苜蓿草App的应用对于农村地区抗凝质量管理的疗效和安全性的影响

目的 评估农村地区抗凝质量现状以及远程管理的效果,为优化抗凝管理方案提供参考。方法 对2016年12月至2019年3月之间对接受苜蓿草App线上管理和常规门诊管理的患者进行回顾性分析,收集患者的基本信息、凝血检测记录以及临床事件发生情况,比较两组患者的国际标准化比值(INR)在治疗范围内的时间百分比(time in therapeutic range,TTR)、临床事件发生率及INR分布情况的差异。结果 本研究共纳入患者583名,线上组的TTR显著高于线下组(83.3% vs 50.3%,P<0.001)。在临床事件方面,线上组较线下组患者更少发生严重出血事件(0.4% vs 3.2%,P=0.004)、华法林相关急诊(4.1% vs 9.3%,P=0.014)和华法林相关住院(12.6% vs 6.7%,P=0.002),但轻微出血事件发生率要高于线下组(12.6% vs 6.7%,P=0.022)。此外,苜蓿草App线上管理能提高INR在正常范围内的百分比(78.0% vs 46.7%,P<0.001)。结论 苜蓿草App线上管理能够改善农村地区患者的抗凝管理质量。     

Pri-miR-378 rs1076064与肺癌铂类联合化疗毒副反应的相关性研究

目的 探讨pri-miR-378 rs1076064与肺癌铂类联合化疗毒副反应的相关性。方法 本研究共纳入467名接受至少两个周期铂类化疗的肺癌患者,使用飞行时间质谱对rs1076064进行基因分型,使用无条件逻辑回归分析评估化疗后毒性反应与其基因型的相关性。结果 研究发现,携带pri-miR-378 rs1076064 G等位基因的小细胞肺癌患者铂类联合化疗的总毒副反应风险增加(校正OR=2.744,95％CI=1.089~6.909,P=0.032);在分层分析中发现,pri-miR-378 rs1076064在依托泊苷联合铂类化疗(加性模型:校正OR=2.820,95％CI=1.119~7.103,P=0.028; 显性模型:校正OR=6.105,95％CI=1.108~33.650,P=0.038)、以顺铂为基础的化疗(加性模型:校正OR=1.931,95％CI=1.026~3.636,P=0.041)、男性人群(显性模型:校正OR=2.120,95％CI=1.115~4.029,P=0.022)和小细胞肺癌(加性模型:校正OR=2.637,95％CI=1.066~6.524,P=0.036;显性模型:校正OR=8.912,95％CI=1.051~75.56,P=0.045)人群中与铂类联合化疗后血液毒副反应显著相关;但未见与胃肠道毒副反应的相关性。结论 pri-miR-378 rs1076064有可能作为预测中国肺癌相关患者人群铂类化疗血液毒性的候选生物标志物。     

非瓣膜性房颤患者达比加群血药浓度监测及对出血风险预测效果评价研究

目的 探讨非瓣膜性房颤患者达比加群血药浓度的影响因素及临床意义,评价血药浓度对达比加群酯出血事件的预测能力。方法 分析143例达比加群稳态血药谷浓度监测结果,采用t检验分析年龄、性别、肌酐清除率(Ccr)、合并用药对达比加群血药浓度的影响;运用受试者工作特征曲线(ROC)分析评估达比加群血药浓度对出血事件的预测能力。结果 143例患者达比加群血药浓度受年龄、性别、Ccr影响(P＜0.05),与活化部分凝血活酶时间(APTT)呈正相关;25例患者发生小出血,APTT、Ccr和血药浓度与出血事件有相关性(P＜0.05),血药浓度预测出血事件的ROC曲线下面积为0.909(P<0.001),曲线中Youden指数最大(0.713)时对应的最佳临界值为154.35 ng·mL^-1,灵敏度和特异度分别为84%和87%,优于Ccr。结论 非瓣膜性房颤患者达比加群血药浓度临床个体差异较大,且血药浓度对出血事件预测灵敏度和特异性高,可为临床个体化用药和安全用药提供指导。     

