气管支气管软化症致体位性呼吸困难1例并文献复习

目的 分析总结气管支气管软化症的临床特点及诊治要点.方法 分析报告山东大学齐鲁医院(青岛)呼吸科收治的气管支气管软化症病例1例,并结合相关文献进行复习.以“气管支气管软化症”为关键词检索中国知网,万方、维普数据库;以“tracheobronchomalacia”为关键词检索pubmed数据库.检索时间自1973年1月至2015年12月.结果 通过检索pubmed和万方、维普、中国知网数据库中有关气管支气管软化症病变的文献共检索到741篇.结论 气管支气管软化症在临床上易误诊漏诊,常规检查缺乏特异性,CT及电子支气管镜检查对于难以诊断的病例具有重要价值.     

基于网络药理学探究莪术油治疗胃癌的潜在活性成分及作用机制

目的:基于网络药理学探讨莪术油治疗胃癌的潜在活性成分及相关分子机制.方法:查阅相关文献,通过中药系统药理学数据库与分析平台(TCMSP)、中药综合数据库(TCMID)及PubChem数据库检索莪术油的化学成分,并上传至Swiss Target Prediction平台获得潜在作用靶点;从GEO数据库获取GSE54129...     

艾拉莫德治疗强直性脊柱炎有效性和安全性的Meta分析

目的 评价艾拉莫德治疗强直性脊柱炎的有效性及安全性.方法 检索PubMed、Embase数据库、Cochrane图书馆、 中国生物医学文献服务系统(SinoMed)、 中国知网全文数据库(CNKI)、维普(VIP)及万方数据等数据库,检索时间截至2020年6月.用Review manager 5.3软件进行统计分析.结...     

穴位注射联合神经生长因子治疗特发性面神经麻痹的系统评价

目的:系统评价特发性面神经麻痹应用穴位注射联合神经生长因子治疗的效果.方法:全面查找和收集特发性面神经麻痹应用穴位注射联合神经生长因子治疗相关的文献资料,并对相关文献行Meta分析.结果:通过数据库检索获得572篇的文献,检索、筛选排除不符合要求的文献,最后纳入文献研究共12篇;12篇文献研究结论均表明特发性面神经麻痹...     

心脏科学文献检索与获取

本文阐述如何准确地检索并获取心脏科学文献，论述了如下几个主题的内容:以中国生物医学文献数据库（CBMdisc）为代表的中文生物医学文摘型数据库，是检索中文文献的首选数据库；美国国立医学图书馆的在线生物医学文献分析与检索系统（MEDLINE）是检索外文文献的首选数据库；获取原文除检索全文数据库外，还可通过资源共享、开放获取等途径；生物信息的检索是新型检索；综合性跨库检索给用户提供了很大的方便。     

血清降钙素原指导AECOPD患者抗菌治疗疗效及预后的meta分析

目的:系统评价血清降钙素原(PCT)在指导慢性阻塞性肺疾病急性加重(AECOPD)患者抗菌治疗的临床意义。方法:通过计算机检索Cochrane、Pubmed、Embase、万方、中国学术期刊全文数据库以及维普中英文数据库,并手工检索有关文献,查阅与监测PCT指导AECOPD患者抗菌治疗相关的国内外文献,检索时限从数据库...     

汉族人群醛固酮合成酶CYP11B2基因多态性位点(rs1799998)与原发性高血压相关性研究的Meta分析

目的:评价醛固酮合酶CYP11B2基因多态性位点rs1799998与原发性高血压(EH)的关系。方法:检索PubMed、EmBase、中国期刊全文数据库、中国生物医学文献数据库、维普中文期刊数据库及万方数据库。检索时间范围至2013年11月之前的所有文献。采用RevMan和R软件进行定量分析、计算汇总OR值、发表偏移、敏感性分析及累计Meta分析等。结果:分别检索到研究我国汉族人群CYP11B2基因rs1799998位点与EH相关性的文献42篇,按入选/排除标准筛选后共有17篇合格文献入选,涉及5 835例EH患者,5278例健康对照者。结论:未发现CYP11B2基因rs1799998位点与EH在中国汉族人群中具有明显相关性。     

