瓜蒌薤白半夏汤加减方治疗冠心病心绞痛的系统评价

目的系统评价瓜蒌薤白半夏汤加减方(GXBD)治疗冠心病心绞痛的有效性与安全性。方法计算机检索CNKI、Wanfang Data、CBM、PubMed数据库,检索相关随机对照试验,收集关于GXBD治疗冠心病心绞痛的临床随机对照试验,筛选文献,提取数据和评价纳入研究质量,使用软件RevMan 5.3进行Meta分析。结果共纳入20项随机对照试验,共计1 810例病人。Meta分析结果显示,试验组GXBD联合常规西药的心绞痛疗效优于对照组常规西药,差异有统计学意义[OR=2.83,95%CI (2.22,3.61),P 0.000 01],根据干预对象的不同进行亚组分析,试验组治疗不稳定型心绞痛病人与稳定型心绞痛病人的心绞痛疗效均高于对照组[OR=4.47,95%CI(2.16,9.27),P 0.000 1;OR=2.48,95%CI(1.22,5.04),P=0.01],试验组心电图疗效和中医证候疗效高于对照组[OR=3.86,95%CI(2.95,5.05),P 0.000 01;OR=4.68,95%CI(2.34,9.39),P 0.000 1]。结论 GXBD可有效改善冠心病心绞痛病人的心绞痛、心电图和中医症候疗效,且安全性较好。但限于纳入研究的文献质量总体一般,上述结论有待更多高质量随机对照试验加以证实。     

经口内镜下贲门缩窄术治疗反流性食管炎效果的Meta分析

目的系统评价经口内镜下贲门缩窄术（PECC）对反流性食管炎（RE）的治疗效果。 方法计算机检索中国知网、维普网、万方数据知识服务平台、中国生物医学、the Cochrane Library、OVID、PubMed、EMBase数据库从2013年1月1日至2022年3月10日有关PECC治疗RE的随机对照试验。对符合纳入标准的文献进行资料提取和质量评价,使用RevMan 5.4软件对数据进行Meta分析。 结果共纳入5篇文献,共352例患者。Meta分析结果显示,PECC组治疗RE有效率高于质子泵抑制剂对照组（OR=5.55,95%CI：1.90~16.22）,复发率低于对照组（OR=0.11,95%CI：0.04~0.35）。 结论PECC对RE患者具有较好的临床治疗效果,但本Meta分析纳入的文献及研究数量较少,以后仍需收集更多相关研究进行验证。     

康复新液联合质子泵抑制剂治疗消化性溃疡的Meta分析

[目的]系统性分析康复新液联合质子泵抑制剂治疗消化性溃疡(PU)的疗效。[方法]应用Stata12.0软件进行Meta分析,对国内外有关康复新液联合质子泵抑制剂治疗PU疗效的随机对照试验,进行定量综合分析。[结果]共有9项随机对照试验纳入研究,经Meta分析其合并OR值为10.69,(95%CI:5.35~21.36),差异具有统计学意义(P0.05)。[结论]当前研究显示,康复新液联合质子泵抑制剂治疗PU的疗效优于单一使用质子泵抑制剂。     

全身低温治疗脑卒中有效性和安全性的Meta分析

目的系统评价全身低温治疗出血性和缺血性脑卒中的有效性和安全性。方法通过计算机检索和人工检索等方法,全面收集有关全身低温治疗脑卒中的随机对照试验(RCT)。对纳入的研究文献进行质量评价,使用RevMan统计软件进行Meta分析。结果有15个随机对照试验符合纳入标准并被录用行Meta分析,分析显示:全身低温可以降低出血性脑卒中的死亡率[OR 0.48,95%CI(0.29,0.79),P=0.004],提高治疗有效性同时不增加肺炎的发生率[OR 1.31,95%CI(0.79,2.17),P=0.3],但是会提高心律失常的发生率[OR 2.62,95%CI(1.04,6.63),P=0.03]。在缺血性脑卒中的治疗中,全身低温并没有降低随访期的死亡率[OR 1.54,95%CI(0.62,3.87),P=0.36],但是会提高肺炎[OR 6.50,95%CI(2.60,16.23),P0.000 1]和心律失常[OR 4.44,95%CI(1.75,11.26),P=0.002]的发生率,与对照组相比,美国国立卫生研究院卒中量表(NIHSS)评分的差异也不具有统计学意义。结论全身亚低温治疗出血性脑卒中安全有效,治疗缺血性脑卒中疗效不显著,治疗同时应注意相关并发症。     

