脑卒中后睡眠障碍影响因素的Meta分析

目的 探讨脑卒中后睡眠障碍的影响因素.方法 在PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普网和中国生物医学文献数据库搜索相关文献,检索时限为建库至2021年1月3日,采用RevMan 5.3软件进行Meta分析.结果 共纳入10项研究,其中8项横断面研究、2项队列研究,共2 938例患者.Meta分析结果显示,卒中史[OR=1.30,95％CI(1.07～1.60)]、高血压[OR=2.20,95％CI(1.80～2.68)]、糖尿病[OR=1.55,95％CI(1.32～1.83)]、冠心病[OR=1.34,95％CI(1.09～1.65)]、高脂血症[OR=1.36,95％CI(1.14～1.62)]、吸烟史[OR=1.36,95％CI(1.07～1.73)]是脑卒中后睡眠障碍的主要影响因素(P＜0.05,P＜0.01).结论 脑卒中患者发生睡眠障碍的影响因素较多,应采取针对性措施预防和降低卒中后睡眠障碍的发生和发展.     

腹主动脉瘤破裂腔内治疗的荟萃分析

目的 系统评价血管腔内修复术(vascular edovascular repair,EVAR)治疗腹主动脉瘤破裂(ruptured abdominal aortic aneurysms,RAAA)的有效性与安全性.方法 计算机检索PubMed、MEDLINE、EMBASE、Cochrane Library、中国生物医学文献数据库、中文科技期刊全文数据库及中国期刊全文数据库等数据库,并辅以手工检索近年发表的中文期刊.对纳入文献采用RevMan 5.0.18软件进行Meta分析.结果 纳入9篇文献.1篇随机对照试验(RCT),8篇队列研究共2402例患者,Meta分析结果显示:与开放手术比较,血管腔内修复术可明显降低术后30 d死亡率[OR =0.47,95％ CI(0.39,0.57),P＜0.01]和并发症发生率OR=0.47,95％ CI(0.39,0.57),P＜0.01.血管腔内修复术与开放手术相比,在术后早期再手术率[ OR=0.86,95％ CI(0.55,1.33),P=0.5]及中期死亡率[OR=1.24,95％ CI(0.46,3.37),P＜0.67]方面差异无统计学意义(P＞0.05).结论 对于合适的腹主动脉瘤破裂的患者,腔内治疗是可行的,并且逐渐显现出相对传统开腹手术更大的优势,短期疗效较好,术后并发症相对较少.     

单侧双通道内镜腰椎融合术安全性的荟萃分析

[目的]系统评价单侧双通道内镜（unilateral biportal endoscopic, UBE）辅助腰椎融合术与传统腰椎融合手术的安全性。[方法]检索The Cochrane Library、PubMed、Embase、Web of Science、Clinical Trals.gov、CBM、CNKI、VIP和万方数据库，收集所有UBE与传统腰椎融合手术的对照研究，检索时限均为建库至2022年4月13日，采用RevMan5.3软件进行荟萃分析，对数据不能合并者进行描述性定性分析。[结果]共纳入9篇文献，均为回顾性队列研究，其中高质量文献7篇，中等质量2篇。总共纳入患者796例，其中UBE组365例，传统组431例。荟萃分析结果显示：UBE组和传统组的总并发症发生率（OR=0.94,95%CI 0.57～1.53,P=0.800）、硬膜外血肿发生率（OR=1.16,95%CI 0.38～3.52,P=0.800）、硬脊膜撕裂发生率（OR=1.80,95%CI 0.76～4.30,P=0.180）、感染发生率（OR=0.35,95%CI 0.09～1.30,P=0.120）差异均...     