国产恩替卡韦对慢性乙型肝炎抗病毒治疗的Meta分析

目的:评价国产恩替卡韦(entecavir,ETV)对慢性乙型肝炎(chronic hepatitis B,CHB)抗病毒治疗的疗效和安全性.方法:检索Medline、PubMed及中国期刊全文数据库,中国生物医学文献数据库等中外文数据库临床对照试验,检索年限从建库检索到2014-02,并辅以文献追溯、手工检索等方法收集查阅文献.凡评价国产ETV治疗CHB的临床随机对照研究,无论语种均纳入,采用χ2检验分析研究间的异质性,以相对危险度为疗效分析统计量进行合并研究,对疗程进行亚组分析,并绘制森林图.结果:共纳入临床随机对照试验6个,包括587个患者,试验组312例,对照组275例.国产ETV组与博路定组比较,2组的谷丙转氨酶(alanineaminotransferase,ALT)复常率、血清HBeAg阴转率、乙型肝炎病毒(hepatitis B virus,HBV)DNA阴转率及不良反应发生率的差异均无统计学意义(均P>0.1).结论:国产ETV在促使ALT回复正常水平、血清HBeAg阴转率、降低患者血清HBV DNA载量及不良反应发生方面与博路定两者相当,是安全、有效的.有必要展开更多高质量的临床随机对照研究,进一步明确其疗效.     

艾曲波帕联合用药治疗成人原发免疫性血小板减少症的有效性及安全性系统评价

目的:系统评价艾曲波帕联合用药治疗成人原发免疫性血小板减少症(ITP)的有效性与安全性.方法:检索Medline,PubMed,Cochrane图书馆、Embase、知网期刊数据库、万方数据库,纳入以艾曲波帕联合其他药物为干预措施治疗成人ITP的文献,检索时间从建库至2020年12月,利用SPSS 25.0软件进行数据...     

红霉素在急性上消化道出血紧急内镜检查中应用的系统评价

目的:系统评价红霉素在急性上消化道出血紧急内镜检查中应用的有效性和安全性.方法:计算机检索Cochrane图书馆临床对照试验,Medline、PubMed及中国期刊全文数据库等中外文数据库.手工检索消化病学周会和美国胃肠病学学会会议论文集:查阅检索到所有文献的参考文献索引,手工检索文献.凡评价急性上消化道出血紧急内镜检查中红霉素应用的随机对照试验,无论语种、是否采用盲法均纳入,应用国际Cochrane协作网系统评价方法对其进行Meta分析.结果:共纳入3个试验包括245例患者.红霉素组与安慰剂组比较,2组在胃排空和需要二次内镜检查方面的差异有统计学意义(OR=5.10,95%CI:1.96-13.27,P=0.0008;OR=0.48,95%CI:0.27-0.88,P=0.021:内镜检查时间、输血量及住院时间的平均值差异无统计学意义(P=0.84、0.07及0.36);3篇试验均无不良反应的报道.结论:急性上消化道出血紧急内镜检查中应用红霉素,在改善内镜视野上是安全有效的     

Efficacy and Safety of Oral Anticoagulants in Patients With Atrial Fibrillation and Stages 4 or 5 Chronic Kidney Disease

PurposeThe aim of this study was to investigate whether oral anticoagulants can provide efficacy and safety profiles better than no anticoagulant in patients with stages 4 or 5 chronic kidney disease and atrial fibrillation.MethodsFrom 2001 to 2017, a cohort of patients with stages 4 or 5 chronic kidney disease and atrial fibrillation based on electronic medical records were selected from Chang Gung Memorial Hospital system in Taiwan. Patients were divided into nonvitamin K antagonist oral anticoagulants (NOACs), warfarin, and nonanticoagulated groups. They were followed from the index date to the occurrence of the study outcomes or for 5 years, whichever occurred first. The outcomes were admissions due to ischemic stroke or systemic embolism or major bleedings. Survival analyses were conducted to estimate the incidence rates of outcomes.ResultsA total of 3771 patients with atrial fibrillation and estimated glomerular filtration rate less than 30 mL/min/1.73m² were enrolled, of whom 2971 were in the nonanticoagulated group, 280 in the NOAC group, and 520 in the warfarin group. About 25% of all subjects (940 patients) were on dialysis. The mean follow-up was 3.2 years. After adjusting for sex, age, comorbidities, and comedication, the warfarin group had a significantly higher risk of ischemic stroke or systemic embolism (adjusted hazard ratio [aHR] 3.1, 95% confidence interval [CI] 2.1-4.6) than the nonanticoagulated group. The NOAC group had a similar risk of ischemic stroke or systemic embolism (aHR 1.1; 95% CI 0.3-3.4) to that of the nonanticoagulated group. Both the warfarin and the NOAC groups had a significantly higher major bleeding risk than the noncoagulated group (aHR 2.8 [95% CI 2.0-3.8] for warfarin; aHR 3.1 [95% CI 1.9-5.2] for NOAC).ConclusionThe use of NOACs or warfarin is not more effective than using no anticoagulants at all in reducing the risk of ischemic stroke or systemic embolism. Both NOACs and warfarin are associated with increased risk of major bleeding. Our results do not support the use of anticoagulants in patients with atrial fibrillation and stages 4-5 chronic kidney disease.     

