血栓通治疗急性脑梗死的Meta分析

目的利用Meta分析方法评价血栓通治疗急性脑梗死的疗效和安全性。方法检索2009年1月至2012年8月国内发表的血栓通治疗急性脑梗死的临床试验的相关文献,利用RevMan 5.1软件对符合条件的文献进行Meta分析。结果共纳入研究13篇。Meta分析结果显示血栓通治疗组与对照组相比,显效率(RR=1.50,95%CI〔1.34,1.67〕,P<0.01)和有效率(RR=1.29,95%CI〔1.22,1.37〕,P<0.01)均有显著统计学差异,且不良反应发生率低,发生率为0.84%。结论血栓通治疗急性脑梗死有较好疗效,且不良反应发生率低,但由于现有研究质量较差,尚需设计严谨的多中心、大样本研究进一步证实。     

水飞蓟宾胶囊对比护肝片改善脂肪肝相关生化指标有效性和安全性的系统评价

目的:基于系统评价,比较水飞蓟宾胶囊与护肝片在改善脂肪肝相关生化指标方面的有效性和安全性。方法:计算机检索万方数据库、中国生物医学文献数据库、中国知网、the Cochrane Library、Embase和PubMed等数据库,纳入水飞蓟宾胶囊与护肝片治疗脂肪肝的随机对照试验(研究组的治疗方案为水飞蓟宾胶囊,对照组为护肝片),检索时间为建库至2021年10月。提取资料、选取文献并评价纳入文献的偏倚风险后,采用Rev Man 5.4软件进行Meta分析。结果:共纳入9篇文献,包括700例患者(研究组患者384例,对照组患者316例)。Meta分析结果显示,研究组患者的总有效率(OR=4.39,95%CI=2.95～6.55,P <0.000 01)、显效率(OR=2.27,95%CI=1.56～3.32,P<0.000 1)、治愈率(OR=2.67,95%CI=1.67～4.28,P<0.000 1)、丙氨酸转氨酶水平(MD=-12.16,95%CI=-15.06～-9.26,P<0.000 01)、天冬氨酸转氨酶水平(MD=-12.32,95%CI=-15.2...     

复方甘草酸苷治疗脂肪肝临床疗效的系统评价

目的：系统评价复方甘草酸苷治疗脂肪肝的临床疗效。方法：检索PubMed、the Cochrane Library、Embase、中国知网、万方数据库和维普数据库,检索2021年11月前发表的复方甘草酸苷治疗脂肪肝的随机对照试验(研究组患者采用复方甘草酸苷+其他治疗,对照组患者采用除复方甘草酸苷外的其他方法治疗),采用RevMan 5.3软件进行Meta分析。结果：纳入9篇文献,共795例受试者,其中研究组400例,对照组395例。Meta分析结果显示,研究组患者的临床有效率明显高于对照组(OR=6.35,95%CI=4.00～10.07,Z=7.85,P<0.000 01),天冬氨酸转氨酶(MD=-31.88,95%CI=-51.14～-12.62,Z=3.24,P=0.001)、丙氨酸转氨酶(非酒精性脂肪性肝病亚组：MD=-14.68,95%CI=-18.15～-11.22,Z=8.30,P<0.000 01;酒精性脂肪性肝病亚组：MD=-29.52,95%CI=-30.77～-28.28,Z=46.36,P<0.000 01)和三酰甘油(MD=-0.73,95%C...     

国产加替沙星与左氧氟沙星双盲随机对照治疗细菌感染的Meta分析

目的:探讨国产加替沙星治疗细菌感染的有效性和安全性.方法:按照系统评价的要求全面检索了中国数字医院图书馆(www.chkd.cnki.net)、中国医学科学院的中国生物医学文献光盘数据库(CBM disk),对符合纳入标准的18篇文献共计2 253名患者进行了Meta分析.结果:国产加替沙星组临床有效率与左氧氟沙星组临床有效率OR合并值1.42(95%CI为1.03～1.98),Z=2.11,P=0.03,差异有显著性;痊愈率、细菌清除率和不良反应发生率没有显著差异.结论:国产加替沙星治疗细菌感染的有效率比左氧氟沙星高.     

