联合利妥昔单抗治疗血小板减少症疗效的Meta分析

目的 系统评价联合利妥昔单抗治疗对血小板减少症的疗效.方法 以中文“利妥昔单抗、美罗华、血小板减少症、系统评价、随机对照试验”;英文“rituximab,thrombocytopenia,systematic review,randomized controlled trial”为检索词,进行计算机检索,筛选联合利妥昔单抗治疗与单纯治疗血小板减少症疗效比较的随机对照试验(RCT)和半RCT.检索范围为PubMed,Cochrane Library,CNKI,CBM,VIP 数据库,检索时间从各数据库建库截至2012年11月.纳入联合利妥昔单抗治疗血小板减少症的随机RCT和半RCT.纳入文献经2位研究者按照纳入标准独立筛选文献,提取资料和评价质量后,采取RevMan5.0软件进行Meta分析.结果 共纳入7个研究,共计410例患者.Meta分析结果显示,联合利妥昔单抗治疗组的总缓解率高于单纯治疗组[OR=2.79,95％CI(1.80～4.31),P＜0.00001],经异质性检验显示7个试验存在异质性(x2 =15.26,P=0.02).结论 联合利妥昔单抗治疗对血小板减少症有一定疗效,有必要开展更多设计良好的临床随机对照试验,进一步证明其临床效果.     

利妥昔单抗治疗扁桃体淋巴瘤的临床疗效观察

目的 探讨利妥昔单抗治疗扁桃体弥漫大B细胞淋巴瘤的临床疗效及不良反应.方法 通过回顾临床资料,研究我院46例扁桃体弥漫大B细胞淋巴瘤患者的临床特点及治疗效果,将46例患者分为两组,一组采用利妥昔单抗联合CHOP方案,利妥昔单抗用量为375mg/m2,每个疗程的第l天使用;另一组单用CHOP方案.结果 利妥昔单抗联合化疗组的完全缓解率（CR）52.1%,总有效率（OR）82.6%;CHOP组CR率34.8%,OR率60.8%,两组疗效比较差异有统计学意义.治疗后的毒副反应比较差异无统计学意义.结论 利妥昔单抗和CHOP方案联用能明显提高扁桃体弥漫大B细胞淋巴瘤患者的CR率和OR率,未增加毒副反应.     

R-CHOP方案治疗B细胞非霍奇淋巴瘤21例分析

目的：观察利妥昔单抗联合化疗治疗B细胞非霍奇淋巴瘤（NHL）的临床疗效及IPI评分对预后的影响。方法：21例B细胞NHL患者,利妥昔单抗联合CHOP方案4～8个疗程。结果：CR 14例,总有效率90.5%;2 a疾病无进展生存率（69.74±10.43）%,2 a总生存率（84.44±8.35）%。IPI评分0～2分者CR率93.3%,总有效率100%,3～5分者CR率0,总有效率66.6%。结论：R-CHOP方案疗效满意,安全性较好,IPI 0～2分者缓解率明显高于3～5分者。     

利妥昔单抗联合化疗治疗儿童成熟B细胞淋巴瘤的有效性和安全性的Meta分析

目的 系统评价利妥昔单抗联合化疗治疗儿童成熟B细胞淋巴瘤的有效性和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、中国知网、万方等数据库,由2名研究者分别进行资料提取、质量评价,并交叉核对,检索时限为从建库至2022年7月。收集利妥昔单抗联合化疗对比单纯化疗的研究,以3年无事件生存率(EFS)、不良反应发生率作为结局指标。使用STATA11.0软件进行Meta分析、亚组分析、敏感性分析和发表偏倚分析。结果 共纳入9项研究,包含908例新诊断的儿童成熟B细胞淋巴瘤患者。Meta分析结果显示,与单纯化疗组相比,利妥昔单抗联合化疗组治疗新诊断的儿童成熟B细胞淋巴瘤的3年EFS明显增高(HR=0.37,95%CI:0.24～0.58,P<0.05)。亚组分析显示,利妥昔单抗使用≥6次时利妥昔单抗联合化疗组3年EFS高于单纯化疗组,差异有统计学意义(HR=0.32,95%CI:0.17～0.57,P<0.05);利妥昔单抗使用4次时利妥昔单抗联合化疗组3年EFS与单纯化疗组相比,差异无统计学意义(HR=0.41,95%CI:0.17～1.01,P...     