雌激素受体β与结直肠癌临床病理特征及预后关系的Meta分析

目的通过Meta分析来评价雌激素受体β表达与结直肠癌临床病理特征及预后的关系,为雌激素受体β在结直肠癌诊断和治疗中的作用提供循证医学证据。 方法检索中国知网、万方、Cochrane Library、PubMed、SpringerLink、EBSCO、MEDLINE等数据库,检索建库开始至2019年12月所有研究雌激素受体β与结直肠癌的文献,提取相关临床资料和数据,根据纳入和排除标准,并根据Cochrane文献质量评估手册评估文献质量,最后采用RevMan 5.3进行Meta分析。 结果最终8篇文献2 149例患者纳入分析。雌激素受体β表达阳性患者预后更好,差异有统计学意义（HR=0.74,95% CI：0.63~0.86,P=0.000 1）。雌激素受体β表达与肿瘤的浸润程度有关,差异有统计学意义（OR=1.44,95% CI：1.15~1.80,P=0.002）,而与性别（OR=1.17,95% CI：0.97~1.40,P=0.10）、肿瘤的分化程度（OR=0.96,95% CI：0.78~1.20,P=0.74）、淋巴结转移（OR=0.90,95% CI：0.74~1.11,P=0.33）、远处转移（OR=0.91,95% CI：0.67~1.23,P=0.55）等无关,差异无统计学意义。 结论雌激素受体β是结直肠癌的独立预后因子,在结直肠癌预后评估和治疗靶点方面具有重要作用。     

妊娠并发肾病综合征的临床研究

目的 探讨妊娠并发肾病综合征患者的妊娠结局及肾功能的变化。 方法 回顾性调查我院2003年至2007年间59例妊娠并发肾病综合征患者的临床资料,包括患者出现肾病的时间、尿蛋白量、血浆白蛋白、Scr、血尿酸、血压;胎儿存活率、死亡率、早产率、出生体质量;以及孕妇产后随访蛋白尿、肾功能和血压情况。采用Logistic回归方法,分析影响妊娠患者的肾脏转归及胎儿预后的危险因素。 结果 孕妇出现蛋白尿孕周平均为（20.35±9.40）周,尿蛋白量（24 h）3.5~15.0 g,中位数5.1 g;血浆白蛋白10~28 g/L,中位数22.5 g/L;Scr 32~825 μmol/L,中位数84 μmol/L;血尿酸196~793 μmol/L,中位数385.5 μmol/L。妊娠高血压综合征发生率为75%,其中先兆子痫占55.5%。胎儿存活率72.9%（43/59）,其中早产占76.7%（33/43）;低体质量儿占62.8%（27/43）。产后50%患者持续肾病综合征。24例原有慢性肾炎,其中75%患者蛋白尿较怀孕前有不同程度的增加。38例伴有肾功能受损,其中36.8%患者产后肾功能受损加重,23.7%进入终末期肾衰竭;其中80%发生在Scr≥265 μmol/L的患者。89%患者产后持续高血压。Logistic 回归结果提示,孕期高尿酸血症（P=0.018,OR=1.012）和Scr升高（P=0.039,OR=1.005）是孕妇产后肾功能受损加重的危险因素。高尿酸血症（P=0.012,OR=1.006）也是胎儿死亡的危险因素。 结论 妊娠并发肾病综合征患者的胎儿存活率低,其中高尿酸血症是威胁孕妇和胎儿的首要危险因素。     

前列腺干细胞抗原(PSCA)基因多态性与肿瘤易感性荟萃分析

目的 探讨分析前列腺干细胞抗原(PSCA)第一外显子区(exon 1)基因多态性与肿瘤易感性是否存在相关性.方法 使用PubMed数据库检索2011年5月以前的相关文献,按纳入标准搜索含有研究PSCA exon 1 C＞T多态性与肿瘤易感性相关的信息.结果 根据检索条件,共有16306例肿瘤患者和17962例对照被纳入当前荟萃分析.分析表明PSCA exon 1 C＞T多态性增加了肿瘤的易感性,在肿瘤分层分析中发现PSCA突变型等位基因T显著增加了膀胱癌(P＜0.001,OR =1.09,95％CI:1.05～ 1.13)和胃癌(P =0.006,OR=1.21,95％CI:1.06～1.39)的易感性.结论 PSCA exon 1 C＞T多态性与膀胱癌和胃癌易感性存在相关性.     