中西医结合治疗激素依赖性皮炎的Meta分析

目的 探讨中西医结合治疗激素依赖性皮炎的临床疗效.方法 检索2005 -2011年国内发表的中西医结合治疗激素依赖性皮炎临床试验的相关文献,采用RevMan 5.0对符合条件的文献进行Meta分析.结果 共有15篇文献,1749例患者满足纳入标准.与西药组相比,中西医结合治疗激素依赖性皮炎有效率的合并检验分析结果为:Z=12,P＜0.00001,合并后的OR值为4.2,95％的可信区间为(3.32 ～5.31).结论 中西医结合治疗激素依赖性皮炎是一种有效的方法.     

百蕊颗粒治疗儿童急性上呼吸道感染疗效及安全性系统评价

目的 系统评价百蕊颗粒治疗儿童急性上呼吸道感染(AURTI)的疗效及安全性。方法 通过计算机系统检索中国知网、万方数据与维普网数据库自建库至2022年9月有关百蕊颗粒治疗儿童AURTI的随机对照研究,并按照Cochrane质量评价标准对纳入研究的方法学质量进行评估,运用RevMan 5.4软件进行Meta分析。结果 纳入文献10篇,涉及患儿1 257例。Meta分析显示百蕊颗粒组总有效率高于对照组(OR=4.26,95%CI:2.94～6.16,P<0.000 01)。依据疾病类型、治疗疗程进行亚组分析,结果显示,疱疹性咽峡炎患者与非疱疹性咽峡炎患者百蕊颗粒组总有效率均高于对照组(OR=5.34,95%CI:3.23～8.84,P<0.000 01;OR=3.12,95%CI:1.80～5.42,P<0.000 1);疗程3～5 d与6～7 d百蕊颗粒组总有效率均高于对照组(OR=5.24,95%CI:3.20～8.59,P<0.000 01;OR=3.14,95%CI:1.79～5.52,P<0.000 1)。百蕊颗粒组退热时间、咽喉部症状消退时间短于对...     

丙种球蛋白对儿童难治性肺炎支原体肺炎疗效的Meta分析

[摘要]目的：系统评价丙种球蛋白对儿童难治性肺炎支原体肺炎（RMPP）的疗效。方法：检索维普、万方数据库、中国知网、中国生物医学文献数据库,结合纳入标准和排除标准严格筛选文献,采用改良Jadad量表评估纳入文献的质量,以总有效率、体温恢复时间、咳嗽缓解时间、肺部啰音消失时间等为主要疗效指标,应用RevMan 5.3软件对纳入的随机对照试验进行Meta分析。结果：共纳入7篇文献,包括580例患儿,其中对照组277例,试验组303例。Meta分析结果显示,丙种球蛋白可缩短RMPP患儿的体温恢复时间（MD=-1.60,95%CI -2.09~1.12,P<0.01）、咳嗽缓解时间（MD=-1.73,95%CI -1.85~-1.60,P<0.01）及肺部啰音消失时间（MD=-0.72,95%CI -0.93~-0.51,P<0.01）,提高治疗总有效率（OR=5.17,95%CI 2.45~10.90,P<0.01）。结论：丙种球蛋白对儿童RMPP的疗效显著。     

头孢丙烯与头孢克洛国内随机对照治疗细菌感染的Meta分析

目的:评价头孢丙烯与头孢克洛随机对照治疗细菌感染的疗效和安全性。方法:通过检索中文科技期刊全文数据库(1994-2010年)与中国生物医学文献数据库(1978-2010年),纳入头孢丙烯与头孢克洛治疗细菌感染的随机对照试验(RCT)文献,对纳入研究进行方法学质量评价,并采用Rev Man 5.0软件进行Meta分析。结果:入选12篇随机对照试验,共1634例患者符合纳入标准;Meta分析结果显示:与头孢克洛比较,头孢丙烯的治疗痊愈率OR合并值1.30(95%CI为1.06~1.59),Z=2.53(P=0.01),差异有显著性;有效率OR合并值1.24(95%CI为0.88~1.75),Z=1.23(P=0.22),差异无显著性;细菌清除率OR合并值1.28(95%CI为0.81~2.03),Z=1.08(P=0.28),差异无显著性。结论:目前国内证据表明,头孢丙烯治疗细菌感染痊愈率优于头孢克洛,但受纳入文献质量影响,以上结论需要高质量的临床证据进一步证实。     