弥漫大B细胞淋巴瘤患者Bcl-2、p53和CD55表达与利妥昔单抗疗效的相关性研究

目的探讨弥漫大B细胞淋巴瘤（DLBCL）分子标记物Bcl-2、p53及CD55与利妥昔单抗疗效之间的关系。方法回顾性分析69例采用利妥昔单抗联合化疗治疗DLBCL患者的临床资料,采用免疫组化sP法检测Bcl-2、p53及CD55蛋白的表达,分析其表达与利妥昔单抗疗效之间的关系。结果采用利妥昔单抗联合化疗治疗DLBCI。患者完全缓解（CR）38例（55．1％）,部分缓解（PR）20例（29．0％）,总有效率（CR＋PR）为84．1％。Bcl-2表达阳性者的疗效明显好于阴性者（P=0．043）;p53及CD55蛋白的表达与利妥昔单抗疗效无关（P〉0．05）。结论在利妥昔单抗联合化疗治疗的DLBCL患者中,Bcl-2表达阴性者疗效较差,p53蛋白表达则与疗效元关。     

吉西他滨、奥沙利铂、地塞米松±利妥昔单抗挽救治疗复发或难治性非霍奇金淋巴瘤的临床观察

目的：临床观察吉西他滨、奥沙利铂、地塞米松加减利妥昔单抗（Gemox＋Dxm±R）挽救性治疗复发或难治性非霍奇金淋巴瘤（NHL）的近期临床疗效和毒副反应。方法回顾性分析25例经正规标准方案治疗复发或难治的NHL患者,采用Gemox＋Dxm±R（吉西他滨1000 mg/m2,静脉滴注,第1、8天;奥沙利泊130 mg/m2,静脉滴注,第1天;地塞米松20 mg/d,第1～5天;±利妥昔单抗375 mg/m2,第0天）,21～28 d为一个周期,每化疗2个周期后评价疗效,每1个周期化疗后评价毒副反应。结果25例患者均接受2～4个疗程化疗,每例都可接受评价疗效。16例获得缓解（64%）,其中完全缓解（CR）3例,部分缓解（PR）13例。9例患者在初诊时使用过利妥昔单抗,6例患者在复发难治后首次使用利妥昔单抗联合该挽救化疗方案,3例患者在二线挽救性方案化疗获得缓解后接受自体造血干细胞支持下的大剂量的化疗。化疗后主要毒副反应为胃肠道反应、骨髓抑制、脱发、乏力、末梢神经病变。中位随访13个月（1～36个月）,1年,2年,3年的生存率分别为92%,60%,36%。结论 Gemox＋Dxm±R组成的二线挽救性方案对复发难治性NHL近期疗效较好,毒副反应小,患者都能耐受。该研究方案对复发难治性NHL治疗在临床疗效方面具有重要意义,也是安全、有效的,值得进一步多中心大宗病例的临床研究。     

利妥昔单抗联合化疗治疗HBsAg阳性的非霍奇金淋巴瘤患者的安全性分析

【目的】观察利妥昔单抗与化疗联合治疗 HBsAg阳性的非霍奇金淋巴瘤（NHL）患者的有效性及安全性。【方法】回顾性分析2009年2月至2013年12月广州中山大学附属肿瘤医院病理确诊的 N H L伴HBsAg阳性的149例住院患者的临床资料。149例中男92例,女57例,中位年龄44（19～74）岁。所有患者均接受利妥昔单抗联合化疗,所有患者每日口服拉米夫定100 mg或恩替卡韦500μg ,化疗后定期监测肝功能及HBV‐DNA。【结果】149例患者治疗后均无严重肝功能损伤。其中病毒高拷贝数35例（HBV DNA＞104 copy／mL ）,无一例病毒激活。化疗前肝功能异常33例,无肝功能损害加重现象。【结论】在有效抗病毒及激素减量的同时,密切监测乙肝DNA及肝功能,并严格遵循抗病毒药物的停药时间,HBsAg阳性淋巴瘤患者接受利妥昔单抗联合化疗安全有效。     

