抗结核治疗中预防应用保肝药临床试验的中文文献系统评价

我国结核病负担较高,每年仅新发现的初复治病例即达98万[1],加上原患未治愈者,每年接受治疗的病例超过100万.抗结核治疗使用的一、二线药物均可引起不良反应,其中影响最大且发病率较高的为肝损害[2].     

抗结核治疗中预防应用保肝药临床试验的中文文献系统评价

我国结核病负担较高,每年仅新发现的初复治病例即达98万[1],加上原患未治愈者,每年接受治疗的病例超过100万.抗结核治疗使用的一、二线药物均可引起不良反应,其中影响最大且发病率较高的为肝损害[2].     

抗结核药肝损害前后应用保肝药疗效观察

目的 观察抗结核药肝损害前后应用保肝药的效果,寻找有效预防方法.方法 210例初治涂阳肺结核分为两组,均采用＂2HRZE/4HR＂方案化疗.治疗组140例,抗结核和保肝药同服至疗程结束;对照组70例直接化疗,出现肝功异常后给予保肝药,至疗程结束.结果 治疗组药物性肝炎发生率为5 7%;中断化疗比例为2 2%;调整化疗方案为1 4%;与对照组的17 1%、10 0%、7 1%比较均有统计学意义（P〈0 01）.结论 化疗同时应用保肝药,可显著提高肝脏抗结核药损害的能力,从而避免不必要地停药,提高化疗成功率,建议常规应用.     

保肝药的临床应用分析与展望

本文介绍各类常用保肝药物的分类、作用机制、临床应用的性价比、常见不良反应及配合禁忌.     

抗结核药物致肝损伤的发病机制及预防和治疗药物研究进展

目的为结核病诊疗过程中抗结核药所致药物性肝损伤的预防和治疗药物的选择提供参考。方法以"药物性肝损伤"、"抗结核药"、"药物性肝损伤发病机制"、"护肝药物"等为关键词,通过PubMed、ScienceDirect和万方数据库检索国内外相关文献,综述了抗结核药致药物性肝损伤的发病机制及预防和治疗药物研究进展。结果抗结核药所致药物性肝损伤确切机制尚未完全透彻,目前观点主要存在"免疫介导肝损伤"和"非免疫介导的对肝脏的直接毒性作用"两种机制。已用于临床的护肝药物主要有抗炎抗氧化、降酶、利胆降脂、保护和修复肝细胞等药理作用机制的药物制剂。结论由于致病因素复杂,在应用护肝药物时,应考虑患者具体情况,权衡利弊,根据各类护肝药物的药理作用特点,合理选择恰当的护肝药物,密切关注不良反应,最大程度保证患者用药的有效性和安全性,避免护肝药的无指征滥用和不必要联用。     

54例抗结核药致儿童药物性肝损伤的临床特点及护理对策

目的:探究抗结核药物导致儿童药物性肝损伤的临床特点及护理对策,为临床医学提供治疗经验,帮助患儿早日恢复身体健康.方法:选取我院自2015年12月~2016年12月确诊为抗结核药物所致儿童肝炎的患者资料54例,对这54例患者进行回顾性分析.并总结护理措施,以为临床提供治疗经验.结果:比较患者的肝功能指标及住院时间,显示出肝细胞型、胆汁郁积型、混合型这三种类型的患儿发生率最高.其中胆汁郁积型的患儿住院时间最长,而且经过一段时间的护理照料之后患者的治疗依从性能够有所提高.结论:在临床上应当慎重对儿童患者用药,在药物抗结核治疗之后患者容易出现不良反应,使得药物对患儿的肝造成不同程度的损伤,必须进行积极的防治,并采取有效的护理措施,以降低患者的身体损伤程度.     