中药治疗甲状腺功能亢进症的Meta分析

目的:评价中药治疗甲状腺功能亢进症的有效性及安全性。方法:计算机检索VIP,CNKI,WANGFANG DATA,CBM中关于中药治疗甲亢的临床研究文献,选择从建库至2014年1月以来符合要求的随机对照试验(RCT)。利用Cochrane手册进行文献质量评价,利用revman5.2软件进行Meta分析。结果:共纳入15篇随机对照试验,合计1291例患者。Meta分析显示,中药治疗甲亢与单纯西药比较总有效率(临床控制率+显效率+有效率)差异有统计学意义(OR=2.48,95%可信区间[1.75,3.53],Z=5.05,P0.00001)。中药治疗甲亢与单纯西药比较治愈率(临床控制率)差异有统计学意义(OR=2.22,95%可信区间[1.30,3.79],Z=2.94,P=0.003)。结论:采用中药治疗甲亢的总有效率和治愈率明显优于单纯西药组,但根据GRADE证据质量评价,发现证据质量不高,仍需要更多大样本、多中心、高质量的随机对照试验进行验证。     

国内抗幽门螺旋杆菌治疗在儿童原发免疫性血小板减少症中疗效的Meta分析和试验序贯分析

目的:系统评价国内抗幽门螺旋杆菌治疗在儿童原发免疫性血小板减少症的疗效。方法:计算机检索VIP、CNKI、Wanfang、SinoMed、Medline、Cochrane Library、PubMed,检索时间为各数据库建库至2019年4月16日,按照预先制定的遴选标准筛选出抗Hp(幽门螺旋杆菌)治疗儿童ITP(原发免疫性血小板减少症)的随机对照试验。用Rev Man5.3软件进行Meta分析,用TSA 0.9.5.10Beta软件进行试验序贯分析。结果:共检索出268篇文献,最终纳入14个研究,总样本量为833例。Meta分析结果显示:常规治疗联合抗Hp治疗在临床疗效、复发率、血小板计数、血液流变学指标和Hp阳性率等方面优于单纯常规治疗组,但在不良反应方面,由于文献数量较少,暂不能得出结论。试验序贯分析显示:在临床总有效率方面,累积Z值穿过了传统界值和TSA界值,提前得到肯定结论;在半年内复发率方面,累积Z值虽然穿过了传统界值,但并未与TSA界值相交,提示Meta分析结果可能为假阳性。结论:本研究结果提示常规治疗联合抗Hp治疗能增加儿童ITP的临床疗效,降低复发率。但因纳入研究质量等问题,本研究结论还有待更多关于抗Hp治疗的儿童ITP患者的高质量、随机双盲的随机对照试验。     

静脉用丙种球蛋白联合甲泼尼龙冲击治疗免疫性血小板减少症的疗效观察

目的 探索静脉用丙种球蛋白联合甲泼尼龙(甲强龙)冲击治疗免疫性血小板减少症(ITP)的临床疗效.方法 将92例ITP患儿按随机数字表法分为两组,对照组(46例)给予甲强龙治疗,观察组(46例)给予甲强龙联合丙种球蛋白冲击治疗,比较临床治疗效果.结果 观察组有效率(89.13%)较对照组(73.91%)明显提高,差异有统计学意义(Z=5.83,P<0.01).观察组患儿治疗后血小板计数(122.45±12.63)×109·L-1较治疗前(12.04±1.50)×109·L-1和对照组同期(71.54±7.34)×109·L-1均有明显增加(P<0.05).患儿主要不良反应为柯兴综合征面容、高血压、高血糖、恶心、头痛等,两组不良反应发生率比较差异无统计学意义(P>0.05).观察组复发率(4.35%)明显低于对照组(17.39%),差异有统计学意义(P<0.05).结论 静脉用丙种球蛋白冲击治疗ITP可明显改善患儿临床症状,提高外周血中血小板计数,降低复发率,具有较高的临床应用价值.     