利妥昔单抗联合化疗治疗CD20^＋的B细胞型非霍奇金淋巴瘤的护理

目的：探讨利妥昔单抗（商品名：美罗华）联合CHOP（环磷酰胺、长春新碱、多柔比星、泼尼松）化疗方案治疗CD20^＋非霍奇金淋巴瘤（NHIL）的疗效及毒副作用。方法：化疗使用CHOP方案，联合第1天使用美罗华375mg／m^2第2天行CHOP方案。结果：治疗效果明显，毒副作用小于传统化疗方案。结论：美罗华联合化疗可改善NHL患者的预后，取得了良好效果，提高了患者的生存期，且毒副作用小。     

利妥昔单抗联合化疗治疗恶性淋巴瘤的护理

总结了17例利妥昔单抗联合CHOP方案治疗CD20+的B细胞非霍奇金淋巴瘤的护理方法.主要包括化疗前给予心理护理,减轻患者焦虑,使其能较好地配合治疗;治疗期间重点做好不良反应的观察及护理,预防和减轻不良反应的发生.本组治疗过程中未出现因利妥昔单抗引起的严重不良反应,患者治疗均顺利进行.认为恰当的护理可预防和减轻利妥昔单抗的不良反应,确保治疗顺利进行,提高治疗效果.     

利妥昔单抗联合CHOP化疗方案治疗恶性淋巴瘤的效果观察

目的：探究利妥昔单抗联合CHOP化疗方案治疗恶性淋巴瘤的临床效果。方法：采用随机数字表法将2016年1月~2019年12月收治的60例恶性淋巴瘤患者分为对照组和观察组,各30例。对照组予以CHOP化疗方案治疗,观察组接受利妥昔单抗联合CHOP化疗方案治疗。比较两组临床疗效及不良反应发生情况。结果：观察组治疗总有效率显著高于对照组,不良反应发生率低于对照组,差异有统计学意义（P＜0.05）。结论：利妥昔单抗联合CHOP化疗方案治疗恶性淋巴瘤的效果显著,可以缩小病灶,抑制疾病恶化,且临床用药安全性高。     

Cost-effectiveness of pegfilgrastim versus filgrastim primary prophylaxis in women with early-stage breast cancer receiving chemotherapy in the united states

Background: Prophylaxis with granulocyte colony-stimulating factor reduces the risk for febrile neutropenia (FN) in patients receiving myelosuppressive chemotherapy.Objective: We estimated the incremental cost-effectiveness of primary prophylaxis (starting in cycle 1 of chemotherapy) with pegfilgrastim versus filgrastim in women with early-stage breast cancer receiving myelosuppressive chemotherapy in the United States.Methods: A decision-analytic model was constructed from a health payer's perspective with a lifetime study horizon. The model considered direct medical costs and outcomes related to reduced FN and potential survival benefits due to reduced FN-related mortality and on-time receipt of full-dose chemotherapy. Sensitivity analyses were conducted.Results: Pegfilgrastim was cost-saving and more effective (ie, dominant strategy) than 11-day filgrastim. The incremental cost-effectiveness ratio (ICER) for pegfilgrastim versus 6-day filgrastim was $12,904 per FN episode avoided. Adding the survival benefit due to reduced FN mortality and receipt of optimal chemotherapy dose yielded an ICER of $31,511 per quality-adjusted life year (QALY) gained and $14,415 per QALY gained, respectively. The most influential factors included inpatient FN case-fatality rate, cost of pegfilgrastim and filgrastim, baseline probability of FN, relative risk for FN between filgrastim and pegfil-grastim, and cost of administration of filgrastim.Conclusion: Pegfilgrastim was cost-saving compared with 11-day filgrastim and cost-effective compared with 6-day filgrastim from a health payer's perspective for the primary prophylaxis of FN in these women with early-stage breast cancer receiving myelosuppressive chemotherapy.     

