舌下免疫治疗变应性支气管哮喘疗效与安全性的Meta分析

目的 评价舌下免疫治疗(SLIT)变应性支气管哮喘(以下简称哮喘)的疗效与安全性,为SLIT的临床应用提供可靠的循证医学证据.方法 检索中国知网、万方数据库、Pubmed、Medline国内外公开发表的SLIT变应性哮喘的随机对照试验(RCT);采用Jadad评分法评估各项研究的质量;Meta分析用Stata 11.0软件完成;采用固定或随机效应模型分析研究结果;无法进行合并的效应量采用描述性分析;采用Egger's和Begg's检验评价发表偏倚.结果 纳入6项RCT研究,Meta分析结果显示,与对照组比,SLIT组哮喘症状评分显著降低[标准化均数差(SMD)=-0.89,95％ CI-1.36～-0.43,P=0.000],哮喘药物使用评分降低(SMD=-4.53,95％CI-6.97～-2.08,P=0.000);第1秒用力呼气容积(FEV1)(SMD =0.19,95％ CI-0.02～0.41,P=0.078)和血清变应原特异性IgE水平(SMD=0.05,95％ CI-0.58 ～0.69,P=0.870)差异无统计学意义(P＞0.05);SLIT无明显不良反应;Egger's和Begg's检验结果显示无发表偏倚.结论 SLIT可以明显降低变应性哮喘症状评分、药物使用评分,是一种安全有效的免疫途径;但需要开展更高质量的RCT研究,为SLIT的广泛应用提供更加有力的证据.     

白介素—5与支气管哮喘的治疗

白介素 5(IL 5)是调节嗜酸粒细胞在肺内募集的主要细胞因子 ,在哮喘发病机制中起关键作用。用抗IL 5单克隆抗体治疗哮喘有一定作用。从基因水平上抑制IL 5转录将成为治疗哮喘的一个新的策略。     

IL—T与嗜酸性细胞在哮喘中的相互联系及抗IL—5的治疗进展

ＩＬ－５是一种自激活的Ｔ细胞产生的细胞因子，对嗜酸性细胞的功能调节有显的作用。本旨在阐明ＩＬ－５与嗜酸性细胞在哮喘中的相互联系及抗ＩＬ－５的治疗进展。     

特异性抗体治疗哮喘的研究进展

抑制气道变态反应性炎症的形成是治疗哮喘最重要的途径,本文着重介绍几类特异性抗体在支气管哮喘治疗中的研究进展。     

哮喘患者血清白细胞介素—5的检测及意义

哮喘患者血清白细胞介素－５的检测及意义邓火金孙滨战兴利史皆然哮喘是一种慢性气道炎症，有多种细胞因子参与了炎症的发生和发展，其中以白细胞介素（ＩＬ）－５最为重要。为此，我们对３０例哮喘患者血清ＩＬ－５水平进行了检测，以探讨ＩＬ－５在哮喘发病中的作用。一...     

白介素—5,嗜酸粒细胞与支气管哮喘

已知多种细胞因子参与哮喘的发病，白介素－５是重要的因子这一。本就白介素－５及其受体的结构；以及在嗜酸粒细胞增多和哮喘发病中的作用等作一综述。     

脑心通治疗脑梗死的疗效及安全性Meta分析

目的评价脑心通治疗脑梗死的疗效和安全性。方法选用中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)、万方数据资源系统数据库(W.F)、美国国立医学图书馆(PubMed)、Cochrane图书馆(后文以"C.L"简称)中相关内容等作为资料源,对其1995年1月—2011年4月正式刊载的符合纳入标准的58篇有关脑梗塞的脑心通治疗的随机对照试验(RCT)文献进行Meta分析。结果脑心通胶囊组临床疗效有效率比对照组高22%;治疗后神经功能缺损评分明显低于对照组;血液流变学指标明显低于对照组。脑心通胶囊组与对照组比较,治疗后三酰甘油、红细胞比容差异无统计学意义。结论脑心通治疗脑梗塞的疗效确切,与其他药物相比较,具有很好的应用前景。     

IL—5在支气管哮喘中的作用研究进展

白介素－５（ＩＬ－５）是细胞系特异性细胞因子，主要作用于嗜酸细胞和嗜碱粒细胞，本对于近年来ＩＬ－５在哮喘中的研究作一综述，通过分析ＩＬ－５在支气管哮喘中的作用，探讨其作为一种具有相对特异性的指标判断气道炎症的可行性。     