特发性血小板减少性紫癜86例治疗体会

目的总结和比较特发性血小板减少性紫癜（ITP）的三组治疗方法。方法对2005年1月-2009年6月商丘市第一人民医院血液科收治86例ITP患者随机分为WIG（丙种球蛋白）组,泼尼松组,IVIG及泼尼松联合用药组三个治疗组,比较其疗效。结果联合用药组出血症状控制时间最短,与IVIG组比较无差异（P〉0．05）;与泼尼松组比较有统计学意义（P〈0．01）;IVIG组的血小板达到有效的时间最快,与另两组相比差异有统计学意义（P〈0．01）;2周后血小板计数比较,联合用药组效果最好,联合用药组与波尼松组和IVIG组比较有统计学意义（P〈0．01）。结论大剂量免疫球蛋白联合糖皮质激素治疗ITP是一种能快速而明显升高血小板、快速控制出血的疗效确切的治疗方法。     

A comparison between IV paracetamol and IV metamizol for postoperative analgesia after retinal surgery

OBJECTIVE: To assess clinical efficacy of IV paracetamol 1 g and IV metamizol 1 IV metamizol 1 g on a 24-h dosing schedule in this randomized, double-blinded, placebo-controlled study of 38 ASA physical status I-III patients undergoing retinal surgery. RESEARCH DESIGN AND METHODS: General anaesthesia using remifentanil, propofol, and desflurane was performed for surgery. The patients were randomly allocated to three groups, receiving infusions of paracetamol 1 g/100 mL (Para Group), of metamizol 1 g/100 mL (Meta Group), or of 100 mL of saline solution as placebo control (Plac Group) 30 min before arrival in the recovery area and every 6 h up to 24 h postoperatively. All patients had unrestricted access to intravenous opioid rescue medication. MAIN OUTCOME MEASURES: The primary efficacy variables were pain scores at rest over 30 h postoperatively analysed by using repeated ANOVA measurement. Secondary efficacy variables were pain scores on coughing, also analysed by repeated ANOVA measurement. RESULTS: Five patients in the Plac Group and one patient in the Meta Group interrupted the study protocol. Regarding pain scores at rest, Mauchly-test of sphericity was significant (p = 0.03). For the p time effects a significant result was detected (p < 0.001). The main effect between the three treatment groups was significantly different (p = 0.01). The Bonferroni adjusted pair wise comparisons between p the Plac Group and the Para Group showed a significant difference in favour of IV paracetamol (p = 0.024; mean difference 14.8; p 95% CI 1.6-28.0), between the Plac Group and the Meta Group in favour of IV metamizol (p = 0.025; mean difference 14.4; 95% CI p 1.5-27.4), and no significant difference between the Para Group and the Meta Group (p = 1.0; mean difference 0.4; 95% CI-12.8 to 13.6). Pain scores on coughing showed a significant different main effect between the three treatment groups (p = 0.022). The Bonferroni adjusted pair wise comparisons between the Plac Group and the Para Group showed a significant difference in favour of IV paracetamol (p = 0.032; mean difference 17.9; 95% CI 1.3-34.6), a p difference, though not reaching statistical significance, in favour of IV metamizol between the Plac Group and the Meta Group (p = 0.081; p mean difference 15.0; 95% CI -1.4 to 31.4), and no significant difference between the Para Group and the Meta Group (p = 1.0; p mean difference 2.9; 95% CI -13.8 6 to 19.6). None of the patients experienced itching; one patient in the Meta Group developed a mild erythema. There was no statistical difference in the incidence of nausea (Plac vs. Para Group: p = 0.94, Plac vs. Meta Group: p = 0.98, Para vs Meta Group: p = 0.95) or vomiting (Plac vs. Para Group: p = 0.73, Plac vs. Meta Group: p = 0.85, Para vs Meta Group: p = 0.86) between the groups. Patients in the Plac Group experienced significantly more often sedation than patients in the Meta Group (p = 0.049). There was a trend of higher sedation in the Plac Group than in the Para Group, which did not reach statistical significance (p = 0.07). There was no difference in sedation between the Meta and the Para Groups (p = 0.84). CONCLUSION: IV paracetamol 1 g has a similar analgesic potency as IV metamizol 1 g for postoperative analgesia after retinal surgery.     