自体骨髓干细胞移植治疗糖尿病周围神经病变的系统评价

目的 系统评价自体骨髓干细胞移植治疗糖尿病周围神经病(diabetic peripheral neuropathy,DPN)的疗效和安全性.方法 计算机检索CBM (1978～2011.6)、CNKI (1979～2011.6)、MEDLINE (1950 ～ 2011.6)、PubMed (1950～2011.6)、EMbase (1970 ～ 2011.6)和The Cochrane Library(2011年第3期),收集自体骨髓干细胞移植治疗DPN的随机对照试验(RCT),并追溯纳入研究的参考文献.由2位研究者按照纳入与排除标准筛选文献、提取资料并评价质量后,采用RevMan 5.0软件进行Meta分析.结果 最终纳入4个RCT,共计68例DPN患者、136条患肢,但大多数纳入研究的方法学质量较差.Meta分析结果显示:自体骨髓干细胞治疗糖尿病周围神经病变可使肢体疼痛、麻木、冷感、间歇性跛行、静息痛显著好转甚至消失;与常规治疗相比,自体骨髓干细胞治疗DPN可显著提高双下肢胫神经的感觉神经传导速度[MD=5.75,95％CI (3.86,7.64),P＜0.000 01]及胫神经运动神经传导速度[MD=4.04,95％CI (0.90,7.18),P=0.001],也能显著提高腓神经的感觉神经传导速度[MD=7.47,95％CI (4.00,10.94),P＜0.000 1]及运动神经传导速度[MD=3.83,95％CI (0.07,7.58),P=0.0s].且无不良反应报告.结论 现有证据显示,自体骨髓干细胞移植治疗对DPN有一定疗效.但由于缺乏高质量的RCT支持,上述结论尚需开展更多高质量RCT加以验证.     

A cost‐effectiveness analysis of sunitinib in patients with metastatic renal cell carcinoma intolerant to or experiencing disease progression on immunotherapy: perspective of the Spanish National Health System

Aim: To investigate the cost‐effectiveness of sunitinib (50 mg/day, schedule 4/2) vs. best supportive care (BSC) in patients with cytokine‐refractory metastatic renal cell carcinoma (mRCC), from the perspective of the Spanish National Health Service. Material and Methods: A Markov model compared the cost‐effectiveness (taking into account drugs; medical visits; laboratory tests; X‐rays; terminal care; adverse event management) of sunitinib and BSC across three disease states: no progression, survival with progression and death from mRCC or other causes. Results: The monthly incremental cost‐effectiveness ratio (ICER) values for sunitinib treatment were €6073/progression‐free survival month, €25 199/life years and €34 196/quality‐adjusted life years (QALY) gained. In 95% of cases, the ICER/QALY values were below the accepted €45 000/QALY threshold. Efficacy and cost of sunitinib had the greatest impact on cost‐effectiveness. Conclusion: Sunitinib has a good cost‐effectiveness profile in mRCC. The cost per life year and QALY gained is affordable according to current effectiveness thresholds in developed countries.     

胺碘酮治疗急性心肌梗死溶栓术后再灌注心律失常的Meta分析

目的 系统评价胺碘酮治疗急性心肌梗死溶栓术后再灌注心律失常的疗效,为合理制定急性心肌梗死溶栓治疗方案提供高质量证据.方法 计算机检索PubMed、EMbase、The Cochrane Library(2012年第3期)、CBM、CNKI、VIP及WanFang Date数据库,全面收集胺碘酮治疗急性心肌梗死溶栓术后再灌注心律失常的随机对照试验(RCT),检索时限均为建库至2013年1月,并追溯纳入研究的参考文献.由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析.结果 共纳入5个RCT,440例患者.Meta分析结果显示:与空白对照组比较,胺碘酮组可降低急性心肌梗死溶栓术后RA的总发生率[RR=0.60,95％CI (0.48,0.74),P＜0.000 01]和室颤发生率[RR=0.47,95％CI (0.26,0.85),P=0.01],且不影响溶栓术后冠脉再通率[RR=1.00,95％CI (0.88,1.15),P=0.94],但不能降低术后病死率[RR=0.33,95％CI (0.10,1.09),P=0.07].结论 现有证据表明,胺碘酮能降低急性心肌梗死溶栓术后再灌注心律失常发生率,但未能降低病死率.受纳入研究质量和数量限制,上述结论尚需更多高质量RCT结果加以验证.     