Non-Vitamin K Antagonists Versus Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Valves: A Systematic Review and Meta-Analysis

BackgroundPatients with atrial fibrillation and bioprosthetic valves are at high risk for thromboembolic events. The pooled efficacy and safety of non-vitamin K oral anticoagulants (NOACs), as a class, relative to warfarin in this population is not well-known. We aimed to compare the efficacy and safety of NOACs relative to warfarin in patients with bioprosthetic valves or valve repair.MethodsWe systematically searched EMBASE, PubMed, and Cochrane databases for randomized controlled trials comparing NOACs to warfarin in patients with atrial fibrillation and bioprosthetic valves or valve repair. We pooled outcomes for stroke or systemic embolism, ischemic stroke, hemorrhagic stroke, and major bleeding.ResultsWe included 4 trials with 1379 patients, of whom 723 (52.4%) received a NOAC. Mean follow-up ranged from 90 days to 2.8 years. In the pooled analysis, stroke or systemic embolism was significantly lower in patients treated with NOACs (1.9%) compared with warfarin (3.7%) (odds ratio [OR] 0.43; 95% confidence interval [CI] 0.22-0.85; P = .02). Ischemic stroke (OR 0.72; 95% CI 0.18-2.93), hemorrhagic stroke (OR 0.18; 95% CI 0.03-1.05), cardiovascular death (OR 0.78; 95% CI 0.38-1.62), and all-cause mortality (OR 0.94; 95% CI 0.55-1.62) were not significantly different among groups. Major bleeding was significantly lower in patients treated with NOAC (2.8%) compared with warfarin (4.7%) (OR 0.49; 95% CI 0.28-0.88; P = .02).ConclusionsIn patients with atrial fibrillation and bioprosthetic valves or valve repair, NOACs are associated with a reduced incidence of thromboembolic events and major bleeding as compared with warfarin. Thus, NOACs may be considered a preferred option for this patient population.     

达比加群酯对非瓣膜性房颤导管消融围术期抗凝疗效和安全性的 Meta 分析

目的：系统评价达比加群酯对非瓣膜性房颤导管消融围术期的抗凝疗效和安全性。方法计算机检索 PubMed、EMbase、The Cochrane Library（2016年第2期）、CMB、知网、万方和维普数据库,搜集有关房颤导管消融围术期使用达比加群酯和华法林抗凝治疗的随机对照及非随机对照的研究文献,由两位评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用 RevMan 5．3软件进行 Meta 分析。结果最终纳入23个研究、共7673例患者。Meta 分析结果显示：达比加群酯组脑卒中或短暂性脑缺血发生率与华法林组无明显区别[OR ＝1．0,95％CI：0．60～1．68,P ＝0．99],大出血事件发生率无明显区别[OR ＝0．79,95％CI：0．52～1．19, P ＝0．25],小出血事件发生率显著降低[OR ＝0．71,95％CI：0．57～0．87,P ＝0．001]。结论达比加群酯在房颤导管消融围术期抗凝疗效及大出血并发症的发生率上与华法林无明显区别,小出血并发症的发生率较华法林降低。     

Effectiveness and Safety of Anticoagulants in Adults with Non-valvular Atrial Fibrillation and Concomitant Coronary/Peripheral Artery Disease

Background

Direct oral anticoagulants (DOAC) are at least non-inferior to warfarin in efficacy and safety among patients with nonvalvular atrial fibrillation. Limited evidence is available regarding outcomes for nonvalvular atrial fibrillation patients with coronary/peripheral artery disease.