Treatment of immune thrombocytopenic purpura in children : current concepts

Treatment of immune thrombocytopenic purpura (ITP), the most common bleeding disorder of childhood, is a controversial subject for most practitioners. Diagnosis and management of ITP has historically been based primarily on expert opinion rather than on evidence. Due to a paucity of carefully conducted clinical trials in children, the management of ITP varies widely, ranging from observation only, to aggressive management with intravenous immunoglobulin (IVIG), intravenous anti-D rhesus (Rh)0 immunoglobulin (IV RhIG), corticosteroids, and splenectomy. To address the controversies, the American Society of Hematology (ASH) and the British Society for Hematology (BSH) have developed ITP practice guidelines. These guidelines, based on expert opinion, differ in their recommendations for treatment. The ASH guidelines favor therapy based on a low platelet count, and the more current BSH guidelines recommend a more conservative 'wait and watch' approach.In addition to treating children with severe bleeding symptoms, there is a tendency (not evidence based) to treat early in order to prevent a life-threatening bleeding episode, including intracerebral hemorrhage. Corticosteroids are a highly effective therapy, inexpensive, and can usually increase the platelet count within hours to days. However, chronic or prolonged use is associated with toxicity. In the US, based on the knowledge of known toxicities of corticosteroids, as well as the efficacy of alternative treatments (IV RhIG, IVIG), many pediatricians prefer to treat with IVIG and IV RhIG, reserving corticosteroid treatment for serious bleeding or refractory disease. However, in the UK, for the most part, corticosteroids are used as first-line therapy in children with ITP. Splenectomy is rarely indicated in children except for those with life-threatening bleeding and chronic, severe ITP with impairment of quality of life. For children who develop chronic or refractory ITP, immunosuppressive drugs and/or chemotherapy agents may offer some promise. However, the long-term effects of these drugs in children are unknown and they should not be considered unless there is unequivocal evidence that the patient is refractory to IV RhIG, IVIG, and corticosteroids.To date, virtually all of the randomized clinical trials conducted in children with ITP have focused on platelet counts as the sole outcome measure. Only carefully designed, multicenter, randomized clinical trials comparing the effects of different treatment modalities in terms of bleeding, quality of life, adverse effects, and treatment-related costs will be able to address the controversies surrounding childhood ITP treatment and allow management of this condition to be based on scientific data rather than treatment philosophy.     

Immune thrombocytopenic purpura – current management practices

The treatment of patients with immune thrombocytopenic purpura (ITP) is changing rapidly, as new agents demonstrate the capability of improving outcomes and decreasing toxicity. Prior to 1981, the only effective treatment options available to increase platelet counts in persons with ITP were corticosteroids and splenectomy. In recent years, intravenous immunoglobulin (IVIg) and intravenous Rh immunoglobulin (IV RhIg) have demonstrated efficacy comparable to that of corticosteroids for increasing platelet counts in ITP. In addition, IVIg and IV RhIg have demonstrated efficacy for maintaining corticosteroid-induced increased platelet counts by periodic infusion, causing a transient impairment of reticuloendothelial clearance function (medical splenectomy). Thus, the time-proven efficacy of corticosteroids for initial treatment of ITP (induction) may now be supplemented with IVIg or IV RhIg infusions for patients requiring ongoing treatment to support a timely and complete steroid taper, while sustaining the increased platelet count (maintenance) with less toxicity. Several investigators have reported that rituximab (anti-CD20) induced sustained remissions with minimal toxicity, in patients with chronic ITP. These reports are promising and, if confirmed, will provide another effective (spleen-sparing) option for managing acute ITP and a long-awaited option for patients who have had a splenectomy and are refractory to conventional agents. Other treatments, including danazol, azathioprine, cyclophosphamide, vinca alkaloids and cyclosporin A, have advocates, but evidence of their efficacy is limited to relatively small and mostly uncontrolled clinical trials. In our opinion, these agents should be reserved for symptomatic thrombocytopenia after refractoriness to corticosteroids, IVIg, IV RhIg, splenectomy and rituximab has been clearly established.     

