ABO血型与深静脉血栓发生风险关系的病例对照研究及Meta分析

背景与目的:深静脉血栓(DVT)是住院患者常见的并发症,其病因复杂,如何预防DVT的发生是临床工作的重点。本研究通过病例对照研究及Meta分析探讨ABO血型与DVT发生风险的关系,以期为DVT的个体化预防及精准治疗提供依据。方法:选择2012年10月—2018年12月苏北人民医院血管外科的500例住院DVT患者(多次住院患者只统计首次住院),并按诱因(无明显诱因、妊娠、外伤、手术、癌症、长期卧床)及性别1:1配对选择同期500例非DVT住院患者行病例-对照研究。检索多个国内外数据库收集相关病例-对照研究,检索时间从建库至2019年10月1日,根据纳入标准和排除标准筛选文献,经质量评价及提取数据后,采用Review Manager 5.3软件进行Meta分析。结果:病例-对照研究中,整体分析结果显示,非O型血较O型血个体DVT发生风险升高(RR=2.859,95% CI=2.142～3.817,P0.01);按诱因进行亚组分析,结果显示,在无明显诱因(RR=2.845,95% CI=1.819～4.282,P0.05)、外伤(RR=3.11,95% CI=1.477～6.552,P0.05)、手术(RR=2.613,95% CI=1.271～5.373,P0.05)及癌症(RR=2.962,95% CI=1.436～6.106,P0.05)患者中,非O型血是DVT发生的可能危险因素,而在妊娠(RR=1,95%CI=0.034～29.807,P0.05)及卧床(RR=5.714,95% CI=0.528～30.325,P0.05)患者未表现出明显关系。Meta分析结果显示,O型血个体发生DVT风险低于非O血型人群(RR=0.62,95% CI=0.56～0.69,P0.05)。结论:对无明显诱因组、外伤组、手术组及癌症组患者,将ABO血型纳入DVT危险因素的综合分析中,对于血栓的个体化干预和精准治疗有一定临床价值。对于妊娠组及长期卧床组患者,ABO血型的不一定能表现出足够临床价值,仍需进一步验证。     

乳腺癌组织中VEGF-D的表达与临床意义关系的Meta分析

目的:系统评价国内有关乳腺癌组织中血管内皮生长因子-D(VEGF-D)表达与临床意义的关系.方法:检索CNKI、pubmedCBM和万方数据库并辅以文献追溯的方法,收集公开发表的有关乳腺癌组织中VEGF-D表达及其与临床意义的病例对照研究.检索年限均从2002年～2012年.按纳入排除标准筛选文献并评价纳入研究质量后,应用RevMan5.O软件进行Meta分析.结果:共纳入11个病例对照研究.Meta分析结果显示:VEGF-D在乳腺癌淋巴结转移阳性组和阴性组[OR=2.26,95％ CI(1.75,2.92)]及乳腺癌1-2期组和≥3期组[OR=0.45,95％CI(0.24,0.86)]之间的表达有统计学意义,而在≤50岁组和＞50岁组[OR=1.02,95％CI(0.73,1.42)],组织学1～2级组与3级组[OR=1.21,95％CI(0.83,1.78)]和肿瘤大小≤2 cm组与＞2 cm组[OR=1.23,95％CI(0.88,1.74)]之间的表达无统计学意义.结论:目前国内外证据证明,VEGF-D可能参与乳腺癌淋巴结转移等发生发展等的过程,并可能成为乳腺癌预后的重要因素.     

腹腔镜与开腹肝切除术治疗肝癌疗效的Meta分析

目的：系统评价腹腔镜肝切除术（LLR）与开腹肝切除术（OLR）治疗肝癌的近、远期疗效和安全性。方法：检索相关期刊、资料、会议文献和学位论文数据库,收集比较LLR与OLR治疗肝癌疗效的病例-对照研究。按MOOSE 规范对纳入研究进行分析,提取数据并用RevMan5.3软件对数据进行Meta分析。
　　结果：最终共纳入15篇病例-对照研究,共1246例患者,LLR组499例,OLR组747例。Meta分析结果显示,LLR组与OLR组的手术时间,1、3、5年生存率,1、3、5年无瘤生存率,3年肿瘤复发率组间差异均无统计学意义（均P>0.05）;LLR与OLR相比术中出血量少、术后并发症发生率低、围手术期死亡率低、术后住院天数少（均P<0.05）。
　　结论：LLR可以达到与OLR同样的根治效果,两者近、远期疗效无明显差异,且LLR围手术期不良事件少于OLR。     

