药物流产与手术流产比较可接受性的Meta分析

目的 评价米非司酮配伍米索前列醇药物流产与手术流产终止早期妊娠的可接受性，为非意愿妊娠妇女选择流产方法提供参考和为临床医生的临床决策提供证据。方法 检索MEDLINE、EMBASE、Cochranelibrary、CBMdisc、CNKI、VIP等6个医学数据库，手工检索12种相关杂志，并追查参考文献。由2名评价员独立筛选、评价文献和提取数据。对没有异质性的文献进行Meta分析。结果 纳入9篇文献（3565例病例）。流产前妇女认为药物流产痛苦更少（OR=466．51，95％CI：91．37～2381．88）；而手术流产更快捷（OR=0．02，95％CI：0．01～0．06）。流产后妇女对两种流产方法满意度相似，差异无统计学意义（P=0．89）；药物流产的再选择率更高（OR=2．72，95％a：2．13～3．47）；向他人推荐药物流产的比率也更高（OR=4．91，95％CI：2．16～11．16）。结论 药物流产是一种痛苦小的方法，但不如手术流产快捷，其再次选择率和推荐给他人的比率高于手术流产。药物流产与手术流产比较各有利弊，二者的满意度相似，不能相互代替。     

Steriods for multiple sclerosis and optic neuritis: a meta-analysis of randomized controlled clinical trials

We conducted a meta-analysis of randomized controlled clinical trials on steroid treatment for multiple sclerosis and optic neuritis. Of the 25 trials comparing steroids and controls without steroid treatment that we identified 12 were selected for this review. A meta-analysis was conducted to calculate the overall odds ratio across the studies for the numbers of patients without functional improvement and with new relapses. The trials included a total of 1714 patients: 998 with multiple sclerosis and 716 with optic neuritis. Any type of corticosteroids or adrenocorticotropic hormone (ACTH) treatment was considered, as was any dosage, route of administration, and length of treatment. Main outcome measures were: (a) number of multiple sclerosis patients who did not improve by at least one point on the EDSS or equivalent scale, or number of optic neuritis patients without complete recovery of visual acuity at 8 or 30 days and at longer follow-up; (b) number of multiple sclerosis patients with at least one new relapse, or number of optic neuritis patients in whom definite multiple sclerosis was diagnosed at longer follow-up. We found that corticosteroids or ACTH produced a significant improvement in disability or visual acuity at 30 days (odds ratio 0.49; 95 % CI 0.37–0.64). The improvement was not statistically significant at longer follow-up (0.85; 95 % CI 0.67–1.09). The treatment did not significantly reduce the number of patients with relapses (0.74; 95 % CI 0.54–1.01). Both low and high doses were effective for 30-day improvement, but only high-dose and short-term therapy were factors that identified subgroups with some reduction in the risk of new relapse. However, the power of the statistical analysis to detect a reliable difference in the subgroups was low. Steroid treatment is therefore effective in accelerating short-term recovery in patients with multiple sclerosis or optic neuritis. Whether steroids are also effective in reducing the risk of relapse, and the optimal dose and length of treatment must still be determined. Received: 5 August 1999, Received in revised form: 29 December 1999, Accepted: 22 January 2000     

Piracetam in acute stroke: a systematic review

We studied whether the administration of piracetam in acute, presumed ischemic stroke affects case fatality and functional outcome. The Cochrane Stroke Group strategy was used to evaluate all randomized controlled trials of patients with presumed ischemic stroke examined within 48 h; death and (when available) functional outcome were used as end points. Three studies were included; the most recent one contributed more than 97% of the data. There were 501 patients treated with piracetam and 501 controls. Piracetam was associated with a nonsignificant 31% increase in the odds of death (95% CI –5% to 81%). This result was due almost completely to the effect of the larger trial, which, however, reported that the difference in case fatality rate between piracetam and control disappeared after correcting for the imbalance in stroke severity between the two groups. Data on functional outcome were available only for the largest study, and no difference was reported. Data obtained from the manufacturer suggested a nonsignificant trend (–10%) towards reduction in dependency with piracetam (CI –33% to 20%); the proportions of patients dead or dependent in the two groups were the same. Relevant adverse effects were not reported. The evidence from this review does not support routine administration of piracetam in patients with acute ischemic stroke; however, since a possible beneficial effect cannot completely be ruled out, further controlled trials are warranted. Received: 31 August 1999/Received in revised form: 3 November 1999/Accepted: 25 November 1999     

我国婴儿早产部分危险因素的Meta分析

目的:综合评价早产与其危险因素的关联性。方法:应用Meta分析方法对已发表的10篇关于早产危险因素的病例对照研究文献进行综合分析,共累积病例1 257例,对照1 511例。根据齐性检验结果决定采用何种模型来计算OR及其95%可信区间,若同质选用固定效应模型,若不同质选用随机效应模型。结果:胎膜早破、妊高征、前置胎盘、多胎、胆淤症5个研究因素的合并OR及其95%可信区间分别为4.11(3.22,5.23)、3.14(1.45,6.79)、13.02(5.71,29.72)、3.94(1.91,8.11)和21.85(6.38,74.80)。结论:早产与胎膜早破、妊高征、前置胎盘、多胎、胆淤症有关。     

