.10,1.32),P<0.000]、生活质量改善率[RR=1.62,95%CI(1.42,1.85),P<0.000]、体质量增加率[RR=1.39,95%CI(1.06,1.82),P=0.02]、白细胞下降发生率[RR=0.34,95%CI(0.25,0.47),P<0.000]、胃肠道反应发生率[RR=0.27,95%CI(0.10,0.78),P=0.02]、Ⅲ~Ⅳ级放射性损伤发生率[RR=0.35,95%CI(0.22,0.55),P<0.000]显著优于对照组,两组比较差异有统计学意义。结论:康艾注射液辅助放疗治疗恶性肿疗效与安全性均更好。受纳入研究方法学的局限性,该结论有待更多高质量、大样本、长期随访的RCT进一步验证。     

系统评价万古霉素联合地塞米松鞘内注射治疗颅内感染的有效性和安全性

目的:系统评价万古霉素联合地塞米松鞘内注射治疗颅内感染的临床疗效和安全性,为临床提供循证参考。方法:计算机检索Pub Med、Medline、中国期刊全文数据库、中文科技期刊数据库和万方数据库,收集万古霉素联合地塞米松鞘内注射治疗颅内感染的随机对照试验(RCT)。由两位评价员独立筛选文献、提取资料并按照Cochrane系统评价员手册5.0.1版评价纳入研究的偏倚风险后,采用Rev Man 5.2统计软件进行Meta分析。结果:最终纳入8项RCT,合计543例患者。Meta分析结果显示,与头孢曲松钠或万古霉素静脉滴注相比,万古霉素联合地塞米松鞘内注射可明显提高颅内感染患者有效率[RR=1.18,95%CI(1.11,1.26),P<0.001]和脑脊液细菌清除率[RR=1.13,95%CI(1.01,1.27),P<0.001],缩短临床治疗时间[SMD=-1.60,95%CI(-1.89,-1.30),P<0.001],减少不良反应发生率[RR=0.48,95%CI(0.32,0.73),P<0.001],同时还能明显改善患者颅内压[SMD=-1.78,95%CI(-2.10,-1.47),P<0.001]、脑脊液蛋白定量[SMD=-0.18,95%CI(-0.25,-0.11),P<0.001]和脑脊液葡萄糖定量[SMD=1.77,95%CI(0.91,2.63),P<0.001],差异均有统计学意义。结论:万古霉素联合地塞米松鞘内注射治疗颅内感染临床疗效较好,可以提高脑脊液细菌清除率,缩短治疗时间,降低患者颅内压和脑脊液蛋白定量,提高脑脊液葡萄糖定量,且安全性较好。     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

半导体激光治疗老年人压疮疗效观察

目的探讨半导体激光局部照射治疗老年人压疮疗效.方法:收集2012年1月-2015年6月48例压疮患者,分为半导体组和常规组各24例.常规组采用常规治疗,半导体组采用半导体激光加常规治疗,10 d为1个疗程,不超过3个疗程.疗程结束后比较两组疗效.结果:半导体组压疮愈显率为83.33％,创面愈合时间为(12.75±5.51)d,常规组分别为54.17％和(19.63±8.65)d,组间差异有统计学意义(P＜0.05),两组均未见不良反应.结论:半导体激光加常规治疗压疮效果肯定,无明显不良反应,且操作简便.     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.     

Problems in the evaluation of hypnosis in the treatment of alcoholism

Although hypnotherapy has been applied to alcoholism for over a century and is accepted by the AMA as a medically valid technique, the effectiveness of hypnosis in treating alcoholics remains controversial. Systematic evaluation has been hampered by the unique role of hypnosis as a cultural artifact, by problems in defining and verifying hypnotic intervention, by individual and situational variation in hypnotizability, and by difficulty in separating hypnosis from the therapies to which it is applied. Clinicians using hypnosis are likely to continue to base their claims for its effectiveness on intuition, especially since no study has demonstrated that hypnotherapy is contraindicated for patients requesting its use.     

Pharmacological analysis of the participation of the catecholaminergic system in the development of the abstinence syndrome in rats

The behavioural activity of rats in "the open field" was studied. It was revealed that rats alcoholized for 8 months do not practically differ in their behavioural indicators from the intact ones. After the discontinuation of alcohol marked disturbances appear in their behaviour, that are arrested by apomorphine (0,1 mg/kg). In intact animals dopamine (50 mkg into the brain ventricles) induces behavioural disorders similar to those in rats during abstinence. Noradrenaline does not induce similar disorders. A conclusion is made on the dopaminergic nature of disorders in the behaviour of rats in the state of alcohol abstinence.     

HACCP在学校集体食堂卫生管理中的应用研究

目的 通过HACCP在学校集体食堂管理中的应用,提高食品卫生水平,保障学生的身体健康。方法 HACCP原则。结果 食品卫生达到较高水平,极大地减少了食物中毒的发生。结论 提示HACCP原则可在学校集体食堂的卫生管理中发挥有效作用。     

The role of the gut flora in the reduction of sulphinpyrazone in the rat

Sulphinpyrazone underwent both reduction to a sulphide and oxidation to a sulphone after parenteral administration to normal Wistar rats. Oral administration was associated with a bioavailability of about 75% and with a 3-fold greater formation of the sulphide. However, no sulphide was detected in the plasma after oral administration of sulphinpyrazone to germ-free (BD/X) rats or normal rats treated with oral antibiotics. In vitro studies showed that the major site of reduction of sulphinpyrazone was the contents of the hind gut with little activity detected in the liver or other tissues. The sulphide was oxidised in vivo to sulphinpyrazone and small amounts of sulphone, while the latter underwent only slight reduction to sulphinpyrazone, but did not give detectable levels of the sulphide. These data suggest that the gut microflora are the main site of reduction of sulphinpyrazone in the rat in vivo.