阿来佐单抗对肾移植后急性排斥反应和移植肾存活率影响的荟萃分析

目的 探讨阿来佐单抗对肾移植后急性排斥反应(AR)和移植肾存活率的影响.方法搜集国内外关于阿来佐单抗用于预防肾移植后AR的随机对照试验,对符合纳入标准的文献进行荟萃分析.评价疗效及差异的指标采用比值比(OR)及其95％可信区间(CI).采用RevMan5.1软件进行统计学分析.结果 共有国内外9个随机对照研究符合纳入标准.荟萃分析结果显示,阿来佐单抗具有良好的抗AR作用,术后半年阿来佐单抗组的AR发生率比对照组低55.5％(OR=0.37,95％CI为0.24～0.58,P＜0.01),术后1年阿来佐单抗组的AR发生率比对照组低51.1％(OR=0.43,95％CI为0.29～0.64,P＜0.01),术后2年阿来佐单抗组的AR发生率比对照组低28.2％(OR=0.69,95％CI为0.47～1.02,P＜0.01).阿来佐单抗组的移植肾存活率与对照组比较,差异无统计学意义(OR=1.18,95％CI为0.76～1.85,P=0.46),阿来佐单抗组的受者存活率与对照组比较,差异无统计学意义(OR=0.94,95％CI为0.52～1.72,P=0.85).结论 阿来佐单抗对肾移植后AR具有明显的预防作用,但对术后移植肾和受者的存活率无明显影响.     

吲哚菁绿联合亚甲蓝在早期乳腺癌前哨淋巴结活检中应用的荟萃分析

目的 评价吲哚菁绿(indocyanine green, ICG)联合亚甲蓝(methylene blue, MB)在早期乳腺癌前哨淋巴结活检(sentinel lymph node biopsy, SLNB)中的临床应用价值。方法 检索2000年1月1日～2021年5月15日已公开发表在中国生物医学文献数据库、中国知网、万方数据库、维普数据库、PubMed、EMBASE、Web of Science及Cochrane Library有关ICG联合MB在早期乳腺癌SLNB中应用的临床研究。荟萃分析比较不同方法之间病人检出率(identification rate, IR)、假阴性率(false negative rate, FNR)、特异度、准确度的差异。借助Egger检验评估文献发表偏倚。结果 本次荟萃分析共计纳入21篇文献(4 813例病人),结果显示,对比单用MB,ICG联合MB的IR(OR=7.19,CI=5.23～9.87,P<0.001)、特异度(OR=4.18,95%CI=1.78～9.83,P<0.001)及准确度(OR=4.60,95%CI=2.10～10...     

Meta分析HLA-DRB1等位基因多态性对于食管癌发生的影响

目的 采用系统评价的方法探究HLA-DRB1等位基因多态性与食管癌发生的相关性.方法 计算机检索Medline、EMbase、Cochrane Library、Web of Science、CBM、CNKI、VIP、万方等数据库查找相关文献.中文检索关键词:食管癌、HLA-DRB1;英文关键词:esophageal neoplasm、HLA-DRB1.按照纳入和排除标准筛选后提取数据,采用Stata12.0软件进行Meta分析.结果 最终纳入5篇文献,共包含1630例患者.Meta分析结果显示,食管癌组HLA-DRB1*0901基因易感率明显高于正常人,两组基因易感率差异有统计学意义[OR=1.70,95％ CI(1.31,2.20),P＜0.001];食管癌患者HLA-DRB1* 1501基因易感率明显高于正常人,两组基因易感率差异有统计学意义[OR=3.02,95％ CI(1.65,5.51),P＜0.001];食管癌组HLA-DRB1* 0301基因易感率明显高于正常人,两组基因易感率差异有统计学意义[OR =2.84,95％ CI(0.43,18.96),P＜0.001].结论 食管癌的发生与HLA-DRB1* 0901、HLA-DRB1* 1501与HLA-DRB1* 0301基因有关,但由于目前有关食管癌的发生与HLA-DRB1* 1501和HLA-DRB1* 0301基因之间的关系所研究文献较少,且纳入文献之间存在明显统计学异质性,因此食管癌的发生与它们之间的关系仍有待论证.     