饮酒、吸烟和嗜盐等生活方式与高血压发病关联的Meta分析

目的：综合评价我国居民过量饮酒、吸烟和嗜盐等生活方式与高血压发病的关联。方法：采用Meta分析方法，对检索并人选的国内20篇有关高血压危险因素的病例对照研究文献进行综合定量分析。结果：过量饮酒、吸烟、嗜盐合并OR值（95％CI）分别为1．25（1．09～1．43）、1．11（1．03～1．19）、1．59（1．12～2．25）。结论：过量饮酒、吸烟、嗜盐等生活方式可增加我国居民高血压发病的危险性。     

类风湿关节炎治疗前后血清基质金属蛋白酶-3及普通实验室指标的比较

目的分析比较血清基质金属蛋白酶-3(matrixmetalloproteinase-3,MMP-3)、血沉(ESR)、类风湿因子(RF)、C反应蛋白(CRP)等在类风湿关节炎(rheumatoidarthritis,RA)患者治疗前后的变化,为RA的疗效判断提供新的指标。方法分别测定45例初诊RA患者血清中MMP-3、ESR、RF、CRP水平及治疗后的上述指标,进行比较。结果45例RA患者治疗后此4项指标较治疗前均有不同程度的下降,且差异均有统计学意义(P<0.01)。以平均下降率表示:ESR下降率最大,CRP次之,MMP-3位居第3,RF最小。但在不同X线分期时,各指标的下降率不同。结论MMP-3可作为除ESR、CRP、RF外的判断RA疗效的指标。     

谷胱甘肽-S-转移酶M1基因多态与食管癌的Meta分析

目的 对谷胱甘肽-S-转移酶M1(GSTM1)基因多态与食管癌的关联性进行Meta分析。方法 以食管癌组与对照组人群基因型分布的OR值为效应指标,各资料间进行一致性检验,以确定采用固定或随机效应模型进行合并分析。发表偏倚评估用漏斗图法进行。结果 共收集国内外相关资料11篇,积累病例1190例,对照1964名,合并OR值为1.197(95％CI:0.846～1.692)。对其中5篇资料按吸烟与否分层,吸烟组合并OR值为1.523(95％CI:1.099～2.109);不吸烟组合并OR值为0.933(95％CI:0.469～1.692)。结论 GSTM1基因多态与食管癌的易感性无关,但携带GSTM1空白基因型的吸烟者患食管癌的危险性可能会增加。     

肺脏超声对新生儿肺炎诊断价值的Meta分析

目的　采用 Meta 分析方法来评价肺脏超声对新生儿肺炎的诊断价值。方法　检索PubMed、Cochrane library、Embase、CNKI 和万方数据库,按照诊断性试验的纳入和排除标准,获取符合本研究要求的文献,检索时间为建库至 2018年9月。共检索到907篇文献,选取其中8篇进一步分析,并对文献质量进行QUADAS2标准评价,采用Q检验和I 2统计量进行异质性检验,采用 Meta-Disc 1.4 软件进行统计学分析,评价肺脏超声对新生儿肺炎的诊断价值。 结果　共纳入8篇文献、1078例。采用随机效应模型对纳入的研究进行统计分析,合并敏感度为0.96（95%CI：0.95～0.98）,合并特异度为0.98（95%CI：0.95～0.99）,合并阳性似然比为19.52（95%CI：5.00～76.15）,合并阴性似然比为0.04（95%CI：0.01～0.16）,合并诊断优势比为565.45（81.80～3908.58）,拟合ROC 曲线下面积0.9950。结论　肺脏超声诊断新生儿肺炎的敏感度和特异度较X线高。鉴于其相对容易操作、实时可用、低成本和无电离辐射,目前的证据支持超声作为新生儿肺炎诊断的替代手段。     

小针刀治疗屈指肌腱狭窄性腱鞘炎疗效的Meta分析

目的 :通过系统评价,比较小针刀疗法和封闭疗法治疗屈指肌腱狭窄性腱鞘炎的疗效以及安全性。方法 :检索中国知网(1962~2015年)、维普数据库(1993~2015年)、万方数据(2000~2015年)、pubmed中文数据库(1994~2015年),并且应用手工输入法检索相关医学期刊,纳入小针刀疗法与封闭疗法对比治疗屈指肌腱狭窄性腱鞘炎的随机对照试验,经2名评价者按要求对筛选后的资料进行交叉核对后,采用Rev Man 5.2软件进行Meta分析。结果:共纳入7个随机对照试验,包含患者1 174例,但没有筛选到高质量文献。Meta分析结果显示,小针刀组治疗屈指肌腱狭窄性腱鞘炎总有效率明显高于对照组,OR=9.07,95%CI[4.64,17.76],Z=6.44,P0.00001;小针刀组治疗屈指肌腱狭窄性腱鞘炎痊愈率明显高于对照组,OR=7.86,95%CI[5.75,10.74],Z=12.93,P0.00001。结论:小针刀治疗屈指肌腱狭窄性腱鞘炎疗效优于封闭疗法。由于纳入试验数目有限且文献质量较低,漏斗图表现出发表偏倚,需设计更严格的随机对照试验来进一步验证上述结论。