OPG基因多态性与骨质疏松发病风险相关性的荟萃分析

目的 评价OPG基因A163G和T950C的多态性与骨质疏松发病风险的相关性。方法 在万方数据库、中国知网、中国生物医学文献数据库、PubMed数据库中全面检索关于OPG基因启动子A163G和T950C多态性与骨质疏松相关的文献,对纳人的文献进行质量评价,并采用RevMan5. 3软件进行meta分析。结果 共有13篇文献被纳人本次的meta分析,关于A163G的文献有7篇,累计骨质疏松病例组805人,健康对照组948人;关于T950C的文献有8篇,累计骨质疏松病例组1286人,健康对照组1252人。关于A163G的meta分析显示等位基因G可能会增加骨质疏松的风险[OR = 1. 37,95% CI：1. 12 - 1.68,P = 0.003],在高加索人、男性和女性及绝经后妇女的亚组分析中显示同样的结果。关于T950C的meta分析显示等位基因T、C在增加骨质疏松的风险上无统计学意义[OR = 1.03,95% CI：0. 82 - 1.28,P =0.004],在种族和性别的亚组分析中同样无统计学意义。结论 OPG基因T950C的多态性并没有证实与骨质疏松的风险有关,但A163G的多态性可能会增加骨质疏松的风险。     

绝经后女性骨密度与冠状动脉粥样硬化关系的Meta 分析

目的从循证医学角度探讨绝经后女性骨密度与冠状动脉粥样硬化的关系,为冠心病早期防治提供理论依据。方法 通过制定检索策略,在PubMed、EMbase、Ovid、EBSCO、CNKI、中国生物医学文献、维普中文科技期刊等数据库中检索近10年 发表的相关文献,对所有符合要求的相关病例对照研究文献进行评价,应用Review Manager 5. 2分析软件对数据进行分析。 结果最终共纳人8个病例对照研究,包括骨密度降低组(低骨量和骨质疏松)986例患者,对照组926例患者。Meta分析结 果显示：各研究数据异质性检验结果I2 =0%,x2 =6. 52,P =0.48,各研究间异质性小,采用固定效应模型,合并效应量OR = 2. 81,95% CI为2. 26 - 3. 50,低骨密度组与骨量正常组冠状动脉粥样硬化的发病率差异有统计学意义。结论绝经后女性骨 密度的降低与冠状动脉粥样硬化的发生有显著相关性,骨量减少和骨质疏松可能是冠状动脉粥样硬化的危险因素。     

磁共振成像对肝硬变相关结节诊断价值的meta分析

目的应用meta分析探讨磁共振成像（MRI）对肝硬变相关结节的诊断价值。方法计算机检索15年来PubMed、CochraneDatabaseSystematicReviews、EMbase数据库中MRI对肝硬变相关结节影像诊断的病例对照研究的英文文献,研究者对文献质量进行严格评价和资料提取,提取符合质量标准的文献中的诊断用metadisc1．40软件进行meta分析,以病理诊断为金标准,分别合并MRI及CT诊断肝硬变相关结节的灵敏度、特异度、阴性似然比和阳性似然比,采用拟合受试者_T作特征曲线（SROC）模型分析两者的诊断价值,并对二者的各项数据进行比较。结果6个病例对照研究共917例患者776个结节纳入研究。meta分析结果显示,MRI诊断肝硬变相关结节的汇总敏感度（95％C／）和汇总特异度（95％c,）分别为87％（83％～89％）和79％（73％～84％）,汇总阳性似然比和汇总阴性似然比分别为3．95和0．18,SROC曲线下面积（AuC）为0．8956;螺旋CT增强扫描诊断肝硬变相关结节的汇总敏感度（95％cD和汇总特异度（95％cD分别是69％（65％～73％）和83％（77％～88％）,汇总阳性似然比和汇总阴性似然比分别为3．29和0．42,SROC曲线下的面积为0．7287。MRI的汇总敏感度、阳性似然比和SROC曲线下面积明显高于CT。结论MRI对肝硬变相关结节诊断的准确性明显优于CT,MRI应成为肝硬变相关结节定性的首选影像学检查手段,以提高小肝癌的早期诊断水平。     