华法林对中国人心房颤动患者抗栓的安全性和有效性研究

目的　通过回顾性分析心房颤动 (房颤 )患者的抗栓治疗 ,初步探讨中国人华法林国际标准化率 (INR)的合理范围。方法　调查 4 35例房颤患者应用华法林抗凝及INR监测情况 ,分析出血和血栓栓塞事件的危险因素及与INR的关系。结果　华法林疗程时间中位数 7个月 ,平均剂量为(2 77± 0 83)mg。共发生出血事件 31例 (7 11% ) ,其中严重出血 5例 ,轻微出血 2 6例。发生出血患者年龄略高于对照组 [(6 5 1± 10 0 )岁与 (6 2 0± 12 2岁 ) ],但差异无统计学意义 (P =0 2 5 9) ;出血患者血压高于对照组 ,合并心力衰竭较多 (P =0 0 5 )。多因素分析中INR≥ 3为预测出血的独立危险因素 (OR =3 74 )。血栓栓塞事件 37(17 4 7% )例 ,发生缺血性卒中或栓塞的危险随INR下降明显增加。结论　房颤患者华法林抗凝目标INR值应避免低于 1 5或高于 3 0。     

Which Oral Anticoagulant for Which Atrial Fibrillation Patient: Recent Clinical Trials and Evidence-Based Choices

Current practice guidelines recommend oral anticoagulant therapy for most patients with nonvalvular atrial fibrillation with more than a low risk of stroke. Although warfarin is very effective and the risk of major bleeding is acceptable, the use of the drug is challenging for patients and physicians. The 3 novel oral anticoagulants (NOACs), dabigatran, rivaroxaban, and apixaban, have been shown to be either noninferior or superior to warfarin for the prevention of stroke and/or systemic embolism and their rates of major bleeding are no greater than warfarin. They are much easier for patients to use and for physicians to manage. Except for certain situations in which the NOACs have not been evaluated or some feature of warfarin is preferable, clinical guidelines generally recommend a preference for a NOAC over warfarin when oral anticoagulation is indicated. Although the NOACs have many similarities in their advantageous pharmacokinetic and pharmacodynamic characteristics, there are a number of difference between them with regard to particular patient characteristics (eg, age ≥ 75 years, renal dysfunction, coronary artery disease, venous thromboembolism, risk of bleeding, prior stroke and/or transient ischemic attack, side effects, dose regimens, and cost-effectiveness). These differences are outlined and discussed in terms of their potential relevance in deciding among the 3 available NOACs for stroke prevention in atrial fibrillation.     

利伐沙班用于非瓣膜性心房颤动伴肾功能不全患者的效果与安全性

目的 探讨利伐沙班用于非瓣膜性心房颤动（NVAF）伴肾功能不全患者的效果与安全性。 方法 选择2017年1月～2018年6月于复旦大学附属中山医院青浦分院就诊的非瓣膜性房颤伴肾功能不全患者297例为研究对象,采用随机数字表法分为华法林组（n = 148）和利伐沙班组（n = 149）;华法林组患者给予华法林治疗,利伐沙班组患者给予利伐沙班进行治疗。分析比较两组患者肾功能指标,生存情况,疗效终点事件发生率及安全性终点事件发生率。 结果 治疗前,两组患者的血肌酐和肌酐清除率的差异无统计学意义;治疗后,两组的血肌酐均显著高于治疗前,且华法林组的血肌酐高于利伐沙班组;肌酐清除率均低于治疗前,且华法林组的肌酐清除率低于利伐沙班组（均P<0.05）;华法林组的中位总生存期（OS）为20个月,利伐沙班组的中位OS为20个月,利伐沙班组的死亡风险与华法林组无显著差异（HR = 0.940,95%CI:0.714～1.237）;华法林组和利伐沙班组在主要终点事件发生方面的差异无统计学意义（HR:0.650;95%CI:0.183～2.303;）;华法林组和利伐沙班组在主要安全事件发生方面的差异无统计学意义（HR:0.922;CI:0.581～1.464）。 结论 非瓣膜性房颤伴肾功能不全患者抗凝治疗中,口服利伐沙班比华法林在延缓肾功能进展方面更为有效,但其在预后生存情况,预防脑卒中、全身性栓塞及出血事件发生方面无显著差异。     

Comparative Stroke,Bleeding, and Mortality Risks in Older Medicare Patients Treated with Oral Anticoagulants for Nonvalvular Atrial Fibrillation