体外冲击波对阴茎硬结症的临床疗效Meta分析

目的 系统评价体外冲击波对阴茎硬结症的临床疗效.方法 通过计算机检索2015年12月以前Pubmed、Medline、Embase数据库,纳入体外冲击波(ESWT)治疗阴茎硬结症的随机对照试验.按照纳入和排除标准进行文献筛选,用Jadad量表对纳入文献的方法学评价,并提取资料.采用Review manager 5.3软件进行Meta分析.结果 共有8篇研究被纳入,930例患者,其中ESWT组606例,对照组324例.Meta分析结果表明:与对照组相比,体外冲击波治疗组阴茎局部疼痛人数明显减少[OR=3.91,95％ CI(2.11,7.23)],白膜纤维斑块缩小人数明显减少[OR =3.18,95％ CI(2.24,4.51)],阴茎勃起后弯曲度减小的人数也减少[OR =3.18,95％CI (2.24,4.51)],性生活能力提高的人数明显增加[OR=3.38,95％ CI(1.83,6.24)].结论 体外冲击波能减轻阴茎硬结症患者的疼痛,缩小白膜斑块,改善弯曲畸形,提高性生活能力,对阴茎硬结症有一定的疗效.     

Early predictive value of red cell distribution width for contrast-induced nephropathy in patients after enhanced computed tomography

Objective To explore the early predictive value of red cell distribution width (RDW) for contrast-induced nephropathy (CIN) in patients after enhanced computed tomography (CT). Methods A total of 218 patients who underwent enhanced CT between June 2015 and June 2017 at Huizhou Central Municipal Hospital were enrolled in this study. Patients were divided into CIN group and no-CIN group. The diagnostic criteria for CIN is an increase in serum creatinine (Scr) of more than 44.2 μmol/L or 25% of the baseline value within 3 days of contrast agent use. The general information and clinical characteristics in two groups were compared. The risk factors of CIN were analyzed by logistic regression analysis. The receiver operator characteristic curve (ROC) was used to assess the value of RDW for predicting the occurrence of CIN. Results Among 218 patients, 10(4.59%) patients had CIN. In the CIN group age, baseline Scr and baseline RDW were significantly higher, while hemoglobin, baseline estimated glomerular filtration rate (eGFR), red blood cell, white blood cell, albumin, and high-density lipoprotein cholesterol were significantly lower than those in the no-CIN group (all P＜0.05). Binary logistic regression analysis revealed that baseline RDW (OR=2.250, 95% CI 1.031-4.911, P=0.042) and eGFR (OR=0.963, 95% CI 0.928-0.999, P=0.044) were correlated with the occurrence of CIN. ROC analysis confirmed the area under the curve of RDW as a predictor of CIN was 0.798 (P＜0.001). The cut-off value of RDW was 14.5%, and the diagnostic sensitivity and specificity in CIN were 70.00% and 85.58%, respectively. Conclusions Increased baseline RDW and decreased eGFR are the risk factors of the occurrence of CIN after enhanced CT. RDW has a good predictive value, and it may be a good biomarker for the early diagnosis of CIN.     