哮喘与冠心病风险相关性队列研究的Meta分析

目的系统评价哮喘与冠心病发病风险的关系。方法计算机检索中国知网、万方数据库、Pub Med及EMbase数据库中公开发表的有关哮喘与冠心病发病关系的队列研究文献,检索时限均为建库至2015年11月,采用NOS量表评价所纳入研究的质量,利用Meta分析方法计算纳入文献的合并HR值及95%CI值,并根据入选文献的研究性别、地域、人群来源差别,以及入选文献质量评分的高低进行亚组分析。结果最终纳入文献共6篇,随访队列总人数为510 822例,累计冠心病患者18 105例,Meta分析结果显示,与未患哮喘者相比,哮喘患者冠心病发病风险增加(HR=1.41,95%CI:1.36~1.45,P0.001);亚组分析显示,哮喘人群中女性发生冠心病的风险高于男性,按地域、研究人群、质量评分不同进行的亚组分析均提示哮喘增加冠心病发病风险,结果均有统计学意义。结论哮喘与冠心病的发生有一定的关联,可能是冠心病的危险因素之一。     

白细胞介素4受体A Q576R基因多态性与支气管哮喘易感性关系的荟萃分析

目的 应用荟萃分析方法探讨白细胞介素4受体A(IL-4RA)Q576R基因多态性与支气管哮喘(简称哮喘)易感性的关系.方法 检索Pubmed数据库、Embase数据库、中国知网、万方数据库中IL-4RA Q576R基因多态性与哮喘易感性关系的病例对照研究,采用隐性模型和显性模型合并IL-4RA Q576R基因多态性与哮喘易感性的OR值,并进行过敏性哮喘和非过敏性哮喘的亚组分析、敏感度分析和文献的发表偏倚检验.结果 纳入的16篇文献均满足遗传平衡检验,累计哮喘病例2675例,其中过敏性哮喘1202例,非过敏性哮喘331例.隐性模型经检验未发现明显异质性,采用固定效应模型分析.显性模型经检验发现明显异质性,采用随机效应模型分析.隐性模型RR/(QQ+QR)计算总体合并OR值为2.02(95%CI为1.53～2.66),其中过敏性哮喘组合并OR值为2.26(95%CI为1.47～3.49).显性模型(RR+QR)/QQ计算总体合并OR值为1.02(95%CI为1.06～1.53).结论 IL-4RA Q576R基因多态性与哮喘易感性有一定相关性.     

Benralizumab and mepolizumab treatment outcomes in two severe asthma clinics

Background and Objective

This study compared the clinical outcomes of severe asthmatics treated with mepolizumab and benralizumab in a tertiary care severe asthma service setting.

Methods

Patient data at baseline, six and 12 months were collected prospectively at two large tertiary hospital severe asthma clinics following treatment initiation. Two hundred and four patients received treatment with mepolizumab (117) or benralizumab (87). Baseline characteristics between groups were similar in regard to age, gender, body mass index, steroid dose and blood eosinophil count. However, the mepolizumab cohort had a higher Asthma Control Questionnaire Score (ACQ) at baseline (4.0 ± 1.1 vs. 3.6 ± 0.9, p = 0.018), accompanied by more frequent reliever medication usage and lower prebronchodilator FEV₁% (56.0 ± 20.1 vs. 63.8 ± 18.9, p = 0.008).

Results

After 6 months treatment, both treatments induced significant improvements in (i) ACQ of 2.3 ± 0.1 (p < 0.001), (ii) oral steroid requiring exacerbations (incident rate ratio 0.26 (0.18–0.37), p < 0.001) and (iii) FEV₁. However, the improvement in FEV₁ was 0.18 (0.05–0.30) litres greater with benralizumab than with mepolizumab (p = 0.002) even when adjusting statistically for baseline differences between groups. These differences were even more pronounced at 12 months post-treatment initiation, when the improvement in exacerbation frequency with benralizumab was 64% greater than with mepolizumab (p = 0.01). Whilst both treatments significantly reduced the blood eosinophil count at 6 and 12 months, this reduction was substantially greater with benralizumab than mepolizumab (−260 cells/μL [−400 to −110, p = 0.001]).