利伐沙班在椎间孔镜微创治疗老年腰椎间盘突出症术后的应用

目的探讨利伐沙班在椎间孔镜微创治疗老年腰椎间盘突出症术后预防性抗凝的有效性和安全性。方法选择2016年3月—2019年5月在邯郸市中心医院接受椎间孔镜技术微创治疗的老年(年龄≥60岁)腰椎间盘突出症患者92例,根据术后预防血栓的方法不同分为2组:利伐沙班组48例术后12 h开始给予利伐沙班10 mg口服,连服14 d;对照组44例术后不给药物性抗凝。比较2组手术时间、术中出血量、切口引流量、术后出血和静脉血栓的发生情况。结果 2组手术时间[利伐沙斑组(70.5±15.7)min,对照组(73.8±12.9)min]和术中出血量[利伐沙斑组(16.2±5.5)mL,对照组(15.7±6.1)mL]比较差异均无统计学意义(P均0.05),术后引流量[利伐沙斑组(29.8±6.3)mL、对照组32.1±7.6 mL]及出血事件发生情况[利伐沙斑组6.2%(3/48)、对照组4.6%(2/44)]2组比较差异均无统计学意义(P均0.05),静脉血栓的发生情况[利伐沙斑组4.2%(2/48),对照组20.4%(8/44)]2组比较差异有统计学意义(P=0.037)。结论利伐沙班显著降低了老年人腰椎间盘突出症椎间孔镜微创治疗术后静脉血栓栓塞症的发生率,也避免了相应的出血风险,是脊柱内镜术后安全可靠的预防性抗凝药物。     

集中采购仿制药说明书一致性评价与风险评估

目的 评估国家药品集采目录江苏省中选药品与相应原研药说明书的差异,为药品生产企业和药品监督管理部门进一步提高一致性评价工作质量提供参考、为仿制药临床应用的安全合理性提供科学依据。方法 对国家药品集采目录江苏省中选药物的原研药和仿制药说明书全部项目进行一致性评价和风险评估,适应证与禁忌项采用SPSS和Medcalc进行统计分析。结果 仿制药与原研药说明书的适应证(P=0.782, ccc=0.93, 95%CI 0.89~0.95)与禁忌项(P=0.935, ccc=0.97, 95%CI 0.96~0.98)一致性较高,风险评估发现2组(2.25%)说明书内容差异可引起极度风险、高度风险9组(10.11%),GRADE循证证据佐证高度及以上风险的差异或成为患者用药安全的隐患。结论 药品监督管理部门应完善、落实仿制药说明书一致性评价的相关法律法规,保证临床安全用药。     

清心解瘀方对稳定性冠心病患者远期预后影响的前瞻性队列研究北大核心CSCD

目的评价清心解瘀方对稳定性冠心病(SACD)患者远期预后的影响。方法在清心解瘀方对SCAD患者1年临床终点事件影响的多中心、随机、双盲、安慰剂对照研究(QUEST试验)的基础上,最终纳入10家代表性三甲医院的916例SCAD患者,其中试验组455例接受常规治疗及清心解瘀方治疗,对照组461例接受常规治疗及安慰剂治疗。于2019年8-12月进行随访,记录患者终点事件。主要复合终点事件包括心源性死亡、非致命性心肌梗死和血运重建,次要复合终点事件包括全因死亡、卒中、因不稳定心绞痛/心力衰竭/恶性心律失常入院。结果患者平均随访时间为(43.2±11.8)个月,中位随访时间为45个月,完成随访患者775例(80.56%),试验组392例(86.15%),对照组383例(83.08%)。试验组主要复合终点事件的发生率(22例,5.61%)低于对照组[39例,10.18%,RR=0.55,95%CI(0.33~0.91),P=0.018];试验组联合终点事件发生率(40例,10.20%)低于对照组[66例,17.23%,RR=0.59,95%CI(0.41~0.85),P=0.004]。清心解瘀方是SCAD患者主要复合终点事件发生风险降低的独立影响因素[HR=0.50,95%CI(0.29~0.85),P=0.011],且在不同亚组人群的结果一致。结论常规治疗基础上加清心解瘀方可减低SCAD患者中位随访45个月主要复合终点事件和联合终点事件的发生风险。(No.ChiCTR-TRC-13004370)     