Cost-effective diagnostic cardiovascular imaging: when does it provide good value for the money?

To summarize the results of all original cost-utility analyses (CUAs) in diagnostic cardiovascular imaging (CVI) and characterize those technologies by estimates of their cost-effectiveness. We systematically searched the literature for original CVI CUAs published between 2000 and 2008. Studies were classified according to several variables including anatomy of interest (e.g. cerebrovascular, aorta, peripheral) and imaging modality under study (e.g. angiography, ultrasound). The results of each study, expressed as cost of the intervention to number of quality-adjusted life years saved ratio (cost/QALY) were additionally classified as favorable or not using 20,000,20,000, 50,000, and $100,000 per QALY thresholds. The distribution of results was assessed with Chi Square or Fisher exact test, as indicated. Sixty-nine percent of all cardiovascular imaging CUAs were published between 2000 and 2008. Thirty-two studies reporting 82 cost/QALY ratios were included in the final sample. The most common vascular areas studied were cerebrovascular (n = 9) and cardiac (n = 8). Sixty-six percent (21/32) of studies focused on sonography, followed by conventional angiography and CT (25%, n = 8, each). Twenty-nine (35.4%), 42 (51.2%), and 53 (64.6%) ratios were favorable at WTP $100,000 per QALY thresholds. The distribution of results was assessed with Chi Square or Fisher exact test, as indicated. Sixty-nine percent of all cardiovascular imaging CUAs were published between 2000 and 2008. Thirty-two studies reporting 82 cost/QALY ratios were included in the final sample. The most common vascular areas studied were cerebrovascular (n = 9) and cardiac (n = 8). Sixty-six percent (21/32) of studies focused on sonography, followed by conventional angiography and CT (25%, n = 8, each). Twenty-nine (35.4%), 42 (51.2%), and 53 (64.6%) ratios were favorable at WTP 20,000/QALY, 50,000/QALY, and50,000/QALY, and 100,000/QALY, respectively. Thirty (36.6%) ratios compared one imaging test versus medical or surgical interventions; 26 (31.7%) ratios compared imaging to a different imaging test and another 26 (31.7%) to no intervention. Imaging interventions were more likely (P < 0.01) to be favorable when compared to observation, medical treatment or non-intervention than when compared to a different imaging test at WTP $100,000/QALY. The diagnostic cardiovascular imaging literature has growth substantially. The studies available have, in general, favorable cost-effectiveness profiles with major determinants relating to being compared against observation, medical or no intervention instead of other imaging tests.     

Assessing the Cost-effectiveness of a Hypothetical Disease-modifying Therapy With Limited Duration for the Treatment of Early Symptomatic Alzheimer Disease