Conclusion

In this large group of severe eosinophilic asthmatics, mepolizumab and benralizumab both improved disease parameters. However, benralizumab treatment appeared significantly more effective than mepolizumab in reducing exacerbations, improving FEV₁ and depleting blood eosinophils.     

含贝达喹啉方案治疗耐多药肺结核疗效与安全性的Meta分析

目的 系统评价含贝达喹啉方案治疗耐多药肺结核(multidrug-resistant pulmonary tuberculosis,MDR-PTB)的疗效与安全性。方法 检索中文数据库,包括中国知网、万方、维普、中国生物医学文献数据库,以及英文数据库,包括The Cochrane Library、PubMed、Embase,搜集含贝达喹啉方案治疗MDR-PTB的随机对照试验,检索时限从建库至2021年12月,由2位研究人员独立筛选文献、提取数据、评价文献质量后,采用RevMan 5.4软件对纳入的数据进行异质性检验分析,对文章进行发表偏倚分析。结果 研究纳入10篇文献,共802例患者。Meta分析结果显示,与常规抗结核治疗方案相比,含贝达喹啉方案治疗MDR-PTB可提高12周末痰菌阴转率(OR=3.17,95%CI:1.85~5.43,P<0.01)、治疗24周末痰菌阴转率(OR=4.09,95%CI:2.74~6.12,P<0.01)、空洞闭合率(OR=3.11,95%CI:1.68~5.74,P<0.01)、病灶吸收率(OR=4.44,95%CI:2.40~8.22,P<0.01)和临床治愈率(OR=4.15, 95%CI:2.27~7.58,P<0.01),降低病亡率(OR=5.22,95%CI:1.16~16.96,P<0.01);与常规抗结核治疗方案相比,含贝达喹啉方案治疗MDR-TB的8周末痰菌阴转率(OR=1.79,95%CI:0.98~3.26,P=0.06)、药物不良反应发生率(OR=2.72,95%CI:0.61~12.19,P=0.19)差异无统计学意义。结论 与常规抗结核治疗方案相比,含贝达喹啉的化疗方案治疗MDR-PTB有助于加速痰菌阴转,提高患者临床疗效,不会增加不良反应,但仍需严密监测心电图,警惕贝达喹啉的心脏毒性。     

Meta analysis about the efficacy and safety of anti-ocular hypertension eye drops without benzalkonium chloride

ObjectiveTo explore the safety and efficacy of eye drops without benzalkonium chloride (BAK) in treating glaucoma and ocular hypertension.MethodsThe clinical case-control literatures about eye drops without BAK treating glaucoma and ocular hypertension were retrieved in PubMed, EMBASE, Cochrane and Chinese Biological and Medical database. Meta 5.0 software was used to analyze the literatures.ResultsFive clinical control studies were included. The results indicated both eye drops could lower the intraocular pressure, and the intraocular pressure-lowering difference between two eye drops was 0.07 mmHg (95% CI: 0.04, 0.19) (P>0.05). Two adverse reactions occurred more were conjunctival injection (10.78%) and allergic conjunctivitis (4.78%). The odd ratio of two eye drops occurring conjunctival injection and allergic conjunctivitis was 0.67 (95% CI, 0.25, 1.10) and 0.82 (95% CI, 0.09, 1.54), respectively (P<0.05) in fixed effect model.ConclusionsThere is no difference between the eye drops with or without BAK in lowering intraocular pressure, but the latter is of higher safety. In consideration of the relatively small sample size of this research, more high-quality clinical research contrasts are needed as evidence.     