The relative renal safety of iso -osmolar contrast media compared with low -osmolar contrast media in intravenous contrast-enhanced CT: a Meta-analysis

Objective To compare the nephrotoxicity of the iso ? osmolar contrast media (iodixanol) to low?osmolar contrast media (LOCM) in intravenous contrast?enhanced CT. Methods Randomized controlled trials (RCTs) of iodixanol or low?osmolar contrast media in intravenous contrast?enhanced CT were searched in the database of VIP, CBM, CNKI, Wanfang, PubMed, EMBASE, Web of Science, Cochrane Library from their start year to July 2012. Screening and information extracted were did by two researchers independently. The quality of the included documents was evaluated by the criterion of Cochrane handbook. Revman software (version 5.0) of the Cochrane collaboration was used in data analysis. Results There was no significant difference in the incidence of contrast?induced nephropathy (CIN) among 6 trials recruited 907 patients between the iodixanol group and the LOCM group [RR=0.64, 95%CI (0.31 ? 1.32), P=0.22] by using serum creatinine increased by more than 44 μmol/L (0.5 mg/dl) as the diagnostic criteria. No considerable difference was existed by using serum creatinine increased by more than 25% as the diagnostic criteria between the two groups [RR=0.79, 95%CI (0.48?1.30), P=0.35]. Subgroup analysis showed there was no obvious difference [RR=0.57, 95%CI (0.30 ? 1.10), P=0.09] between the two groups in patients with increased baseline of serum creatinine. No obvious difference were gained in normal baseline group [RR=1.28, 95%CI (0.57?2.86), P=0.55] . Conclusion Compared with low?osmolar contrast media, iodixanol is not associated with less CIN in intravenous contrast?enhanced CT.     

Prediction of acute kidney injury complicated by sepsis with sTREM - 1 and NGAL as early marker

Objective To determine whether triggering receptor expressed on myeloid cells-1 (sTREM - 1) and urinary neutrophil gelatinase - associated lipocalin (NGAL) were early biomarkers of acute kidney injury (AKI) secondary to sepsis. Methods A total of 141 eligible patients were enrolled in this prospective study. Blood and urine samples were collected at different time points as soon as sepsis was diagnosed. The concentrations of serum creatinine (Scr), urine sTREM-1 and NGAL were measured. According to AKI criteria, patients were divided into the AKI group and non - AKI group. Dynamic changes of levels of Scr, urine sTREM-1 and NGAL were observed in two groups. The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL. Results Among 141 septic patients, 44 (31.2%) cases had concomitant AKI. Twenty four hours after sepsis diagnosed, the level of Scr rose to 1.91 times of the baseline [(140.5±13.6) vs (82.6±15.3) μmol/L, P＜0.05], which met the diagnostic criteria of AKI. In the AKI group, urinary concentrations of sTREM-1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [(100.5±17.4) vs (38.9±14.7) ng/L; (144.6±51.9) vs (56.2±43.8) μg/L, both P＜0.05].And at the following time points, urinary concentrations of sTREM - 1 and NGAL were significantly higher than the baseline levels and that of the non-AKI group (all P＜0.05). At 8 h time point, the area under the curve of urine sTREM-1 was 0.877 (95%CI 0.756-0.914), the sensitivity was 89.1% and specificity was 82.0% with a cutoff value of 70 ng/L. At 8 h time point, the area under the curve of urine NGAL was 0.862 (95% CI 0.703-0.958),the sensitivity was 87.4% and specificity was 85.5% with a cutoff value of 90 μg/L. Conclusions Urinary concentrations of sTREM-1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Scr. Therefore, urinary sTREM-1 and NGAL can be used as early biomarkers of septic AKI.     