基于个体参与者数据Meta分析评价临床药师会诊在感染性疾病治疗中的效果研究

目的 本研究旨在评估临床药师抗感染会诊的效果,探讨临床药师专业对会诊结局的影响。方法 本研究连续纳入2017年4月至2019年12月的感染会诊患者,前瞻性收集患者的基线信息,开展多中心队列研究。以临床医师在治疗中是否采纳临床药师的建议作为暴露因素,以感染治疗有效率作为结局指标。统计分析基于个体参与者数据(individual participant data,IPD)Meta分析。结果 共纳入来自12家三级医疗机构的2 631例感染会诊患者,IPD Meta分析结果显示,在控制其他混杂因素的情况下,临床药师会诊干预能改善患者的预后[合并比值比(OR)=1.80,95%置信区间(CI):1.14~2.84,P=0.012],而感染和非感染专业临床药师的会诊效果相当(OR=0.87,95%CI:0.62~1.22,P=0.421)。结论 临床药师会诊是一种能够优化感染性疾病治疗的干预措施,并且可实现服务的标准化。     

加载口服中成药对PCI术后长期主要不良心脑血管事件影响的Meta分析

目的系统评价加载口服中成药对经皮冠状动脉介入治疗(PCI)术后长期(6个月及以上)主要不良心脑血管事件的影响。方法检索EMBASE、MEDLINE、Cochrane library、中国知网、中国生物医学文献数据库等11个数据库,纳入关于中成药对PCI术后终点事件影响的随机对照试验。运用Rev Man 5.3和STATA 12.0软件进行meta分析。结果纳入29项研究,共计4684例患者。PCI术后,与单纯常规西药治疗相比,加载口服中成药在主要终点事件[RR=0.44,95%CI(0.32,0.62),P0.00001]、心源性死亡[RR=0.34,95%CI(0.15,0.74),P=0.007]、非致死性心肌梗死[RR=0.37,95%CI(0.24,0.58),P0.0001]、再次血运重建[RR=0.43,95%CI(0.31,0.58),P0.00001]、脑卒中[RR=0.50,95%CI(0.29,0.87),P=0.01]、因冠心病再住院[RR=0.59,95%CI(0.46,0.75),P0.0001]、心力衰竭率[RR=0.30,95%CI(0.15,0.58),P=0.0003]方面具有远期疗效优势。结论西医常规治疗基础上加口服中成药,可能降低PCI术后冠心病患者长期主要不良心脑血管事件发生率。     

光比浊法和血小板功能分析法评价P2Y12受体拮抗剂血小板反应性的比较研究

目的 评价光比浊法(light transmittance aggregometry, LTA)和血小板功能分析法(VerifyNow)对抗血小板药物药效学指标-血小板反应性检测结果的一致性。方法 纳入北京大学第一医院收治的,规律服用P2Y12受体抑制剂氯吡格雷或替格瑞洛的冠心病患者,在服药前采集谷浓度血样,使用LTA和VerifyNow两种检测方法对药效学指标血小板反应性进行检测,对两种检测方法结果之间的相关性进行spearman相关性分析;然后分别按LTA和VerifyNow将患者判定为血小板高反应性(high platelet reactivity, HPR)和血小板低反应性(low platelet reactivity,LPR),比较两种方法结果的一致性;最后根据抗血小板治疗药物将患者分为氯吡格雷组和替格瑞洛组,分析在不同药物组LTA和VerifyNow两种检测结果之间的相关性。结果 共纳入116名患者,其中氯吡格雷组39人,替格瑞洛组77人。血小板反应性检测结果显示LTA和VerifyNow检测结果显著相关性,r=0.565,P=3.99×10^-11。但在HPR和LPR的判定方面,两种方法一致性中等(kappa=0.403)。氯吡格雷组的两种检测方法结果具有相关性,r=0.526,P=5.89×10^-4。替格瑞洛组血小板反应性显著低于氯吡格雷组,药效更好,但两种检测方法结果不具有相关性,r=0.120,P=0.299。结论 LTA和VerifyNow检测值整体具有相关性,但在血小板反应性较低的替格瑞洛组无显著相关,两种检测方法判定出的HPR和LPR一致性中等,需要进一步改进判定的阈值。     

