去甲肾上腺素与特利加压素治疗肝肾综合征疗效比较的Meta分析

目的比较去甲肾上腺素和特利加压素治疗肝肾综合征(HRS)的有效性及安全性。方法检索Pubmed、Medline Embase、Cochrane图书馆,CNKI及万方数据库,获取比较去甲肾上腺素和特利加压素治疗HRS疗效的随机对照试验,检索时间截止至2016年10月,由两名评价员独立提取数据并评估结果和偏倚风险,评价指标包括血清肌酐下降程度、HRS缓解率和不良反应。结果共纳入7篇研究,261例HRS患者,与特利加压素相比,去甲肾上腺素治疗HRS后血清肌酐下降程度差异无统计学意义(MD:-0.06 mg/dL;95%CI:-0.18~0.05;P=0.29);HRS缓解率差异无统计学意义(OR:0.84;95%CI:0.49~1.42;P=0.51);与特利加压素相比,去甲肾上腺素治疗HRS后发生的不良反应更少,差异有统计学意义(OR:0.36;95%CI:0.18~0.73;P=0.005)。结论去甲肾上腺素治疗HRS同样安全有效,去甲肾上腺素能否替代特利加压素治疗HRS仍有待大规模、多中心的随机对照试验进一步证实。     

去甲肾上腺素或特利加压素联合白蛋白治疗1型肝肾综合征效果及安全性比较的Meta分析

目的对去甲肾上腺素、特利加压素联合白蛋白治疗1型肝肾综合征(HRS1)的效果及安全性进行系统评价。方法通过检索PubMed、EMBASE、Medline、Cochrane Library、中国知网、万方和维普等国内外数据库有关去甲肾上腺素或特利加压素联合白蛋白治疗HRS1对比研究的文献。对文献进行质量评价。提取HRS逆转率、病死率、不良事件发生率、平均动脉压、肾功能等指标,应用Review Manager 5. 3软件进行数据分析,各研究间的异质性采用χ2检验判断。二分类变量采用比值比(OR)分析,连续性变量采用加权均数差(WMD)分析,两类变量均计算95%可信区间(95%CI)。结果纳入符合标准的随机对照试验6篇,总样本量298例,其中去甲肾上腺素联合白蛋白和特利加压素联合白蛋白组各149例。Meta分析显示两组的HRS逆转率(OR=0. 95,95%CI:0. 60～1. 49,P=0. 81)、病死率(OR=0. 84,95%CI:0. 51～1. 41,P=0. 51)、不良事件发生率(OR=0. 42,95%CI:0. 16～1. 07,P=0. 07)、平均动脉压(SMD=0. 05,95%CI:-0. 92～1. 03,P=0. 92)、肾功能等指标并无明显差异。结论去甲肾上腺素联合白蛋白与特利加压素联合白蛋白治疗HRS1临床效果及安全性一致,临床上需要时可考虑使用去甲肾上腺素替代特利加压素。     

特利加压素对1型肝肾综合征的治疗疗效:一项系统评价及meta分析

目的评价特利加压素治疗1型肝肾综合征的安全性和有效性。方法检索PubMed、Embase等数据库特利加压素治疗1型肝肾综合征有关的随机对照试验;2名研究者独立地对文献进行筛选、质量评价和数据提取,并用RevMan 5.3软件进行安全性和有效性分析。结果研究共纳入13项随机对照试验,共746例患者,试验组均为特利加压素治疗组;对照组包括5项安慰剂、6项去甲肾上腺素、1项多巴胺和1项奥曲肽治疗。总的肝肾综合征缓解为33.7%,死亡率60.1%,meta分析显示特利加压素治疗比对照组更能提高肝肾综合征缓解率(RR=2.13,95%CI:1.26~3.61,P=0.005,I2=51%);但同时伴有更多的不良反应(RR=2.05,95%CI:1.36~3.09,P=0.0006,I2=0%)。亚组分析显示特利加压素比安慰剂对治疗肝肾综合征具有优势;但其疗效和安全性与去甲肾上腺素比较差异无统计学意义。结论特利加压素是治疗1型肝肾综合征患者有效的药物之一。     

特利加压素联合白蛋白治疗Ⅰ型肝肾综合征疗效的荟萃分析

目的收集中英文相关随机对照试验(randomized controlled trial,RCT)的研究结果进行Meta分析,对特利加压素联合白蛋白对肝肾综合征(hepatorenal syndrome,HRS)的疗效进行评价.方法采用Cochrane系统评价方法,检索PubMed,The Cochrane Library,Web of Science and LILACS,Medline,EMBASE,中国生物医学文献数据库,维普中文科技期刊数据库,中国CNKI学术总库,万方数据资源系统等数据库,检索截止2016-07以前的所有公开发表文献.结果 6篇RCT共542例患者纳入本荟萃分析,特利加压素联合白蛋白在HRS治疗中较单独应用白蛋白可明显提高HRS缓解率(OR=5.25,95%CI:2.77-6.52);提高生存率(OR=2.33,95%CI:1.11-4.88);同时可降低血肌酐水平,升高平均动脉压,但对尿量的影响无明显差异.其不良反应包括由于体循环充血及外周循环收缩导致的症状,如腹痛、肢体末端紫绀等,但无致死性不良反应报道.结论特利加压素联合白蛋白对改善HRS较单独应用白蛋白有较好的作用,可提高临床缓解率和生存率,且无明显严重不良反应,安全性好.     