Immune thrombocytopenic purpura - current management practices

The treatment of patients with immune thrombocytopenic purpura (ITP) is changing rapidly, as new agents demonstrate the capability of improving outcomes and decreasing toxicity. Prior to 1981, the only effective treatment options available to increase platelet counts in persons with ITP were corticosteroids and splenectomy. In recent years, intravenous immunoglobulin (IVIg) and intravenous Rh immunoglobulin (IV RhIg) have demonstrated efficacy comparable to that of corticosteroids for increasing platelet counts in ITP. In addition, IVIg and IV RhIg have demonstrated efficacy for maintaining corticosteroid-induced increased platelet counts by periodic infusion, causing a transient impairment of reticuloendothelial clearance function (medical splenectomy). Thus, the time-proven efficacy of corticosteroids for initial treatment of ITP (induction) may now be supplemented with IVIg or IV RhIg infusions for patients requiring ongoing treatment to support a timely and complete steroid taper, while sustaining the increased platelet count (maintenance) with less toxicity. Several investigators have reported that rituximab (anti-CD20) induced sustained remissions with minimal toxicity, in patients with chronic ITP. These reports are promising and, if confirmed, will provide another effective (spleen-sparing) option for managing acute ITP and a long-awaited option for patients who have had a splenectomy and are refractory to conventional agents. Other treatments, including danazol, azathioprine, cyclophosphamide, vinca alkaloids and cyclosporin A, have advocates, but evidence of their efficacy is limited to relatively small and mostly uncontrolled clinical trials. In our opinion, these agents should be reserved for symptomatic thrombocytopenia after refractoriness to corticosteroids, IVIg, IV RhIg, splenectomy and rituximab has been clearly established.     

国内伽玛刀与手术治疗三叉神经痛疗效的Meta分析

目的 评价伽玛刀(GKS)治疗与手术治疗三叉神经痛(TN)的疗效及安全性.方法 计算机检索PubMed、中国生物医学文献数据库、中国期刊全文数据库及万方数据库,纳入GKS治疗与手术治疗TN的随机对照试验(RCT),检索时间截止于2012年12月,由2名评价者按照纳入和排除标准独立选择文献,提取资料并评价质量.采用Stata 11.0软件进行Meta分析.结果 最终纳入系统评价的1篇完全RCT文献和4篇回顾性队列研究,纳入患者564例(GKS组293例,手术组271例).对TN疼痛缓解疗效的分析(OR=0.56,95％CI=0.06～5.64,P=0.625),两组间差异无统计学意义.治疗后面部麻木的分析(OR=0.39,95％CI=0.08～1.91,P=0.243),复发情况分析(OR=1.59,95％CI=0.68～3.73,P=0.287),两组间差异无显著性,其他并发症分析(OR=0.30,95％CI=0.15～0.62,P=0.001),两组间差异有统计学意义.结论 GKS与手术治疗TN在对疼痛的有效率、治疗后面部麻木情况、复发情况方面差异无统计学意义,但在改善治疗后其他并发症方面GKS较手术治疗TN存在显著优势.     