非清髓性外周造血干细胞移植后早期急性肾损伤的多中心临床研究

目的 观察白血病患者非清髓性外周造血干细胞移植后早期急性肾损伤（AKI）的患病率、危险因素及对生存的影响。 方法 对象为2002年1月至2007年5月,在东南大学附属中大医院、南京医科大学附属淮安医院、江苏大学附属镇江第一人民医院3个移植中心接受非清髓性外周造血干细胞移植的白血病患者。观察移植前、移植后100 d内肾功能改变情况及并发症,并随访观察1年。AKI分为3期：1期,Scr升高 ≥26.5 μmol/L,或升高50%~200%;2期,Scr升高>200%~300%;3期,Scr升高>300%,或升高>353.6 μmol/L（急性升高≥44.2 μmol/L）。 结果 62例患者移植后造血均顺利恢复。18例（29%）患者出现不同程度的AKI,其中1期11例,2期6例,3期1例。Logistic多因素回归分析表明,人类白细胞抗原（HLA）不完全匹配、移植后并发症（感染、肝静脉闭塞病、急性移植物抗宿主病）是AKI的独立危险因素,其优势比OR（95% CI）分别为3.6（1.1~13.0）、12.1（2.4~62.4）。移植后1年患者总的病死率为27.4%,且病死率随着AKI的严重程度逐渐增加（log-rank检验,P < 0.01）。 结论 AKI是非清髓性外周造血干细胞移植后的常见并发症之一。HLA不完全匹配、移植后并发症是发生AKI的独立危险因素。AKI对患者移植后1年生存率有重要影响。     

Effect of gender matching on the outcomes of living-donor renal transplantation

Objective To evaluate the effect of gender matching on the outcomes of living-donor renal transplantation. Methods A total of 419 cases of living-donor renal transplantation in our center were divided into male-donor-male-recipient (MDMR) group, male-donor-female-recipient (MDFR) group, female-donor-male-recipient (FDMR) group, female-donor-female-recipient (FDFR) group. The outcomes including graft and patient survival, acute rejection and renal function were analyzed retrospectively. Results Compared to MDMR group, MDFR group and FDFR group had lower Scr [(80.7±17.9), (87.4±21.9) μmol/L vs (120.3±72.5) μmol/L, all P＜0.05] and uric acid (UA) [(318.1±86.4), (303.5±66.9) μmol/L vs (358.4±77.8) μmol/L, P＜0.05] 6 months after operation. Compared to MDFR group, FDMR group had higher Scr[(117.7±27.4) μmol/L vs (80.7±17.9) μmol/L, P＜0.01], UA [(371.0±92.4) μmol/L vs (318.1±86.4) μmol/L, P＜0.05] and lower glomerular filtration rate (GFR) [(70.4±17.8) ml/min vs (79.6±18.9) ml/min, P＜0.05]. Compared to FDMR group, FDFR group had lower Scr [(87.4±21.9) μmol/L vs (117.7±27.4) μmol/L, P＜0.01] and UA [(303.5±66.9) μmol/L vs (371.0±92.4) μmol/L, P＜0.01]. Compared to MDFR group, FDFR group showed lower GFR [(72.4±25.3) ml/min vs (82.7±18.7) ml/min, P＜0.05] 1 year after operation. Compared to MDMR group, FDFR group showed lower UA [(322.9±69.7) μmol/L vs (376.0±66.2) μmol/L, P＜0.05] 2 years after operation. Compared to FDMR group, FDFR group showed lower Scr [(88.7±27.0) μmol/L vs (112.7±27.8) μmol/L, P＜0.05] and UA [(318.3±61.2) μmol/L vs (396.2±100.3) μmol/L, P＜0.05] 3 years after operation. 5 years after operation, there were no significant differences in above indexes, the incidence of slow graft function, acute rejection and survival of graft and patient among groups. Conclusions Male recipients of female donors have the worst renal function while female recipients have better outcomes after operation.     