BackgroundNonvitamin K antagonist oral anticoagulants (NOACs) are alternatives to warfarin in patients with nonvalvular atrial fibrillation. Randomized trials compared NOACs with warfarin, but none have compared individual NOACs against each other for safety and effectiveness.MethodsWe performed a retrospective new-user cohort study of patients with nonvalvular atrial fibrillation enrolled in US Medicare who initiated warfarin (n = 183,318), or a standard dose of dabigatran (150 mg twice daily; n = 86,198), rivaroxaban (20 mg once daily; n = 106,389), or apixaban (5 mg twice daily; n = 73,039) between October 2010 and September 2015. Propensity score-adjusted Cox proportional hazards regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the outcomes of thromboembolic stroke, intracranial hemorrhage, major extracranial bleeding, and all-cause mortality, comparing each NOAC with warfarin, and with each other NOAC.ResultsCompared with warfarin, each NOAC was associated with reduced risks of thromboembolic stroke (20%-29% reduction; P = .002 [dabigatran], P < 0.001 [rivaroxaban, apixaban]), intracranial hemorrhage (35%-62% reduction; P < 0.001 [each NOAC]), and mortality (19%-34% reduction; P < .001 [each NOAC]). The NOACs were similar for thromboembolic stroke but rivaroxaban was associated with increased risks of intracranial hemorrhage (vs dabigatran: HR = 1.71; 95% CI, 1.35-2.17), major extracranial bleeding (vs dabigatran: HR = 1.32; 95% CI, 1.21-1.45; vs apixaban: HR = 2.70; 95% CI, 2.38-3.05), and death (vs dabigatran: HR = 1.12; 95% CI, 1.01-1.24; vs apixaban: HR = 1.23; 95% CI, 1.09-1.38). Dabigatran was associated with reduced risk of intracranial hemorrhage (HR = 0.70; 95% CI ,0.53-0.94) and increased risk of major extracranial bleeding (HR = 2.04; 95% CI, 1.78-2.32) compared with apixaban.ConclusionsAmong patients treated with standard-dose NOAC for nonvalvular atrial fibrillation and warfarin users with similar baseline characteristics, dabigatran, rivaroxaban, and apixaban were associated with a more favorable benefit–harm profile than warfarin. Among NOAC users, dabigatran and apixaban were associated with a more favorable benefit–harm profile than rivaroxaban.     

华法林与阿司匹林预防非瓣膜性心房颤动患者血栓栓塞的随机对照研究

目的通过前瞻性、随机、多中心研究比较阿司匹林与调整剂量华法林预防非瓣膜性心房颤动(房颤)患者发生血栓栓塞的有效性和安全性。方法在18个中心,根据入选标准将非瓣膜性房颤患者随机分配至阿司匹林组(150~160mg/d)和调整剂量华法林组(初始剂量2mg/d),目标国际标准化比值(INR)为2·0~3·0(年龄≥75岁者的INR为1·6~2·5)。常规门诊随访,调整华法林剂量并记录两组患者的终点事件和不良反应发生情况。主要终点事件为缺血性脑卒中和死亡,次要终点事件包括短暂性脑缺血发作、腔隙性脑梗死、外周动脉栓塞、急性心肌梗死和严重出血。结果共704例患者进入分析,阿司匹林组369例,华法林组335例。男性420例(59·7%),平均年龄(63·3±9·9)岁,两组患者基线特征(包括合并疾病和伴随用药)差异无统计学意义。随访时间中位数19个月(2~24个月)。与阿司匹林比较,调整剂量华法林明显降低主要终点事件发生率[2·7%比6·0%,P=0·03,OR0·44,95%可信区间(CI)为0·198~0·960],相对危险下降54%;缺血性脑卒中的相对危险下降62%(1·8%比4·6%,P=0·04,OR0·38,95%CI为0·147~0·977);总血栓栓塞事件相对危险下降52%(10·6%比5·4%,P=0·01,OR0·48,95%CI为0·269~0·858)。次要终点事件两组间差异无统计学意义。华法林组轻微出血和严重出血发生率均高于阿司匹林组(P<0·05)。华法林组总死亡率低于阿司匹林组[4例(1·2%)比8例(2·2%)],但差异无统计学意义(P>0·05);包括主要和次要终点的联合终点事件华法林组低于阿司匹林组(8·4%比13·0%,P=0·047)。结论与阿司匹林相比,华法林可明显降低国人非瓣膜性房颤患者脑卒中的发生率,华法林组出血的发生率高于阿司匹林组,但多数出血并发症发生在INR>3·0。严密监测(INR2·0~3·0)下的调整剂量华法林安全有效。