ACEI抗高血压药时辰疗法的Meta分析

目的 系统评价ACEI抗高血压药物时辰服药对比常规服药治疗高血压的疗效和安全性,为临床治疗提供循证参考.方法 计算机检索PubMed、ACP、MEDLINE、EMBASE、中国知网CNKI、万方数据库、中文科技期刊全文数据库,检索ACEI抗高血压药物时辰服药对比常规服药方式治疗高血压的系列研究,提取资料并评价质量后,采用Rev Man5.0统计软件进行Meta分析.结果 共纳入12项临床研究,合计1286例患者.Meta分析结果显示,时辰服药组的24h平均收缩压(RR=1.41,P＜0.00001,95％CI[-3.15,5.97])、24 h平均舒张压(RR=-1.76,P＜0.00001,95％CI[-2.78,3.09])、白天平均收缩压(RR=2.33,P=0.0007,95％CI[-1.45,6.1])、夜间平均收缩压(RR=-3.96,P=0.002,95％CI[-7.42,-0.5])、夜间平均舒张压(RR=-6.31,P=0.0001,95％CI[-9.31,-1.16])低于常规服药组,差异有统计学意义;而白天平均舒张压(RR=0.41,P=0.4,95％CI[-0.55,1.36])与常规服药组相比,差异无统计意义.结论 ACEI类抗高血压药物按照时间疗法管理的降压效果优于常规疗法.但是受到纳入研究方法学质量的限制,该结论有待大样本、高质量的随机对照试验进一步验证.     

法舒地尔治疗肺动脉高压疗效的Meta分析

目的运用Meta分析方法评价法舒地尔治疗肺动脉高压的疗效。方法计算机检索中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数字化期刊全文库、Pubmed和Cochrane library,对纳入的随机对照试验文献进行质量评价,并采用Rev Man 5.3软件进行Meta分析。结局指标为总有效率、6分钟步行试验(6MWT)、肺动脉收缩压(s PAP)、血氧饱和度(Sa O2)。结果共纳入13篇随机对照试验,共933例患者。Meta分析结果显示,法舒地尔加用常规治疗可有效提高肺动脉高压患者的临床疗效[RR=1.27,95%CI(1.15,1.40),P0.01]和6MWT[WMD=51.82,95%CI(40.66,62.97),P0.01],降低s PAP[WMD=-6.91,95%CI(-8.11,-5.71),P0.01]。Sa O2亚组分析,法舒地尔加用常规治疗可有效提高肺动脉高压患者的Sa O2(P0.01),慢性肺源性心脏病组:WMD=7.85,95%CI(5.68,10.01)、多种原发病组:WMD=3.18,95%CI(1.35,5.01)。结论法舒地尔治疗肺动脉高压具有较好的疗效,但仍需开展高质量的药物临床试验。     

不同剂量丙种球蛋白治疗儿童重症特发性血小板减少性紫癜

目的:探讨不同剂量丙种球蛋白治疗儿童重症特发性血小板减少性紫癜(ITP)的临床效果,为临床治疗提供参考。方法:选取广西壮族自治区南溪山医院2018年3月至2019年2月收治的110例ITP患儿,按随机数表法分为观察组和对照组各55例,两组患儿均给予泼尼松口服治疗,对照组给予大剂量丙种球蛋白,观察组给予中小剂量丙种球蛋白,比较两组患儿治疗前后血小板参数变化情况、血小板恢复正常时间及出血停止时间、临床疗效、不良反应发生情况。结果:两组患儿治疗后各血小板参数较治疗前明显改善(P<0.05),两组治疗前后各指标比较差异无统计学意义(P>0.05);观察组患儿血小板恢复正常时间及出血停止时间较对照组有所延长,对照组患儿治疗第2、3、5天的治疗有效率均高于观察组,两组患儿治疗第5天的治疗有效率均高于治疗第2、3天,但上述差异均无统计学意义(P>0.05)。观察组临床总有效率为90.91%,低于对照组的94.55%,但差异无统计学意义(P>0.05);两组不良反应发生率比较差异无统计学意义(P>0.05);观察组治疗费用低于对照组,差异有统计学意义(P<0.05)。结论:中小剂量丙种球蛋白与大剂量丙种球蛋白治疗儿童重症特发性血小板减少性紫癜疾病的临床疗效相当,可减轻患儿家庭经济负担。