2740人基线血压水平及10年后血压变化与血清肌酐水平的关系

目的 探讨北京部分城区队列人群基线血压水平(1992年)及10年后(2002~2003年)血压的变化与血清肌酐(Scr)水平的关系。 方法 1992年对北京大学社区和首钢地区35~64岁人群进行心血管疾病危险因素的调查，取得了基线数据。2002年对上述人群 (45~74岁) 进行复查，复查中加入了Scr检测指标。对两次资料完整的2740人基线血压水平及10年后血压变化与Scr水平的关系进行分析。 结果 (1)北京部分城区45~74岁人群平均Scr水平为(87.52±20.33) μmol/L，男性Scr [(96.36±15.92) μmol/L]高于女性[(80.44±21.22) μmol/L](P < 0.01)。(2)上述人群中Scr水平异常的发病率为8.7%，男性(13.6%)高于女性(4.4%)(P < 0.01)。其中，肾功能受损的发病率为0.9%，男性(1.6%)高于女性(0.3%)(P < 0.01)。(3)随着基线血压水平的升高，10年后Scr水平呈增加趋势(P < 0.01)。调整性别、年龄、体质指数、血糖、总胆固醇、高密度脂蛋白胆固醇和吸烟等变量后，基线血压≥180/110 mm Hg组Scr水平异常的相对危险是血压<120/80 mm Hg组的3.89倍(95%CI：1.51~10.04)。(4)Scr水平异常的发病率在1992年和2002年血压均正常的人群为6.6%； 在1992年为高血压到2002年血压控制到正常的人群为12.4%；在1992年和2002年均为高血压的人群为16.9%。 结论 高血压与Scr水平密切相关，有效控制血压能够延缓Scr水平的上升，在一定程度上保护肾功能。     

恶性梗阻性黄疸术前减黄利弊的系统评价

目的系统评价恶性梗阻性黄疸患者术前行胆道引流（preoperative biliary drainage,PBD）的利弊。方法计算机检索CochraneLibrary、PubMed、EMBASE、中国生物医学文献数据库等数据库,并辅以手工检索,截止到2010年6月。对纳入的随机对照试验用RevMan5.0软件进行Meta分析。结果纳入7个随机对照试验,Meta分析结果显示：与对照组比较,PBD组术后死亡率（P=0.88）和总并发症发生率（P=0.66）的差异无统计学意义;采用经皮肝穿胆道引流（PTBD）（OR=0.49,95%CI=0.31～0.79,P=0.003）、引流前血清总胆红素〉200μmol/L（OR=0.56,95%CI=0.37～0.84,P=0.006）、引流时间小于4周（OR=0.60,95%CI=0.39～0.93,P=0.020）的患者术后并发症发生率降低。结论选择合适的病例,采取合适的引流方式,控制合适的引流时间,术前减黄可降低恶性梗阻性黄疸患者术后并发症发生率,但不能降低术后死亡率和总并发症发生率。     

帕立骨化醇对慢性肾脏病患者肾小球滤过率及尿蛋白影响的Meta分析

目的 系统评价帕立骨化醇对非透析慢性肾脏病患者估算肾小球滤过率(eGFR)及尿蛋白的影响.方法 计算机检索PubMed、Cochrane、Embase、万方、CNKI、维普等数据库,检索时限均为建库至2014年3月;手工检索美国肾脏病学会、世界肾脏病大会、中华医学会肾脏病学分会年会的会议论文、摘要等.纳入帕立骨化醇对非透析肾脏病患者eGFR及尿蛋白影响的临床随机对照试验研究.由两名评价员独立对纳入的文献进行质量评价和数据提取,用Rev Man 5.2软件进行Meta分析.结果 共纳入7项随机对照试验,共834例患者(其中试验组508例,安慰剂组326例).Meta分析结果显示,与安慰剂组比较,小剂量组(帕立骨化醇＜2 μg/d)对慢性肾脏病患者eGFR的影响差异无统计学意义[标准均数差(SMD)为-0.10,95％CI:-0.28 ～ 0.07,P=0.26];大剂量组(帕立骨化醇2μg/d)eGFR下降差异有统计学意义[SMD=-0.45,95％CI:-0.63-0.27,P＜0.01].与安慰剂组比较,大小剂量组均有降尿蛋白作用[OR(95％CI):2.09(1.52～2.58),P＜0.01],大小剂量组组间降尿蛋白作用的差异无统计学意义[OR(95％CI):1.09(0.62～ 1.91),P=0.77].与安慰剂组比较,小剂量组[OR (95％CI):0.93 (0.57～1.52),P=0.76]和大剂量组[0R(95％CI):2.08 (0.70～ 6.18),P=0.19]均未显著增加不良事件发生率.结论 小剂量帕立骨化醇可减少非透析慢性肾脏病患者尿蛋白,同时对eGFR无影响.大剂量帕立骨化醇(2μg/d)无进一步减少尿蛋白的疗效,且可能带来eGFR下降风险.     