抗结核药致黄疸31例临床分析

从1998年1月至2009年1月我院住院结核病人1192例中,因用抗结核药物而致临床黄胆的共31例。其选例标;住是：①结核病诊断明确;②血胆红素〉17．0mmol／L;③排除其他疾病引起的黄疸;④黄疸出现时正值抗结核药物治疗中,并排除伴用的其他药物引起的黄疸的可能性。抗痨药所致黄疸的发生率与药物种类和剂量有关,与原有肝脏疾患病理损害有关。     

甘利欣胶囊预防抗结核药所致肝脏损害

目的探讨甘利欣胶囊降低抗结核药导致的肝损害，以有效治疗肺结核。方法将河北省沙河市第二医院65例肺结核患者分为3个组，肝太乐组21例，甘草组28例和对照组16例进行临床观察。结果甘草组、肝太乐组及对照组的肝损害率分别为14．29％、19．05％和43．75％；甘草组与对照组比较，差异有统计学意义（x^2=4．71，P〈0．05）；与肝太乐组比较，差异无统计学意义（x^2=0．20，P〉0．05）。结论甘利欣胶囊具有较强的抗炎、抗变态和抗氧化作用，并有保护肝细胞膜和改善肝功能的作用。     

缬沙坦氨氯地平片治疗高血压有效性和安全性的系统评价

目的 系统评价缬沙坦氨氯地平片(倍博特)治疗高血压的有效性和安全性.方法 采用循证医学的方法,将国内外符合纳入标准的12项(共计2 796例患者)关于倍博特治疗高血压的随机对照试验进行Meta分析.采用收缩压、舒张压、24 h平均血压、临床疗效以及不良反应率作为结局指标判定治疗效果.运用RevMan 5.0软件进行Meta分析.结果 Meta分析结果显示倍博特的临床疗效优于氨氯地平组(OR=3.36,95％ CI:2.17～5.19,P＜0.001)、缬沙坦80 mg组(OR =3.19,95％ CI:2.40 ～4.24,P＜0.001)和缬沙坦160 mg组(OR=1.61,95％ CI:1.12 ～2.32,P=0.010);倍博特组患者不良反应的发生率低于氨氯地平组(OR=0.45,95％ CI:0.27～0.74,P＜0.001),而倍博特组与缬沙坦80 mg组及160 mg组不良反应的发生率差异无统计学意义.结论 倍博特治疗高血压的效果优于对照组,且具有较好的安全性.     

我国1996-2015年间肝癌经济负担研究系统评价

目的 整合我国肝癌经济负担证据,为今后研究提供基线数据和方法参考。方法 系统检索PubMed、中国知网和万方数据库1996-2015年间发表文献,描述纳入研究基本特征并分析经济负担结果,费用贴现至2013年值,采用美国卫生保健质量和研究机构（agency for health care research and quality,AHRQ）推荐的量表开展质量评价。结果 最终纳入32篇文献。2篇基于人群的研究,报道的经济负担分别为37.8亿元（省级,直接和间接）和6.0亿元（市级,间接）。30篇基于个体的研究均报道了直接医疗费用,例均费用（21篇）年度中位数为11 663元（3 500~70 567元）,次均费用（9篇）年度中位数为19 202元（7 005~41 118元）,日均费用（13篇）年度中位数为865元（409~1 275元）;20年间三种指标费用均呈缓慢上升趋势;细化构成药品费居多（约56.6%）;5篇基于个体的研究报道了间接费用,中位数为73 440元（35 815~166 967元）。纳入研究质量一般。结论 肝癌在我国人群层面经济负担研究有限。不同地区的肝癌经济负担研究力度与其疾病负担不相匹配。例均费用数据报道较多,但结果解释应谨慎。此外,肝癌所致间接经济负担不容忽视。     

Priorities among effective clinical preventive services: results of a systematic review and analysis