牙周病与前列腺癌发病风险的Meta分析

目的 通过进行系统回顾和Meta分析,评估牙周病与前列腺癌发病风险的相关性。方法 在PubMed、Web of Science、维普、中国知网、万方数据库中检索2021年3月23日之间公开发表关于牙周病患者前列腺癌患病风险的相关研究,对文献进行数据提取,并采用Review Manager 5.4软件进行Meta分析。结果 通过阅读题目、摘要和全文,排除重复文献,再根据纳入和排除标准,共9项研究纳入meta分析。分析结果显示,牙周病患者发生前列腺癌风险是非牙周病人群的1.17倍,差异有统计学意义(HR=1.17,95%CI 1.02～1.35)。结论牙周病与前列腺癌的发病呈正相关,牙周病是前列腺癌的危险因素。牙周病与前列腺癌的关系受地域影响,亚洲地区比欧美地区影响更明显。     

尿石症与骨质疏松相关性的研究进展

尿路结石与骨质疏松均存在钙代谢异常,且发病率高,对生活质量造成严重影响,研究表明两者之间存在一定相关性。高钙尿症通过骨吸收增加等,或为两者发病机制间的关键桥梁。对遗传因素的研究中也发现了许多与两者有关的基因,主要为腺苷酸环化酶10基因、1,25-(OH)2D3-24羟化酶基因、钙敏受体与紧密连接蛋白14基因。但对上述一些基因变异与尿石症和骨质疏松的研究尚存在不同结论,且其具体机制仍待进一步研究。雌激素缺乏通过骨丢失、减少瞬时感受器电位阳离子通道V5表达,造成高钙尿、低骨量,导致尿石症及骨质疏松。高蛋白、高钠、低钙等饮食因素也能影响两者的形成,笔者综述两者之间相关性的研究进展。     

磁共振成像对女性盆腔肿块诊断价值的Meta分析

目的应用Meta分析探讨磁共振成像(MRI)对女性盆腔肿块的诊断价值。方法计算机检索近20年来PubMed、Cochrane Database Systematic Reviews、EMbase、中国知网(CNKI)检索平台以及万方数据库中MRI对女性盆腔肿块诊断价值的病例对照研究文献。研究者对文献质量进行严格评价和资料提取,提取符合质量标准的文献中的诊断数据用Metadisc 1.40软件进行Meta分析,以术后病理诊断为金标准,分别合并MRI及B超诊断女性盆腔肿块的灵敏度、特异度、阴性似然比和阳性似然比,采用拟合受试者工作特征曲线(SROC)分析两者的诊断价值,并对二者的各项数据进行比较。结果 10个自身病例对照研究共649例患者729个肿块纳入研究。Meta分析结果显示:MRI诊断女性盆腔肿块的汇总敏感度(95%CI)和汇总特异度(95%CI)分别为〔89%(84%～92%),P=0.046 6〕和〔87%(83%～90%),P=0.000 2〕,汇总阳性似然比和汇总阴性似然比分别为6.25(P=0.008 5)和0.14(P=0.029 1),SROC曲线下面积(AUC)为0.941;B超的汇总敏感度(95%CI)和汇总特异度(95%CI)分别为〔87%(82%～91%),P=0.000 0〕和〔73%(69%～77%),P=0.000 0〕,汇总阳性似然比和汇总阴性似然比分别为3.07(P=0.000 0)和0.18(P=0.000 1),SROC曲线下的面积为0.897。MRI的汇总特异度、阳性似然比和SROC曲线下的面积明显高于B超。结论 MRI对女性盆腔肿块诊断的准确性明显优于B超,MRI应成为怀疑存在盆腔肿块女性首选的影像学检查手段。     