经神经内镜和显微镜下手术治疗高血压性脑出血疗效的Meta分析

目的 系统评价经神经内镜和显微镜下手术治疗高血压性脑出血(HICH)的疗效。方法 检索2010年1月—2020年10月收录在知网、万方、维普、PubMed、EMbase等中英文数据库,根据纳入及排除标准筛选经神经内镜下和显微镜下手术治疗HICH的临床研究。采用Cochrane偏倚风险评估工具对纳入研究进行质量评价,应用RevMan 5.4软件进行Meta分析。结果 共纳入14项研究,其中观察组651例,对照组752例。Meta分析结果显示：与对照组比较,观察组术后并发症发生率更低[OR=0.53,95%CI(0.33,0.85),P=0.008],术后颅内感染率更低[OR=0.48,95%CI(0.23,0.98),P=0.04],术后肺部感染率更低[OR=0.38,95%CI(0.23,0.60),P<0.000 1],术后再出血率更低[OR=0.47,95%CI(0.22,0.98),P=0.04],血肿清除率更高[MD=2.32,95%CI(1.15,3.49),P=0.000 1],术中出血量更低[MD=-227.45,95%CI(-281.37,-173.54),P&l...     

益气活血法联合介入治疗原发性肝癌疗效评价的Meta分析

目的:评价益气活血法联合介入治疗原发性肝癌的临床疗效,为其在临床应用提供循证医学依据。方法:计算机检索Pubmed、Cochrane Library、中国生物医学文献数据库、中国期刊全文数据库、重庆维普中文科技数据库和万方数据库6大数据库,全面搜集益气活血法联合介入治疗原发性肝癌的随机对照试验,用Jadad量表对纳入文献进行质量评价,提取资料并用RStudio 3.4.4软件进行Meta分析。结果:共纳入12篇随机对照文献,累计受试者947例,其中治疗组478例,对照组469例。Meta分析结果显示:益气活血法联合介入治疗可有效提高近期临床疗效([OR=2.76,95%CI[1.96;3.89],P0.0001),改善生活质量(OR=4.04,95%CI[2.44,6.69],P0.0001),1年生存期有显著提高(OR=2.06,95%CI[1.15,3.66],P=0.0145)。s结论:益气活血法联合介入治疗原发性肝癌有利于全面提高临床疗效,但本研究结论尚需纳入大样本、高质量的RCT进一步证实。     

抗反流支架与常规支架治疗远端食管贲门处狭窄的系统评价

目的:评价置入抗反流支架和常规支架治疗食管癌远端食管贲门处狭窄患者的疗效及安全性.方法:计算机检索PubMed(1978-2011)、EMbase(1966-2011)、CBM(1978-2011)、Cochrane Library(2011年第10期)和CNKI(1979-2011)并手工检索中、英文已发表的资料和会议论文并追索纳入文献的参考文献,查找比较置入抗反流支架和普通支架治疗食管癌远端食管贲门处狭窄患者的随机对照试验(randomized controlled trials,RCTs).对纳入研究进行方法学质量评价之后,采用Rev Man5.1软件进行Meta分析.结果:共纳入5个RCTs,合计234例患者.Meta分析结果表明:抗反流支架与置入常规支架相比,术后患者出现疼痛(RR=0.41,95%CI:0.16,1.06),支架移位(RR=1.02,95%CI:0.50,2.11),梗阻(RR=1.02,95%CI:0.52,1.99),胃食管反流(RR=1.68,95%CI:0.52,5.48),出血(RR=1.39,95%CI:0.44,4.40),食管胃穿孔(RR=0.70,95%CI:0.25,2.00)等方面没有显著性差异.结论:食管癌远端食管贲门处狭窄患者治疗中置入抗反流支架和常规支架的疗效无明显差异.由于纳入研究数量少,加之质量普遍较低,上述结论尚需开展更多设计合理、执行严格的多中心大样本且随访时间足够的RCTs加以验证.     