妇产专科医院的24小时线上用药咨询服务实践

目的 对我院开展试验性24 h线上用药咨询服务的实践数据进行分析。方法 将24 h在线提供药师(男,初级药师)服务的305例患者设为试验组,将其他工作日8:00-17:00在线提供药师服务的354例患者设为对照组。收集患者的性别、年龄、咨询的时间段及“点赞”的数据并进行统计分析。试验组单独分析了咨询问题的类型及患者的“打赏”情况。结果 非工作时间的患者咨询数量在总体中占比达41.0%。试验组相较对照组,男性患者比例更高(P=0.009),节假日、清晨、夜间及深夜等非工作时间的服务比例更多(P<0.001),人均咨询次数及获得的“点赞”量更高(P<0.001)。试验组所咨询的问题类型可分为17大类,82.3%的问题可归为用药与月经、不良事件、用药疗程、特殊剂型指导、妊娠期哺乳期用药安全性、用法用量、非药学问题与用药时机。所统计的项目中仅有年龄观察到与“打赏”行为显著相关,年龄更高的人群(P=0.013)更愿意对药师的服务进行打赏。结论 24 h在线的用药咨询服务有助于提高妇产科相关科室的患者满意度及复诊率,值得推广。建议尽可能安排在线服务的药师男女性均有;对提出非药学问题的患者做出统一的转诊引导;继续探索能更好的评价药学线上咨询服务质量的指标。     

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??OBJECTIVE To evaluate the efficacy and safety of new oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban) in the treatment of atrial fibrillation. METHODS The randomized controlled trials of new oral anticoagulants versus warfarin in the treatment of atrial fibrillation, which had been published from the time of library foundation to May, 2015, were collected from Pubmed, Embase, Medline, Cochrane, ClinicalTrials.gov, CNKI, Wanfang database, and VIP database according to the inclusion criterias. At the same time the quality of the trials was evaluated and the RESULTS of studies were analyzed using RevMan 5.3 software and Stata 13.1 software. RESULTS Eleven randomized controlled trials were included, involving 75 621 patients. Meta-analysis showed that compared with warfarin, the new oral anticoagulants significantly reduced the incidences of all-cause mortality [RR=0.90, 95% CI (0.85, 0.94), P<0.000 1], stroke and systemic embolism [RR=0.86, 95% CI(0.79, 0.93), P=0.000 1], major bleeding [RR=0.79, 95% CI(0.74, 0.84), P<0.000 01], and intracranial bleeding[RR=0.43, 95% CI(0.37, 0.51), P<0.000 01]. No differences were found in the incidence of ischemic stroke [RR=1.02, 95% CI (0.93, 1.12), P=0.71] and myocardial infarction [RR=1.02, 95% CI (0.91, 1.16), P=0.70]. Heterogeneity was lower through subgroup analysis, no publication bias was found in funnel plots of most outcomes, and sensitivity analysis indicated the RESULTS were reliable. CONCLUSION The efficacy and safety of new oral anticoagulants are better than warfarin, which may have broad prospects.     