解脲支原体、沙眼衣原体感染与男性不育关系病例对照的Meta分析

目的采用Meta分析的方法探讨解脲支原体、沙眼衣原体感染与男性不育的关系.方法采用计算机检索和手工检索相结合的方法,检索2011年12月以前的PUBMED, EMBASE,Cochrane图书馆,CNKI,CBMdisc等国内外数据库,查找解脲支原体、沙眼衣原体感染与男性不育关系的病例对照研究.由两位研究者按照纳入与排除标准进行资料提取和质量评价后,采用RevMan 5.0软件对各研究进行数据合并与分析.结果(1)共纳入5个符合要求的病例对照研究,共包括1068例患者;(2)对所纳入的研究进行质量评分,结果质量均4分.(3)单纯解脲支原体感染OR合并值为3.29[95%CI(2.24,4.82),P<0.00001],两组差别有统计学意义;(4)单纯沙眼衣原体感染OR合并值为3.43[95%CI(1.92,6.14),P<0.0001],两组差别有统计学意义;(5)解脲支原体合并沙眼衣原体感染OR合并值为4.64[95%CI(1.90,11.37),P=0.0008],两组差别有统计学意义;结论无论是解脲支原体感染,还是沙眼衣原体感染都是影响男性不育的显著危险因素,而当两者合并感染时更易导致男性不育.由于纳入的研究存在选择性偏倚和发表性偏倚的可能性.期待更多进行高质量的相关对照试验,以提供坚实、可靠的证据.     

Coffee consumption and risk of type 2 diabetes mellitus in Asians: A meta-epidemiological study of population-based cohort studies

BACKGROUNDPrevious systematic reviews have consistently reported that coffee consumption has a preventive effect on the occurrence of type 2 diabetes mellitus (T2DM). However, further evaluations between coffee consumption and the risk of T2DM in Asian populations are needed.AIMTo conduct a meta-epidemiological study on systematic reviews evaluating the association between coffee consumption and the risk of T2DM in Asian people. METHODSThe selection criterion was defined as a population-based prospective cohort study evaluating the association between coffee consumption and the risk of T2DM in Asian populations, reporting the adjusted relative risk (RR) and its 95% confidence interval (CI) for potential confounders. A fixed-effect model meta-analysis was applied to calculate the summary RR and its 95%CI in less than 50% of the I² value indicating the level of heterogeneity. A two-stage fixed-effects dose-response meta-analysis (DRMA) was performed to calculate the risk per unit dose (a cup per day). RESULTSA total of seven studies were selected in this meta-epidemiological study. The risk of T2DM in Asian populations was significantly reduced in the highest to the lowest dose group (summary RR = 0.73, 95%CI: 0.66-0.82; I² value = 0.0%). The DRMA showed that drinking one cup of coffee per day reduced the risk of T2DM in Asian populations by 8% (RR = 0.92, 95%CI: 0.90-0.95). CONCLUSIONThese findings support the conclusion that coffee consumption has a protective effect on the occurrence of T2DM in Asian men and women.     

Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women

Introduction Consumption of coffee and tea, and total intake of caffeine has been claimed to be associated with osteoporotic fracture risk. However, results of earlier studies lack consistency. Methods We examined this relation in a cohort of 31,527 Swedish women aged 40-76 years at baseline in 1988. The consumption of coffee, caffeinated tea and the intake of caffeine were estimated from a self-administered food frequency questionnaire (FFQ). Multivariate-adjusted hazards ratios (HRs) of fractures with 95% confidence intervals (95% CIs) were estimated by Cox proportional hazards models. Results During a mean follow-up of 10.3 years, we observed 3,279 cases with osteoporotic fractures. The highest (>330 mg/day) compared with the lowest (<200 mg/day) quintile of caffeine intake was associated with a modestly increased risk of fracture: HR 1.20 (95% CI: 1.07–1.35). A high coffee consumption significantly increased the risk of fracture (p for trend 0.002), whereas tea drinking was not associated with risk. The increased risk of fracture with both a high caffeine intake and coffee consumption was confined to women with a low calcium intake (<700 mg/day): HR 1.33 (95% CI: 1.07–1.65) with ≥4 cups (600 ml)/day of coffee compared to <1 cup (150 ml)/day. The same comparison but risk estimated for women with a high propensity for fractures (≥2 fracture types) revealed a HR of 1.88 (95% CI: 1.17–3.00). Conclusions In conclusion, our results indicate that a daily intake of 330 mg of caffeine, equivalent to 4 cups (600 ml) of coffee, or more may be associated with a modestly increased risk of osteoporotic fractures, especially in women with a low intake of calcium.     