PurposeClinical trials have produced promising results for disease-modifying therapies (DMTs) for Alzheimer’s disease (AD); however, the evidence on their potential cost-effectiveness is limited. This study assesses the cost-effectiveness of a hypothetical DMT with a limited treatment duration in AD.MethodsWe developed a Markov state–transition model to estimate the cost-effectiveness of a hypothetical DMT plus best supportive care (BSC) versus BSC alone among Americans living with mild cognitive impairment (MCI) due to AD or mild AD. AD states included MCI due to AD, mild AD, moderate AD, severe AD, and death. A hypothetical DMT was assumed to confer a 30% reduction in progression from MCI and mild AD. The base case annual drug acquisition cost was assumed to be $56,000. Other medical and indirect costs were obtained from published literature or list prices. Utilities for patients and caregivers were obtained from the published literature and varied by AD state and care setting (community care or long-term care). We considered 3 DMT treatment strategies: (1) treatment administered until patients reached severe AD (continuous strategy), (2) treatment administered for a maximum duration of 18 months or when patients reached severe AD (fixed-duration strategy), and (3) 40% of patients discontinuing treatment at 6 months because of amyloid plaque clearance and the remaining patients continuing treatment until 18 months or until they reached severe AD (test-and-discontinue strategy). Incremental cost-effectiveness ratios (ICERs) were calculated as the incremental cost per quality-adjusted life-year (QALY) gained.FindingsFrom the health care sector perspective, continuous treatment with a hypothetical DMT versus BSC resulted in an ICER of $612,354 per QALY gained. The ICER decreased to $157,288 per QALY gained in the fixed-duration strategy, driven by large reductions in treatment costs. With 40% of patients discontinuing treatment at 6 months (test-and-discontinue strategy), the ICER was $125,631 per QALY gained. In sensitivity and scenario analyses, the ICER was the most sensitive to changes in treatment efficacy, treatment cost, and the initial population AD state distribution. From the modified societal perspective, ICERs were 6.3%, 20.4%, and 25.1% lower than those from the health care sector perspective for the continuous, fixed-duration, and test-and-discontinue strategies, respectively.ImplicationsUnder a set of assumptions for annual treatment costs and the magnitude and duration of treatment efficacy, DMTs used for a limited duration may deliver value consistent with accepted US cost-effectiveness thresholds.     

When to initiate highly active antiretroviral therapy in sub-Saharan Africa? A South African cost-effectiveness study

BACKGROUND: Large-scale programmes increasing access to highly active antiretroviral therapy (HAART) are being implemented in sub-Saharan Africa. However, cost-effectiveness of initiating treatment at different CD4 count thresholds has not been explored in resource-poor settings. METHODS: A cost-effectiveness analysis was conducted from a public health perspective using primary treatment outcomes, healthcare utilisation and cost data (Jan 2004 local prices; US dollars 1=7.6 Rands) derived from the Cape Town AIDS Cohort. A Markov state-transition model was developed to estimate life-expectancy, lifetime costs, quality-adjusted life-years (QALYs), cost per life-year and QALY gained for initiating HAART at three CD4 cell count thresholds (<200/microl, 200-350/microl and >350/microl), including the no antiretroviral therapy (No-ART) alternative. Each treatment option was compared with the next most effective undominated option. RESULTS: Mean life-expectancy was 6.2, 18.8, 21.0 and 23.3 years; discounted (8%) QALYs were 3.1, 6.2, 6.7 and 7.4; and discounted lifetime costs were US dollars 5,250, US dollars 5,434, US dollars 5,740, US dollars 6,588 for No-ART, and therapy initiation at <200/microl, 200-350/microl and >350/microl scenarios respectively. Clinical benefits increased significantly with early therapy initiation. Initiating therapy at <200/microl had an incremental cost-effectiveness ratio (ICER) of US dollars 54 per QALY versus No-ART, 200-350/microl had an ICER of US dollars 616 versus therapy initiation at <200/microl, and >350/microl had an ICER of US dollars 1,137 versus therapy initiation at 200-350/microl. ICERs were sensitive to HAART cost. CONCLUSIONS: HAART is reasonably cost-effective for HIV-infected patients in South Africa, and most effective if initiated when CD4 count >200/microl. Deferring treatment to <200/microl would reduce the aggregate cost of treatment, but this should be balanced against the significant clinical benefits associated with early therapy.     

参麦注射液治疗肿瘤放化疗后白细胞减少症的Meta分析

目的系统评价参麦注射液治疗肿瘤放化疗后白细胞减少症的疗效。方法计算机检索PubMed(1966~2013.6)、h e Cochrane Library(2013年第5期)、Web of Science(1980~2013.6)、VIP(1989~2013.6)、WanFang Data(1990~2013.6)、CNKI(1980~2013.6)和CBM(1981~2013.6),查找国内外已发表的关于参麦注射液治疗肿瘤放化疗患者白细胞减少症的随机对照试验(RCT)。由2位研究者根据纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.2软件进行Meta分析。结果最终纳入11个研究,共1?009例患者。Meta分析结果显示:参麦注射液在显效率[RR=1.57,95%CI(1.39,1.78),P<0.000?01]及总有效率[RR=1.27,95%CI(1.19,1.36),P<0.000?01]方面优于常规口服升白药,但两者有效率差异无统计学意义[RR=0.90,95%CI(0.74,1.09),P=0.27]。结论参麦注射液治疗肿瘤放化疗后白细胞减少症的疗效优于常规口服升白药物。但受纳入研究的数量及质量限制,本系统评价结论仍需进一步开展更多大样本、严格设计的RCT加以验证。     