BACKGROUND: Decision makers at multiple levels need information about which clinical preventive services matter the most so that they can prioritize their actions. This study was designed to produce comparable estimates of relative health impact and cost effectiveness for services considered effective by the U.S. Preventive Services Task Force and Advisory Committee on Immunization Practices. METHODS: The National Commission on Prevention Priorities (NCPP) guided this update to a 2001 ranking of clinical preventive services. The NCPP used new preventive service recommendations up to December 2004, improved methods, and more complete and recent data and evidence. Each service received 1 to 5 points on each of two measures--clinically preventable burden and cost effectiveness--for a total score ranging from 2 to 10. Priorities for improving delivery rates were established by comparing the ranking with what is known of current delivery rates nationally. RESULTS: The three highest-ranking services each with a total score of 10 are discussing aspirin use with high-risk adults, immunizing children, and tobacco-use screening and brief intervention. High-ranking services (scores of 6 and above) with data indicating low current utilization rates (around 50% or lower) include: tobacco-use screening and brief intervention, screening adults aged 50 and older for colorectal cancer, immunizing adults aged 65 and older against pneumococcal disease, and screening young women for Chlamydia. CONCLUSION: This study identifies the most valuable clinical preventive services that can be offered in medical practice and should help decision-makers select which services to emphasize.     

基于密切接触者队列的新型冠状病毒肺炎病程和相关流行病学参数研究

  目的   评价新冠肺炎暴发疫情中对密切接触者的密切接触者（次密接）进行集中隔离管控的效果。  方法  对2021年12月绍兴市上虞区一起由Delta变异株引起的新冠肺炎本土疫情的次密接管理信息数据库进行分析。如随访的次密接成为感染者,则进一步查阅分析其关联病例、关联密切接触者（密接）及次密接本人的流行病学调查报告。根据密接和次密接随访结局（感染新冠病毒与否）,建立有效、无效、负效和无法评价4类管控效果评价结果。采用描述流行病学方法对次密接管控效果进行评价。  结果  该起疫情共报告感染者387例,符合纳入标准的次密接共8192人,平均每个病例排查次密接21人。99.8 %的次密接经多轮新冠病毒核酸检测均为阴性,属无效管控。随访过程中18例（0.2 %）次密接检出核酸阳性,均为其关联密接同住的家庭成员,其中9例关联密接核酸检测结果全程阴性,提示次密接可能在转运或集中隔离过程中感染。对核酸检出阳性的18例次密接管控效果作进一步评价,结果判为有效的0例,判为无效、负效和无法评价的分别为3例（16.7 %）、9例（50.0 %）和6例（33.3 %）。  结论  该起新冠肺炎暴发疫情对次密接进行集中隔离管控未能取得正面的防控效果,少数次密接反而可能在转运或隔离过程中感染。建议取消暴发疫情中常规对次密接采取集中隔离措施,可代之以居家隔离管理,同时及时对一些涉及面广的防控措施开展效果评价。     

Efficacy and safety of mixed oriental herbal medicines for treating human obesity: a systematic review of randomized clinical trials

The objective of this systematic review was to assess the evidence from rigorous clinical trials evaluating the efficacy of mixed herbal medicine formulations used in traditional Oriental medicines for the treatment of obesity and to describe the safety and types of adverse events reported in such trials. To accomplish this, 14 databases were searched from inception to July 31, 2009. The search terms used were "obesity" or "obese" and "herb," "herbal," or "herbal medicine" without language restriction. All randomized clinical trials using mixed herbal medicines on obese or overweight subjects were considered for inclusion. Of the publications in the identified databases, 1144 results were searched and reviewed, and in total 12 studies were included. Their methodological quality was assessed using the Jadad score. The results of our review provide evidence suggesting that mixed Oriental herbal medicines may be safe and effective for the treatment of obesity when compared with conventional medicine, placebos, or lifestyle control. Many trials also reported improved concomitant conditions including impaired glucose tolerance, hypertension, and inflammation. Small numbers of adverse events were reported, but most were mild or not related to the intervention in itself. No significant mortality was observed in any of the trials. However, the evidence provided by the trials reviewed is not fully convincing because of their poor methodological quality. Therefore, more research and well-designed clinical trials are necessary to address these issues, as well as to assess the safety of mixed Oriental herbal medicines used to treat obesity.