益气活血利水法治疗慢性心力衰竭有效性和安全性的Meta分析

目的系统评价益气活血利水法治疗慢性心力衰竭的疗效及对病人生活质量的影响。方法计算机检索2009年1月1日—2019年6月1日电子数据库及手工检索国内心血管病、中医药期刊、会议论文集中益气活血利水法治疗慢性心力衰竭的临床随机对照研究。采用RevMan 5.3软件对两组临床总有效率、左室射血分数、脑钠肽(BNP)、6 min步行试验(6MWT)及明尼苏达心力衰竭生活质量量表评分进行Meta分析。结果共纳入14项临床随机对照研究,涉及1037例病人,其中中药组522例,对照组515例。Meta分析结果显示:中药组临床总有效率高于对照组[OR=4.30,95%CI(2.88,6.42),P<0.00001],左室射血分数高于对照组[WMD=4.94,95%CI(3.21,6.67),P<0.00001],6MWT长于对照组[WMD=51.91,95%CI(29.17,74.66),P<0.00001];中药组BNP水平低于对照组[WMD=-120.38,95%CI(-158.46,-82.30),P<0.00001],明尼苏达心力衰竭生活质量量表评分低于对照组[WMD=-5.65,95%CI(-6.86,-4.45),P<0.00001]。结论现有证据表明:在常规西药治疗基础上应用益气活血利水法中药治疗慢性心力衰竭较单纯西药更有效,可改善病人生活质量。     

双心模式治疗冠心病合并失眠的Meta分析

目的 应用Meta分析探讨双心模式治疗冠心病合并失眠的疗效。方法 在中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Embase、the Cochrane Library检索获得符合本研究纳入、排除标准的中、英文公开发表文献,时间限定为建库至2022年4月,应用RevMan 5.4.1软件进行Meta分析,从失眠和冠心病方面的指标评价双心模式治疗冠心病合并失眠的效果。结果 纳入的随机对照试验共21个,涉及2 272例患者,其中12篇文献质量相对较高。Meta分析结果显示：在失眠方面,干预组(双心模式治疗)匹兹堡睡眠质量指数(PSQI)评分[MD=-3.55,95%CI(-4.17,-2.93),P<0.05]低于对照组;干预组睡眠质量优良率[OR=4.38,95%CI(2.86,6.72),P<0.05]和失眠疗效有效率[OR=3.70,95%CI(1.70,8.05),P<0.05]均高于对照组;在冠心病方面,干预组心绞痛发作频率[MD=-3.47,95%CI(-4.18,-2.76),P<0.05]和心绞痛持续时间[MD=-3.07,...     

补阳还五汤改善血管性痴呆病人认知及生活能力疗效的Meta分析

目的:系统评价补阳还五汤改善血管性痴呆病人认知及日常生活能力的疗效。方法:检索2010年1月—2022年1月中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、EMbase、the Cochrane Library等数据库中关于补阳还五汤治疗血管性痴呆的随机对照试验(RCT),根据相关纳入与排除标准进行筛选,评价纳入研究的方法学质量,运用RevMan 5.3软件对纳入研究进行Meta分析。结果:共纳入21篇文献,涉及1 693例病人,其中试验组862例,对照组831例。Meta分析结果显示：试验组总有效率[OR=3.21,95%CI(2.41,4.27),P<0.000 01],认知功能[MD=2.85,95%CI(2.16,3.54),P<0.000 01],生活能力[MD=13.46,95%CI(11.68,15.25),P<0.000 01]优于对照组。结论:现有证据表明,补阳还五汤联合常规西药治疗血管性痴呆较单用西药治疗具有明显优势。     

PPI诊断性治疗反流性咽喉炎的临床应用价值研究

目的观察分析质子泵抑制剂(PPI)诊断性治疗反流性咽喉炎的临床应用价值。 方法选取2016年5月至2017年5月新疆维吾尔自治区人民医院接诊的74例疑似反流性咽喉炎患者,采取随机数字表法随机分为试验组和对照组。观察组31例患者给予质子泵抑制剂奥美拉唑诊断性治疗,对照组43例患者给予清热解毒类咽喉炎药物治疗。观察两种治疗方案的症状积分以及临床疗效。 结果观察组31例患者治疗有效率明显高于对照组,差异有统计学意义(P<0.05);治疗后,对照组DeMeester积分下降较观察组明显,差异有统计学意义(P<0.05)。 结论质子泵抑制剂诊断性治疗反流性咽喉炎有临床治疗意义,值得临床推广。     