Urolithiasis,inhibitors and promoters

Summary The aim of this work is to evaluate the role and importance of inhibitors and promoters in urolithiasis. Carrying in mind theoretical considerations, we conclude that in urolithogenic processes, inhibitors and promoters could only play a decisive role in the idiopathic oxalocalcic urolithiasis. We classify the idiopathic oxalocalcic stone-formers into three main groups, considering inhibitory and promoting factors. It is shown that such classification is in good agreement with the clinical results observed in a group of 88 idiopathic oxalocalcic stone-formers.     

Epidemiology,Pathogenesis, and Pathophysiology of Urolithiasis

ContextUrolithiasis (UL) is one of the most common diseases, with worldwide increasing incidence and prevalence. The pathogenesis of calcium oxalate (CaOx) UL, which accounts for >80% of all urinary stones, is only incompletely understood.ObjectiveOur aim was to review trends in epidemiology and current concepts for the pathogenesis and pathophysiology of urinary stone disease.Evidence acquisitionWe reviewed data from the literature and our own series.Evidence synthesisUrinary stone formation is a result of different mechanisms. Completely different pathomechanisms lead to CaOx stone formation, with Randall plaques playing a key role in the pathogenesis.ConclusionsThe lithogenesis of key stones is multifactorial. Lifestyle and dietary choices are important contributing factors. The pathogenesis and pathophysiology of CaOx stones is still incompletely understood. Recent evidence suggests a primary interstitial apatite crystal formation that secondarily leads to CaOx stone formation.     

Urolithiasis after kidney transplantation-clinical and mineralogical aspects

Summary Urolithiasis is a rare complication following kidney transplantation. Experience with this complication in 6 of 426 transplantations performed from 1968 to 1979 is reviewed. The clinical symptoms are different from the disease in non-transplant patients. Three major predisposing causes for the development of calculi after kidney transplantation were found in our patients — urodynamic disorders following complications of the ureterovesical anastomosis, persistent bacteriuria and renal tubular acidosis and, less importantly, the presence of hypertacemia and hypercalciuria as a result of secondary hyperparathyroidism. Crystal-optical and x-ray-diffraction studies contributed to the interpretation of the constituents and texture of the calculi and of the aetiological factors concerned.     

EAU2013版结石诊疗指南新意解读

尿路结石是泌尿外科常见病,治疗方法较多,常用的治疗方法包括体外冲击波碎石术(SWL)、输尿管镜取石术(URS)、经皮肾镜取石术(PNL)、腹腔镜取石术及开放手术。随着SWL和腔镜碎石技术的普及,泌尿外科医师及患者在结石治疗时面临多种选择,甚至遇到两难处境。本文解读2013版更新后EAU指南,希望对规范泌尿系结石的诊断和治疗有一定的帮助。     

Urolithiasis and psoas abscess in a 2-year-old boy with type 1 glycogen storage disease

We report on a pyogenic psoas abscess secondary to an impacted calcium oxalate ureteric stone in a 2-year-old boy with glycogen storage disease type 1 (GSD-1). The patient had a drainage of the abscess through a flank incision followed by percutaneous nephrostomy and open ureterolithotomy. Metabolic acidosis, hyperuricemia, hypocitraturia, and hypercalciuria appear to be significant in the pathogenesis of urolithiasis in patients with GSD-1. Regular ultrasonography of the abdomen along with optimal metabolic control may delay or prevent urolithiasis and its complications in GSD-1 patients.