国内吡柔比星与阿霉素为主的化疗方案治疗非霍奇金淋巴瘤疗效与安全性的Meta分析

目的系统评价国内以吡柔比星（THP）为主的化疗方案与以阿霉素（ADM）为主的化疗方案比较治疗非霍奇金淋巴瘤的有效性与安全性。方法计算机检索PubMed、CNKI、CBM、VIP和WanFangData,查找THP和ADM比较治疗NHL的随机对照试验（RCT）。检索时限均为1989年1月至2012年9月,并手工检索所有纳入文献的参考文献。由2位评价员根据纳入和排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量后,采用RevMan5．0软件进行Meta分析。结果最终纳入15个RCT,共1659例患者。Meta分析结果显示：①在总有效率方面,以THP为主的CTOP方案（C：环磷酰胺,T：毗柔比星,O：长春新碱,P：泼尼松）明显高于以ADM为主的CHOP方案（C：环磷酰胺,H：阿霉素,O：长春新碱,P：泼尼松）,其差异有统计学意义[OR=1．07,95％CI（1．02,1．12）,P=0．006]。②在安全性方面,以THP为主的CTOP方案在一t7脏、胃肠道、肝功损害等方面的副作用明显少于以ADM为主的CHOP方案,其差异均有统计学意义[心脏：OR=0．42。95％CI（O．30,0．57）,P〈0．00001;胃肠道：OR=0．69,95％CI（O．56,0．85）,P=0．0005;OR=0．69,95％CI（O．48,1．00）,P=0．05],但两种化疗方案在骨髓抑制方面差异均无统计学意义[血红蛋白减少：OR=0．83,95％CI（O．6l,1．14）,P=0．25;白细胞减少：OR=0．85,95％CI（0．68,1．07）,P=0．17;血小板减少：OR=0．99,95％CI（0．70,1．39）,P=0．9530结论目前国内研究结果表明,与以ADM为主的CHOP方案相比,以THP为主的CTOP方案治疗非霍奇金淋巴瘤的总有效率更高,且副作用更小。受纳入研究质量和数量限制,上述结论尚需开展更多高质量、大样本的随机双盲对照试验加以验证。     

化瘀解毒之血必净注射液治疗重症肺炎疗效的系统评价

目的系统评价常规方案联合血必净注射液治疗重症肺炎的临床疗效,以期为临床实践提供更可靠的证据。方法计算机检索PubMed(1990~2013.4)、EMbase(1990~2013.4)、h e Cochrane Library(2013年第4期)、CNKI(1982~2013.4)、WanFang Data(1990~2013.4)、VIP(1989~2013.4)和CBM(1978~2013.4)数据库,查找有关采用血必净注射液治疗重症肺炎的随机对照试验(RCT)。由2位研究者按照纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.2软件进行Meta分析。结果最终共纳入12个研究,包括860例患者。Meta分析结果显示:常规方案联合血必净注射液与单纯常规方案比较,联合血必净组在总有效率、显效率、感染程度指标(WBC、CPIS、CRP)、炎症细胞因子(IL-6、IL-8、TNF-α)水平及平均住院天数等方面均优于常规治疗组,且差异均有统计学意义;但两组病死率差异无统计学意义。纳入研究均未报告明显不良反应。结论现有证据显示,常规治疗联合血必净注射液较单纯常规治疗对重症肺炎有较好的治疗效果。但受纳入研究质量所限,上述结论尚需开展更多高质量、大样本的RCT加以验证。