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??OBJECTIVE To evaluate the efficacy and safety of rivaroxaban in the treatment of deep venous thrombosis(DVT). METHODS PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials, CNKI, CBM and WANFANG database were systematically searched. All databases had been searched from up to August 2016. All randomized controlled trials (RCTs) of rivaroxaban therapy in patients with deep venous thrombosis were selected. Meta-analysis was carried out by using RevMan 5.3 software. The incidence of recurrent DVT, recurrent VTE, DVT, pulmonary embolism(PE), major bleeding, clinical relevant non-major bleeding(CRNMB) and all-cause mortality after the treatment were compared and the results were presented with risk ratio (RR) with 95% confidence interval (CI). RESULTS Total 5 RCTs of 4 737 cases were included in this study, including 1 605 cases accepted rivaroxaban (treatment group), other of 3 132 cases accepted other drugs (control group). The results of Meta-analysis were as follows the incidence of recurrent DVT in the rivaroxaban group was lower than that in the unfractionated heparin/low molecular heparin+ vitamin K antagonists (UFH/LMWH+VKA) group (P=0.002). There was no significant difference in the incidence of pulmonary embolism, venous thromboembolism, major bleeding, CRNMB and all-cause mortality between the treatment and control group (P??0.05). CONCLUSION In the treatment of DVT, rivaroxban shows better efficacy than that of traditional anticoagulant therapy (UFH/LMWH+VKA) and it will not increase the risk of adverse events such as bleeding and death.     

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??OBJECTIVE To evaluate the effectiveness and safety of nedaplatin versus cisplatin in the treatment of local advanced nasopharyngeal carcinoma. METHODS Such databases as Cochrane Library, Pubmed, Embase, CNKI, VIP, WanFang data and CBM were searched from the date of their establishment to April 2015 to collect the randomized controlled trials on chemotherapy containing nedaplatin versus cisplatin for local advanced nasopharyngeal carcinoma. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the quality. The Meta-analysis was carried out by Revman 5.3 software. RESULTS A total of nine RCTs involving 1032 patients were included. The results of Meta-analysis suggested that, compared with cisplatin-containing chemotherapy, nedaplatin-containing chemotherapy had comparable short-term effects and similar incidences of leukopenia, liver function impairment and neurovirulence, and lower incidences of nausea and vomiting without statistically significant difference. Meanwhile nedaplatin-containing chemotherapy could significantly reduce the risk of anemia (RR=0.81, 95% CI 0.70 to 0.94, P=0.004) and renal function impairment (RR=0.35, 95% CI 0.19 to 0.67, P=0.001), but it was associated with higher risk of thrombocytopenia (RR=1.35, 95% CI 1.17 to 1.57, P<0.000 1). CONCLUSION Nedaplatin chemotherapy can be an alternative regimen to cisplatin chemotherapy for advanced nasopharyngeal carcinoma patients who are unable to tolerate the side effects of cisplatin.     

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??OBJECTIVE To review systematically the association of dipeptidyl peptidase-4 inhibitors on pancreatitis and/or pancreatic cancer risk in type-2 diabetes mellitus. METHODS Databases including The Cochrane Library, PubMed, Embase, Clinical Trials.gov, CNKI, WanFang Data and CBM, were searched electronically for randomized controlled trials (RCTs) of DPP-4 inhibitors in pancreatitis and pancreatic cancer risk in T2DM patients up to June 2017. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using Rev Man 5.3 software. RESULTS A total of 39 RCTs involving 65 189 patients were included. The results of Meta-analysis showed that there were no significant differences between the DPP-4 inhibitors group and the control group in the pancreatitis and/or pancreatic cancer adverse events (RR=0.92, 95%CI 0.69 to 1.23, P=0.59), pancreatitis (RR=1.05, 95%CI 0.76 to 1.4, P=0.79) and pancreatic cancer (RR=0.62, 95%CI (0.35, 1.08), P=0.09). Subgroup analyses showed there were no significant differences of acute pancreatitis events between DPP-4 inhibitors group and the control group (RR=1.42, 95%CI 0.82 to 2.47, P=0.21). CONCLUSION The present Meta-analysis of RCTs data does not suggest that DPP-4 inhibitors are associated with pancreatitis and/or pancreatic cancer. Long-term clinical studies are required to further prove this conclusion.     