延长双重抗血小板治疗时间对冠心病患者的疗效和安全性的Meta分析

目的 比较短期与长期双重抗血小板治疗对冠心病患者的疗效和安全性。方法 计算机检索PubMed、Cochrane Central Register of Controlled Trials、中国生物医学文献数据库、CNKI全文数据库,收集2001年1月至2014年6月公开发表的有关短期双重抗血小板治疗和长期双重抗血小板治疗疗效比较的随机对照试验（RCTs）,手检已获文献的参考文献、会议摘要及相关网站。对文献质量进行严格评价后,对符合要求的RCTs进行资料提取并采用RevMan5.0软件进行Meta分析。结果 共纳入5项RCTs,Meta分析显示：短期和长期双重抗血小板治疗组全因死亡率（OR=0.87,95%CI：0.65～1.17,P=0.36）、心肌梗死发生率（OR=1.04,95%CI：0.73～1.48,P=0.84）、支架内血栓发生率（OR=1.23,95%CI：0.70～2.17,P=0.47）、再血管化发生率（OR=0.94,95%CI：0.71～1.25,P=0.68）、心源性死亡（OR=0.96,95%CI：0.62～1.48,P=0.84）、脑卒中发生率（OR=0.66,95%CI：0.40～1.07,P=0.09）均无统计学意义;短期双重抗血小板治疗组大出血发生率（OR=0.48,95%CI：0.25～0.93,P=0.03）低于长期双重抗血小板治疗组。结论 在冠心病双重抗血小板治疗中,短期和长期双重抗血小板治疗在全因死亡率、心肌梗死发生率、支架内血栓发生率、再血管化发生率、心源性死亡、脑卒中发生率二者相似,短期双重抗血小板治疗有更低的大出血发生率,,初步显示了短期双重抗血小板治疗安全性的优越性。     

替吉奥联合经肝动脉化疗栓塞治疗原发性肝癌疗效及安全性的Meta分析

目的评价替吉奥联合经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗原发性肝癌的疗效及安全性。方法使用计算机检索从建库至2018年2月公开发表在Pub Med、Embase、Cochrane和中国期刊全文数据库等多个数据库中替吉奥联合TACE与单独TACE治疗原发性肝癌的疗效相比较的临床研究文献。并使用Rev Man 5.3对所纳入的研究进行Meta分析,使用Begg法和Egger法分析发表偏倚。结果最终纳入9篇研究文献,共569例原发性肝癌患者。其中包括随机对照研究8篇和队列研究1篇。替吉奥联合TACE治疗原发性肝癌的客观有效率及疾病控制率分别为69.8%和89.9%,均优于单独使用TACE的42.9%和65.6%(P均0.05);替吉奥联合TACE治疗原发性肝癌的1年、2年及3年总体生存率分别为80.00%、49.74%和37.64%,明显高于单独使用TACE治疗的53.33%、24.10%和14.12%(P均0.05)。不良反应以骨髓抑制、恶心、呕吐、腹痛和发热多见,予以对症处理后好转,无其他严重不良反应。结论替吉奥联合TACE治疗原发性肝癌优于TACE治疗,可提高临床疗效,改善患者总体生存率且不良反应可耐受。     

扎鲁司特治疗哮喘的临床疗效和安全性观察

目的　探讨扎鲁司特对哮喘患者的疗效和安全性。方法　对３９０ 例哮喘患者进行开放性、非对照、多中心研究， 观察病人用药前及用药后肺功能、哮喘自觉症状、不良反应。结果　扎鲁司特使病人的ＦＥＶ１ 由治疗前的２－１１Ｌ 上升至治疗后２－２８Ｌ， 晨间ＰＥＦ（ＰＥＦａｍ） 从３１５－２２Ｌ／ｍｉｎ 升至３５０－２７Ｌ／ｍｉｎ， 上述肺功能及用药后哮喘症状评分、夜间憋醒次数、无症状天数、吸入性β２ 受体激动剂用量与用药前相比， 均明显改善， Ｐ＜ ０－０１。可疑药物不良反应发生率２－１％ ， 主要是消化道不适和头痛。结论　扎鲁司特可提高哮喘患者的肺功能， 改善哮喘症状， 具有良好的安全性。     