特利加压素联合白蛋白比较米多君和奥曲肽联合白蛋白治疗肝肾综合征:一项随机试验

<正>肝肾综合征(HRS)是肝硬化的严重并发症,未经治疗其病死率较高。特利加压素联合白蛋白可有效地逆转HRS,由于特利加压素在美国未获批准,因此米多君和奥曲肽联合白蛋白作为一种替代治疗用于HRS。为了比较特利加压素联合白蛋白与米多君和奥曲肽联合白蛋白治疗HRS的疗效,Cavallin等进行了一项随机对照试验。随机分配27例患者接受特利加压素联合白蛋白治疗(TERLI组),22例患者接受米多君和奥曲肽联合白蛋白治疗(MID/OCT组)。TERLI组给予静脉滴注特利加压素,起始剂量为3 mg/24 h,如无应答则逐步     

特利加压素与去甲肾上腺素在肝肾综合征治疗中的比较

目的 比较去甲肾上腺素与特利加压索在肝肾综合征(HRS)治疗中的效果.方法 59例Ⅰ型HRS患者中,20例接受去甲肾上腺素治疗,6～16 mg/d,治疗至肾功能逆转,最多15 d;16例接受特利加压素治疗,0.5～2 mg/4h,治疗至肾功能逆转,最多15 d;23例为安慰剂治疗(对照组).所有患者均用白蛋白10 g/d治疗.观察患者治疗前后肝功能、肾功能、电解质、存活时间.统计学处理采用t检验和X2检验.结果 治疗15d后,20例接受去甲肾上腺素治疗的HRS患者,12例肾功能逆转(60％);16例接受特利加压素治疗患者,14例肾功能逆转(87.5％);对照组23例病情较治疗前恶化;特利加压素组与其他两组比较,差异有统计学意义(P＜0.05).去甲肾上腺素组、特利加压素组和对照组的综合应答率分别为80％、100％和17.4％,差异有统计学意义(P＜0.05).结论 特利加压素、去甲肾上腺素是治疗HRS的有效药物,特利加压素疗效更佳,两者远期疗效尚不确定.     

特利加压素治疗肝肾综合征患者临床有效性及安全性的Meta分析

目的从循证医学的角度对特利加压素治疗肝肾综合征的有效性和安全性进行分析,以期为临床应用提供医学依据。方法以"特利加压素"、"肝肾综合征"为关键词检索,检索时间截至2016年1月,检索数据库为CNKI、万方、PubMed、CBM、Embase、CCTR及Medline;采用Cochrane系统评价方法,对符合筛选标准的文献进行评价,采用Review Manger6.0软件进行Meta分析。结果在检索出的51篇文献中符合纳入标准的共4篇英文文献,包括234例HRS患者,均为随机对照临床试验。按照Cochrane质量评价标准,纳入的文献均为B级。Meta分析结果显示:特利加压素治疗HRS患者的有效率与对照组相比差异有统计学意义(OR=6.85,95%CI:3.47~13.55,P0.00001)。各项研究的Meta分析不存在显著的发表偏倚,结果较为稳定。采用特利加压素治疗的部分HRS患者出现不良反应,但耐受性均较好,一般可自行缓解,稍严重的经对症干预后均得到有效缓解。结论特利加压素可显著提高HRS患者的生存率,降低肌酐水平,增加尿量,改善肾脏功能,有效性及安全性良好。     

特利加压素治疗肝肾综合征的循证医学依据

肝肾综合征(hepatorenal syndrome, HRS)是肝硬化的严重并发症之一,主要表现为少尿、尿钠潴留和血清肌酐升高.肝移植是治疗肝肾综合征的最佳方式,但仅有少部分患者进行了肝移植.目前药物治疗方式主要为血管收缩剂联合白蛋白.特利加压素是一种人工合成的血管加压素类似物,主要用于治疗肝肾综合征.本文旨在从循证医学角度回顾特利加压素治疗HRS的当前现状.     

特利加压素联合白蛋白治疗肝肾综合征效果的预测因素

肝肾综合征(HRS)是终末期肝病的严重并发症,主要发生于有明显循环功能障碍的晚期肝硬化患者,预后较差。目前首选的药物治疗方案是特利加压素联合白蛋白治疗。关于特利加压素联合白蛋白治疗效果的预测因素的研究较多,但尚未有相关综合报道。从HRS的发病机制和药物作用机制方面回顾了这一疾病的最新研究进展,从基线资料、治疗后变化及治疗方案等方面对特利加压素联合白蛋白治疗效果的预测因素的研究进展进行了综述,指出早期识别有助于预测治疗反应的因素具有重要的临床意义。     

特利加压素治疗肝肾综合征疗效分析及不良反应研究

目的观察特利加压素治疗肝肾综合征（HRS）的近远期疗效及不良反应。方法将42例患者随机分为两组：A 组22例为基础治疗联合特利加压素;B 组20例为基础治疗。观察治疗期间患者临床症状、尿量、肌酐、平均动脉压及血钠等指标。结果与 B 组比较,A 组患者治疗后临床症状明显改善,尿量增加（P ＜0．01）,平均动脉压上升（P ＜0．01）,血肌酐值下降（P ＜0．01）,但两种治疗方案对血钠的影响差异无统计学意义（P ＞0．05）。A 组出现相关不良反应（房性期前收缩、痉挛性腹痛、水样泻等）,而 B 组无明显不良反应发生。A 组患者生存期较 B 组明显延长（P ＜0．05）,特别是Ⅱ型 HRS 患者的生存期延长更明显（P ＜0．01）。结论特利加压素治疗HRS 有明显的疗效优势,同时也有一定的不良反应,但通常发生的不良反应较为轻微,并且能较明显改善 HRS 患者的生存期。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.