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??OBJECTIVE To assess efficacy and safety of simeprevir-based therapy for the treatment of hepatitis C virus genotype 1. METHODS We searched Pubmed, EMBASE, the Cochrane Library, highwire, CBM, CNKI, Wanfang, VIP Database and literature from some relative paper based magazines also be retrieved. Randomised controlled trials(RCTs)of examining simeprevir plus ribavirin(RBV) and pegylated-interferon(peg-IFN) among adults with chronic HCV infection were included.Select the RCTs according to the inclusion criterion, then appraise them critiically by Cochrane handbook. All outcomes were pooled by the RevMan5.2 software of Cochrane Collaboration. Data were extracted on virological responses including sustained virological response at post-treatment week 12(SVR12), SVR24, serious adverse event(SAE),treat-ment discontinuation due to an adverse event(TDAE). RESULTS Eight RCTs were finally included involving 2 758 patients who were treated with simeprevir, RBV and peg-IFN. The RESULTS of Meta-analysis showed that SVR12 rates was[OR=3.92,95%CI(2.86,5.39), P??0.000 01], SVR24 rates was[12 week:OR=3.79,95%CI(2.86,5.01), P??0.000 01], [24 week:OR=4.12,95%CI(2.69,6.30), P??0.000 01], SAE rates was[12 week:OR=0.67,95%CI(0.47,0.95),P=0.02], TDAE rates was[12 week:OR=0.85, 95%CI(0.54, 1.33), P=0.48],[24 week:OR=0.82,95%CI(0.42,1.60), P=0.55]. CONCLUSION Evidence shows that, simeprevir-based treatment(simeprevir plus ribavirin and pegylated-interferon)for treating genotype 1 chronic HCV infection is better than PR treatment in SVR12 rates,SVR24 rates and SAE rates(course of treatment is 12 weeks). However, they are alike in TDAE rates.     

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??OBJECTIVE To systematically review the efficacy and safety of dipeptidyl peptidase-4(DPP-4) inhibitors versus glucagon like peptide-1(GLP-1) receptor agonists for type 2 diabetes mellitus(T2DM). METHODS Databases including EMbase,PubMed, The Cochrane Library, Clinical Trial, CBM,CNKI and WanFang Data, were searched electronically for randomized controlled trials (RCTs) of DPP-4 inhibitors versus GLP-1 receptor agonists for T2DM up to December 2015. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using RevMan 5.3 soft ware. RESULTS A total of 13 RCTs were included. The RESULTS of Meta-analysis showed that compared with DPP-4 inhibitors, GLP-1 receptor agonists were more effective in reducing the levels of fasting plasma glucose [MD=0.93, 95%CI(0.48,1.38), P??0.000 1] and glycated hemoglobin [MD=0.53,95%CI(0.34,0.73), P??0.000 01] and BMI [MD=1.53,95%CI(0.83,2.22),P??0.001]. However, DPP-4 inhibitors were more effective than GLP-1 receptor agonists in the reducing the 2-hour postprandial blood glucose level. And GLP-1 receptor agonists were more prone to cause gastrointestinal adverse reactions than DPP-4 inhibitors [RR=0.44,95% CI (0.33, 0.59), P<0.000 1]. CONCLUSION GLP-1 receptor agonists are superior to DPP-4 inhibitors in controlling the fasting plasma glucose and glycated hemoglobin levels and reducing the body weight of T2DM patients, while DPP-4 inhibitors have better efficacy in reducing 2-hour postprandial blood glucose level, with better tolerability.     