苯二氮卓类与非苯二氮卓类对慢性阻塞性肺疾病机械通气患者镇静的有效性和安全性的 Meta 分析

目的：通过Meta分析比较苯二氮卓类与非苯二氮卓类对COPD机械通气患者的有效性和安全性。方法通过检索美国国立医学图书馆Pubmed数据库、EMbase、Cochrane临床试验数据库、C N K I、万方等数据库,并辅以手工检索和文献追溯的方式,检索时限均自建库至2015年4月份,收集所有使用苯二氮卓类镇静有效性和安全性的随机对照试验（RC T ）。由2位研究者对纳入研究进行资料提取和质量评价后,采用RevMan 4.3软件进行Meta分析。结果最终纳入6个RCT研究,共计421例患者进行分析,其中苯二氮卓类组患者189例,非苯二氮卓类组患者232例。与非苯二氮卓类比较,苯二氮卓类有延长 COPD 患者机械通气时间[均数差（MD ）为1.21,95％可信区间（95％ CI ）为0.18～2.24,I2＝84.5％,P＝0.02]和停药后清醒时间（MD为0.68,95％ CI为0.06～1.30,I2＝97％,P ＝0.03）。但并不降低心血管不良事件的发生率（ RR为0.84,95％ CI为0.60～1.17,I2＝0％,P ＝0.30）。采用亚组分析,分别比较咪达唑仑和丙泊酚、右美托咪定对COPD患者谵妄、呼吸机相关性肺炎（VAP）发生率以及ICU住院时间,显示与咪达唑仑比较,右美托咪定能降低C O PD患者的谵妄发生率（ RR为2.88,95％ CI为1.67～4.97, I2＝0％, P ＝0.0001）和V A P发生率（ RR为2.59,95％ CI为1.37～4.87,I2＝0％,P＝0.003）,并且能减少COPD患者入住ICU时间（MD为1.53,95％ CI为0.80～2.25,I2＝66.2％,P ＜0.0001）,与丙泊酚组比较差异无统计学意义。结论与非苯二氮卓类比较,苯二氮卓类有增加COPD患者住ICU时间和机械通气时间,延长停药后清醒时间,其中与右美托咪定比较,苯二氮卓类会增加COPD患者谵妄及VAP发生的风险。     

Leukotriene receptor antagonists: efficacy and safety in children with asthma

To date, only one study of chronic use of a leukotriene receptor antagonist in children has been published. The efficacy and safety of montelukast in children 6-14 years of age with asthma (n = 336) was studied during an 8-week, double-blind, placebo-controlled trial. There was significantly greater improvement in forced expired volume in 1 sec (FEV(1)) from baseline for the montelukast group (8. 23%) compared to the placebo group (3.58%). There was a significant decrease in use of beta agonists for symptom relief and a significant decrease in the percentage of days and percentage of patients with asthma exacerbations. An asthma-specific quality of life questionnaire revealed significant overall improvement in quality of life and significant improvement in the quality of life domains for symptoms, activity, and emotions. Adverse effects were not significantly different for montelukast than for placebo, with the exception of allergic rhinitis which was more prevalent in the placebo group. A 6-month open follow-up of patients from the above study was undertaken. Effects of montelukast on FEV(1) were consistent over the 6 months, with the increase in FEV(1) not significantly different from a small control group treated with beclomethasone. Quality of life remained significantly improved throughout the open treatment period. In conclusion, leukotriene receptor antagonists are of value for the treatment of children with asthma.     

A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves' patients

This report details the 26- and 36-yr outcomes of 116 patients under the age of 20 yr with Graves' disease who were treated with radioiodine between 1953 and 1973. Contacted by telephone and mail in 1991-1992, 107 of them supplied personal historical data, and their physicians furnished interval histories, physical examinations, and laboratory data. This was repeated in 2001-2002, with 98 of them being contacted. At the time of treatment, the patients' ages ranged between 3 yr, 7 months and 19 yr, 9 months. Six were less than 6 yr of age, 11 were between 6 and 11 yr, 45 were between 11 and 15 yr, and 45 were between 16 and 19 yr. The average length of follow-up in 1991-1992 was 26.1 yr; that in 2001-2002 was 36.2 yr. None of the patients developed cancer of the thyroid or leukemia. Early on, when the objective of treatment was euthyroidism, the dose of radioiodine was low, and retreatment was frequently needed. Later, the doses used were increased. Over time, all but two patients became hypothyroid. Pregnancies did not result in an unusual number of congenital anomalies or spontaneous abortions. Treating young people with Graves' disease with radioiodine is safe and effective over the long term.     

比索洛尔和美托洛尔的降压疗效及安全性对比

目的：对比观察国产比索洛尔（博苏）和美托洛尔（倍他洛克）治疗轻、中度高血压患者的临床疗效与安全性。方法：46例轻、中度高血压患者随机分成比索洛尔和美托洛尔两组，分别每日口服1次比索洛尔及2次美托洛尔，治疗8周，并用24小时动态血压监测评价用药前及用药8周后24小时血压变化情况。结果：服药第8周降压总有效率比索洛尔组91．3％，美托洛尔组73．9％，与用药前相比两组治疗后的收缩压及舒张压均显著降低，但比索洛尔组优于美托洛尔组（P〈0．05），且副作用少（P〈0．01），对血脂、血糖无影响。结论：国产比索洛尔降低轻、中度高血压患者的血压，安全有效，并优于美托洛尔。