Gastroesophageal reflux disease: then and now

Although Galen first described esophagitis almost 2000 years ago, its relation to acid was only recognized in the 19th century by Rokitansky. Considerably more interest in the symptoms and complications of esophagitis has been evident over the last century, as gastroesophageal reflux disease displaced peptic ulceration and became the principal acid-related disease of our times. Of particular interest has been the recognition of the clinical significance of the previously overlooked extraesophageal manifestations of the disease such as laryngitis, asthma, and sleep disturbance. The evolution of highly effective medical therapy has over the last decade drastically reduced the need for surgical intervention for control of symptoms except under select conditions, especially volume-related reflux and children with refractory symptoms. The proton pump inhibitor class of drugs is indisputably the most effective overall form of management, while individual proton pump inhibitors appear to be equivalent in their efficacy. Issues that remain to be resolved include the management of nonerosive gastroesophageal reflux disease, the long-term dependence of many patients on acid-suppressing medication, and the recognition of atypical manifestations and rare but serious complications of gastroesophageal reflux disease. In this respect, Barrett's esophagus still presents a major biologic and management conundrum for the physicians and scientists alike.     

Medical therapy of reflux laryngitis

Laryngeal signs and symptoms are frequently associated with gastroesophageal reflux disease (GERD). Establishing the diagnosis of laryngopharyngeal reflux (LPR), however, is enigmatic as there are no tests that specifically define GERD-related laryngitis. Furthermore, in contrast to typical GERD, the treatment data for LPR using acid suppression with proton pump inhibitors has not shown a statistically significant advantage over placebo. This review highlights the current challenges for establishing the diagnosis of GERD-related LPR and focuses on the limitations of medical therapy directed toward gastric acid suppression.     

胃食管反流与支气管哮喘之间的关系及抑酸药物对其的作用

目的探讨胃食管反流与支气管哮喘之间的关系及制酸药物对胃食管反流（GER）的作用分析。 方法随机选取新疆维吾尔自治区人民医院2016年9月至2017年9月接诊的122例哮喘患者的临床资料。根据有无发生胃食管反流将本组患者分为观察组（49例）和对照组（73例）。观察组49例患者为胃食管反流合并支气管哮喘，将观察组49例患者进行随机细分，25例患者利用制酸药物（质子泵抑制剂兰索拉唑）进行治疗，24例患者选择安慰剂进行治疗。对照组73例哮喘患者未合并胃食管反流。对2组患者临床资料进行分析。对比2组患者肺功能指标等相关资料，以此探讨胃食管反流与支气管哮喘的相互关系。评价制酸药物对胃食管反流的影响。 结果观察组45例患者肺功能各项指标明显差于对照组73例患者，差异有统计学意义（P<0.05）。制酸治疗组与安慰剂治疗组比较，差异有统计学意义（P<0.05）。 结论支气管哮喘患者容易因各种因素发生胃食管反流，胃食管反流也容易诱发支气管哮喘，并且在发生胃食管反流后会加重哮喘患者病情会，是难治性哮喘的重要诱因。临床治疗胃食管反流患者应利用抑酸药物进行相应的抗反流治疗，效果显著，可显著改善肺功能。     

Laryngitis and gastroesophageal reflux disease: increasing prevalence or poor diagnostic tests?

Laryngeal signs and symptoms are often associated with gastroesophageal reflux disease (GERD). However, such diagnoses presume that laryngeal findings may be specific for GERD. However, neither laryngoscopy, EGD or pH monitoring are specific tests for identifying GERD related laryngitis. Non-placebo controlled trials often show clinical benefit from proton pump inhibitor therapy; however, suffer from lack of controls. GERD may be one cause of laryngeal signs and symptoms in a subgroup of patients but not in all those currently so suspected. Future, studies are needed in this area to better delineate this association.     

Proton Pump Inhibitors Improve Acid-Related Dyspepsia in Gastroesophageal Reflux Disease Patients

It has been reported that proton pump inhibitors are more effective than H2 receptor antagonists in patients with functional dyspepsia. Dyspeptic symptoms that respond to proton pump inhibitors are classified as acid-related dyspepsia. A new questionnaire for assessing gastroesophageal reflux disease (GERD), the Frequency Scale for Symptoms of GERD, covers the 12 most common symptoms of GERD patients. A quantitative assessment of the changes of reflux symptoms and acid-related dyspepsia was made in GERD patients receiving proton pump inhibitor therapy. Sixty-eight GERD patients receiving proton pump inhibitor therapy completed the questionnaire before and after treatment for 8 weeks. There is a significant positive correlation between reflux symptoms and acid-related dyspepsia before and after therapy (r = 0.569 and r = 0.569; both P's < 0.001) and acid-related dyspepsia in patients with both nonerosive and erosive GERD. We conclude that GERD patients suffer not only from reflux symptoms, but also from acid-related dyspepsia, and proton pump inhibitors improve both types of symptoms.     