Effectiveness of Huachansu injection combined with chemotherapy for treatment of gastric cancer in China: a systematic review and Meta-analysis

OBJECTIVE: to evaluate the effectiveness and safety of Huachansu(HCS) injection plus chemotherapy in the treatment of gastric cancer.METHODS: A thorough and systematic retrieval of randomized controlled trials(RCTs) concerning HCS injection for treating gastric cancer was conducted in several electronic databases from inception to May 10, 2018. The quality of the RCTs was assessed by the Cochrane risk of bias tool. And the data about objective remission rate, performance status, adverse drug rea...     

中成药辅助治疗冠心病合并高脂血症的Meta分析

目的评价中成药辅助治疗冠心病合并高脂血症的有效性。方法计算机全面检索知网、万方、维普、SinoMed、PubMed、Cochrane Library数据库,依据纳入及排除标准筛选随机对照临床试验,进行数据提取,采用"偏倚风险评估工具"评价研究质量,运用Review Manager 5.3软件进行Meta分析。结果最终纳入研究文献25篇,共计2625例患者,中成药组1351例,对照组1274例。Meta分析结果显示,在西医治疗基础上,中成药组在改善1)临床症状:心绞痛发作情况[RR=1.45,95%CI(1.24,1.69),P<0.00001]和心电图表现[RR=1.20,95%CI(1.12,1.28),P<0.00001],2)血脂水平:TC[WMD=0.86,95%CI(0.62,1.11),P<0.00001]、TAG[WMD=0.56,95%CI(0.45,0.68),P<0.00001]、LDL-C[WMD=0.51,95%CI(0.35,0.67),P<0.00001]、HDL-C[WMD=0.26,95%CI(0.15,0.37),P<0.00001]、总降脂幅度[RR=1.14,95%CI(1.04,1.25),P=0.004]方面均优于对照组,而不良反应发生率[RR=0.97,95%CI(0.59,1.58),P=0.90],中成药组与对照组比较无统计学意义。结论在西医治疗基础上,中成药有改善心绞痛发作、心电图表现及辅助降脂的疗效,同时不增加治疗中不良反应发生风险。     

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??OBJECTIVE To evaluate the effectiveness of pharmacist-participated warfarin anticoagulation management by patient education and medication consultation on patients with pulmonary embolism(PE). METHODS A total of 204 PE patients were hospitalized in respiratory wards from March 2015 to April 2017 enrolled eventually. Evaluation endpoints including the percentage of INRs within the therapeutic range(TTR), the percentage of INRs within the expanded range(TER), INR recall intervals, bleeding events, emergency department visits and hospitalizations related to anticoagulation therapy. RESULTS TTR and TER of intervention group were(70.89??26.02)% and(87.71??20.01)% respectively, which were both significantly higher than(47.79??22.31)% and(71.23??21.47)% in control group(P=0.000). INR recall intervals were(27.48??12.81) d versus(43.35??13.65) d (P=0.000). There were no significant differences between two groups in total bleeding events(41.96% vs 29.35%, P=0.062), minor bleeding events(38.39% vs 27.17%, P=0.091) and major bleeding events(3.57% vs 2.17%, P=0.864). And a significantly decreased in emergency department visits of intervention group(9.82% vs 1.09%, P=0.008), whereas no difference was observed in hospitalizations(8.04% vs 2.17%, P=0.125). CONCLUSION Clinical pharmacists participated in anticoagulation management of pulmonary embolism patients, which helped patients to monitor INRs more regularly, INR controlling better and decrease frequency of emergency department visits.     

益气活血法治疗稳定型心绞痛临床疗效的Meta分析

目的:对运用中医益气活血为原则治疗稳定型心绞痛的临床疗效进行系统评价,为中医药治疗稳定型心绞痛提供循证医学依据.方法:检索国家知识基础设施数据库(CNKI);中国学术期刊数据库(CSPD);中文科技期刊数据库(CCD),中文生物医学文献数据库(CBM),纳入以益气活血为治疗原则,观察组采用中西结合、以中医为主的治疗,对...