Role of inhibitor of nuclear factor kappa B kinase alpha on renal inflammation after ischemia-reperfusion injury and its associated mechanism

Objective To reveal the role of inhibitor of nuclear factor kappa B kinase alpha(IKKα) in renal inflammation after renal ischemia-reperfusion （IR） injury and its potential associated mechanism. Methods Ischemia-reperfusion injury models were induced in a total of 24 healthy C57BL/6 male mice. Renal function and histological changes were estimated. The expression and site of IKKα, p52, RelB, IL-10 and IL-18 were determined by immunohistochemistry and Western blotting. After the short hairpin RNA(shRNA)targeting IKKα was injected into renal parenchyma, renal function and protein expressions of IKKα, p52, RelB, IL-10, IL-18 were detected. Results Compared with sham-operated group[Scr(7.30±0.13) μmol/L, BUN (8.39±0.30) mmol/L], levels of Scr [(29.80±2.10) μmol/L, (27.00±3.40) μmol/L, (23.00±3.70) μmol/L] and BUN [(9.47±3.50) mmol/L, (11.68±4.30) mmol/L, (13.12±2.10) mmol/L] were higher on day 1, 3, 7 and the injury of kidney was serious in IR injury group. Immunohistochemical expression of both IL-18 and IL-10 were increased. Markedly increased IKKα, p52 and RelB protein expression were noted in experiments from day 1 to day 7 during kidney recovery period, with a peak on day 3 and then decreasing toward baseline after day 7. Compared with IR injury group, low-expression of IKKα by injection of shRNA up-regulated the expression of IL-18 and down-regulated the expression of IKKα, p52, RelB and IL-10. Conclusions The NF-κB pathway is activated and IKKα expression is up-regulated during the kidney ischemia-reperfusion injury, low-expression of IKKα may block inflammation resolution via down-regulation of alternative NF-κB pathway family members of both p52 and RelB.     

Risk of bradykinin B2 receptor ‐58T/C gene polymorphism on hypertension: A meta‐analysis

The risk of bradykinin B2 receptor (BDKRB2)‐58T/C gene polymorphism on hypertension remains controversial. The Cochrane Library, Chinese Biomedical Database, EBSCO, Embase, ISI, MEDLINE, and PubMed were retrieved, and relevant articles were selected. The significant association between BDKRB2 ‐58T/C gene polymorphism and risk of hypertension were found under C‐allele comparison (odds ratio (OR): 1.22, 95% confidential intervals (CI): 1.05–1.42), recessive model (OR: 1.32, 95% CI: 1.07–1.64), dominant model (OR: 0.74, 95% CI: 0.58–0.94), homozygote model (OR: 1.66, 95% CI: 1.11–2.47) and heterozygote model (OR: 1.23, 95% CI: 1.06–1.43). The magnitude of the association between the BDKRB2‐58T/C gene polymorphism and risk of hypertension was substantiated in Asians under C‐allele comparison (OR: 1.24, 95% CI: 1.04–1.49), recessive model (OR: 1.39, 95% CI: 1.04–1.86), dominant model (OR: 0.72, 95% CI: 0.56–0.93), homozygote model (OR: 1.78, 95% CI: 1.09–2.90) and heterozygote model (OR: 1.26, 95% CI: 1.07–1.49). No publication bias was found in the meta‐analysis. The meta‐analysis suggested ‐58C allele and ‐58CC genotype increase the risk of hypertension in Asians and African‐Americans. Inversely, ‐58TT genotype decreases the risk of hypertension in Asians and African‐Americans.