The effect of rabeprazole alone or in combination with H2 receptor blocker on intragastric pH: a pilot study.

BACKGROUND/AIMS: Proton pump inhibitors have been widely used in recent years. However, there are studies suggesting that proton pump inhibitors may not control the gastric acidity effectively during the night, especially in gastroesophageal reflux disease. It has therefore been suggested that H2 receptor blockers should be added to the therapy. The aim of our study was to evaluate the effects of proton pump inhibitors alone or in combination with H2 receptor blockers on gastric acidity with 24-hour gastric pH monitoring. METHODS: Esophagogastroscopy and 24-hour gastric pH monitoring were performed on 10 patients with dyspeptic symptoms. No patient had antacidity. All patients had erosive antral gastritis. Patients were randomized to two groups as either proton pump inhibitor therapy group (rabeprazole 20 mg/day, p.o.) or proton pump inhibitor + H2 receptor blocker therapy group (rabeprazole 20 mg/day, p.o. + famotidine 40 mg/day, p.o). After one month of treatment, 24-hour gastric pH monitoring was re-performed. RESULTS: Seven female and three male patients were enrolled into the study. The mean age was 51.1+/-11.56 years. All patients had antral erosive gastritis. Gastric pH was measured as less than 4 in 81.4% of the 24-hour period prior to rabeprazole treatment. With rabeprazole treatment this ratio decreased to 27.6% (p<0.05). These ratios were 86.3% and 4.55%, respectively, in the group that received combination therapy (p<0.05). CONCLUSIONS: Combination therapy with H2 receptor blockers and proton pump inhibitors seemed to control intra-gastric pH better than proton pump inhibitors alone. Use of H2 receptor blockers and proton pump inhibitors in combination to control intra-gastric pH is more beneficial.     

40 mg pantoprazole and 40 mg esomeprazole are equivalent in the healing of esophageal lesions and relief from gastroesophageal reflux disease-related symptoms

BACKGROUND: Proton pump inhibitors are regarded as the most effective class of acid suppressive medication for gastroesophageal reflux disease treatment. There is considerable interest regarding the dose equivalence between various proton pump inhibitors. GOALS: To compare the efficacy of pantoprazole and esomeprazole with regard to healing and relief from gastroesophageal reflux disease-related symptoms. STUDY: Multicenter, randomized, double-blind study. Patients with gastroesophageal reflux disease grades B/C (Los Angeles classification) received 40 mg pantoprazole daily (n = 113) or 40 mg esomeprazole daily (n = 114). Healing (endoscopy) and relief from gastroesophageal reflux disease-related symptoms (direct questioning) were assessed at first and final visit (after 4, 6, 8, or 10 weeks of treatment). RESULTS: Overall healing in both treatment groups was 88% of patients (intention-to-treat population), 95% (pantoprazole), and 90% (esomeprazole) (per-protocol population); statistically, this indicates "at least equivalence" between treatments. Overall relief from gastroesophageal reflux disease-related symptoms was similar for pantoprazole (55%) and esomeprazole (51%, per-protoco). No correlation between healing and symptom relief was seen. The majority of reported adverse events were assessed as "not related" to the study drug. Pantoprazole and esomeprazole have comparably good safety and tolerability. CONCLUSION: In patients with gastroesophageal reflux disease, 40 mg pantoprazole daily and 40 mg esomeprazole daily are equally effective for healing of esophageal lesions and relieving gastroesophageal reflux disease-related symptoms.     

Use of proton pump inhibitors during pregnancy and rates of major malformations: a meta-analysis

Proton pump inhibitors are used to treat gastroesophageal reflux, a symptom common in pregnancy. The aim of this study was to systematically analyze the available data on the risk for malformations following use of these agents in the first trimester of pregnancy. Medline, EMBASE, published abstracts, and reference lists were searched for articles reporting on proton pump inhibitor use in pregnancy. Summary relative risks and 95% confidence intervals (95% CI) were calculated using the Mantel-Haenszel method. Five cohort studies met the inclusion criteria for this meta-analysis. With almost 600 exposed pregnancies, the overall relative risk was 1.18 with a 95%CI of 0.72–1.94. In conclusion, proton pump inhibitors do not present a major teratogenic risk when used in recommend doses. These data are reassuring for the countless patients who have used these agents in the early part of their pregnancies.