白细胞介素抑制剂与肿瘤坏死因子-α抑制剂治疗银屑病的有效性及安全性比较的Meta分析

银屑病是一种慢性、复发性、炎症性、系统性疾病,斑块状银屑病是其常见的类型。目前认为辅助性T细胞与白细胞介素(interleukin,IL)-23/IL-17轴是其发病的关键免疫学机制[1]。目前,治疗银屑病的生物制剂主要分为两大类,一类是肿瘤坏死因子(tumor necrosis factor,TNF)-α抑制剂,主要包括依那西普、阿达木单抗、英夫利西单抗和培塞利珠单抗;另一类是IL抑制剂,主要包括IL-12/23抑制剂(乌司奴单抗).

抗白细胞介素-5单克隆抗体治疗哮喘效果的Meta分析

目的:系统评价抗白细胞介素-5(IL-5)单克隆抗体治疗哮喘的临床效果。方法:在PubMed、Embase和Cochrane对照试验中央注册中心检索有关抗IL-5单克隆抗体治疗哮喘的随机对照试验文献,检索时间为截至2024年3月,对数据采用CMA 2.0软件进行Meta分析。结果:纳入21篇文献,共8717例患者,试验组4593例,对照组4124例。Meta分析结果显示,在第1秒用力呼气容积(FEV1)、哮喘生活质量问卷评分、不良事件发生情况方面,试验组优于对照组。结论:抗IL-5单克隆抗体治疗哮喘的临床效果较好,可改善患者FEV1、生活质量,且安全性较高。

扶正化瘀散结法联合西药治疗厌食-恶病质综合征有效性的Meta分析

目的系统评价扶正化瘀散结法联合西药治疗厌食-恶病质综合征的有效性。方法系统检索维普(VIP)、中国知网(CNKI)、万方数据知识服务平台(Wan Fang)、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Embase数据库、Cochrane Library数据库,利用Jadad、Cochrane协作网RCT质量评价标准对纳入文献的研究质量进行评价,Meta分析提取数据。结果1)共纳入17个随机对照研究(RCT),患者1423例,纳入研究质量一般;2)Meta分析合并RR值包括体重变化[RR=1.36,95%CI(1.08,1.71),P=0.009]、KPS评分变化[RR=1.44,95%CI(1.29,1.60),P<0.00001]、进食量变化[RR=1.33,95%CI(1.15,1.55),P=0.0002]、白蛋白变化[MD=3.01,95%CI(2.10,3.93),P<0.00001]以及血红蛋白变化[MD=10.74,95%CI(1.91,19.58),P=0.02]。结论本研究证实扶正化瘀散结法在厌食-恶病质综合征应用的有效性优于单纯西药治疗或结合营养支持治疗。

Protein induced by vitamin K absence or antagonist-Ⅱ versus alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: A systematic review with meta-analysis

Background: As a promising biomarker of hepatocellular carcinoma(HCC), protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) has been studied extensively. However, its diagnostic capability varies across HCC studies. This study aimed to compare the performance of PIVKA-Ⅱ with alpha-fetoprotein(AFP) in the diagnosis of HCC. Data sources: A systematic literature search was conducted to identify the studies from MEDLINE, Embase and Cochrane Library Databases, which were published up to December 20, 2017 to compare the diagnostic capability of PIVKA-Ⅱ and AFP for HCC. The data were pooled using random effects model. Pooled sensitivity and specificity were calculated. Summary receiver operating characteristic curve(ROC) was employed to evaluate the diagnostic accuracy of each marker. Results: Thirty-one studies were included. The pooled sensitivity(95% CI) of PIVKA-Ⅱ and AFP was 0.66(0.65–0.68) and 0.66(0.65–0.67), respectively in diagnosis of HCC; and the corresponding pooled specificity(95% CI) was 0.89(0.88–0.90) and 0.84(0.83–0.85), respectively. The area under the ROC curve(AUC) of PIVKA-Ⅱ and AFP was 0.856(0.817–0.895) and 0.770(0.728–0.811), respectively. Subgroup analysis showed that PIVKA-Ⅱ was superior to AFP in terms of the AUC for both small HCC( < 3 cm) [0.863(0.825–0.901) vs 0.717(0.658–0.776)] and large HCC( ≥ 3 cm) [0.854(0.811–0.897) vs 0.729(0.682–0.776)]; for American [0.926(0.897–0.955) vs 0.698(0.594–0.662)], European [0.772(0.743–0.801) vs 0.628(0.594–0.662)], Asian [0.838(0.812–0.864) vs 0.785(0.764–0.806)] and African [0.812(0.794–0.840) vs 0.721(0.675–0.767)] HCC patients; and for HBV-related [0.909(0.866–0.951) vs 0.714(0.673–0.755)] and mixed-etiology [0.847(0.821–0.873) vs 0.794(0.772–0.816)] HCC. Conclusion: This meta-analysis indicates that PIVKA-Ⅱ is better than AFP in terms of the accuracy for diagnosing HCC, regardless of tumor size, patient ethnic group, or HCC etiology.

Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease:A meta-analysis

AIM:To compare the results of transvaginal cholecystectomy(TVC) and conventional laparoscopic cholecystectomy(CLC) for gallbladder disease.METHODS:We performed a literature search of Pub Med,EMBASE,Ovid,Web of Science,Cochrane Library,Google Scholar,Meta Register of Controlled Trials,Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC.Data were extracted by two authors.Mean difference (MD), standardized mean difference(SMD),odds ratios and risk rate with 95%CIs were calculated using fixed- or random-effects models.Statistical heterogeneity was evaluated with the χ2 test.The fixed-effects model was used in the absence of statistically significant heterogeneity.The randomeffects model was chosen when heterogeneity was found.RESULTS:There were 730 patients in nine controlled clinical trials.No significant difference was found regarding demographic characteristics(P > 0.5),including anesthetic risk score,age,body mass index,and abdominal surgical history between the TVC and CLC groups.Both groups had similar mortality,morbidity,and return to work after surgery.Patients in the TVC group had a lower pain score on postoperative day 1(SMD:-0.957,95%CI:-1.488 to-0.426,P < 0.001),needed less postoperative analgesic medication(SMD:-0.574,95%CI:-0.807 to-0.341,P < 0.001) and stayed for a shorter time in hospital(MD:-1.004 d,95%CI:-1.779 to 0.228,P = 0.011),but had longer operative time(MD:17.307 min,95%CI:6.789 to 27.826,P = 0.001).TVC had no significant influence on postoperative sexual function and quality of life.Better cosmetic results and satisfaction were achieved in the TVC group.CONCLUSION:TVC is safe and effective for gallbladder disease.However,vaginal injury might occur,and further trials are needed to compare TVC with CLC.

Effect of Na Fe EDTA-Fortified Soy Sauce on Anemia Prevalence in China: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective To assess the effect of sodium iron ethylenediaminetetraacetate （NaFeEDTA）-fortified soy sauce on anemia prevalence in the Chinese population. Methods A systematic review was performed to identify potential studies by searching the electronic databases of PubMed, Cochrane Library, WHO Library, HighWire, CNKI, and other sources. The selection criteria included randomized controlled trials that compared the efficacy of NaFeEDTA-fortified soy sauce with that of non-fortified soy sauce. Anemia rates and hemoglobin levels were the outcomes of interest. Inclusion decisions, quality assessment, and data extraction were performed by two reviewers independently. A total of 16 studies met the inclusion criteria for anemia rate analysis, of which 12 studies met the inclusion criteria for hemoglobin analysis. All included studies assessed the effect of NaFeEDTA-fortified soy sauce on anemia rates and hemoglobin concentrations. Results After the intervention, the hemoglobin concentration increased and anemia rates decreased significantly as compared with the non-fortified soy sauce groups. For anemia rates, data from 16 studies could be pooled, and the pooled estimate odds ratio was 0.25 （95% CI 0.19-0.35）. For hemoglobin concentrations, data from 12 studies could be pooled, and the pooled weighted mean difference was 8.81 g/L （95% CI 5.96-11.67）. Conclusion NaFeEDTA-fortified soy sauce has a positive effect on anemia control and prevention in the at-risk population.

伤科接骨片治疗骨折临床效果的Meta分析及其“病-症-方”关联功效机制

目的系统评价伤科接骨片干预骨折的临床疗效,并从“病-症-方”关联角度,探索该中成药品种的作用机制及其各功效组的配伍特点。方法首先检索中文数据库(中国知网、万方数据库、维普数据库)和英文数据库(PubMed、Cochrane Library、EMbase)自建库至2024年1月伤科接骨片干预骨折的临床研究文献,应用风险评价工具对文献研究内容进行质量评价,提取数据并采用Stata 16.0版软件进行分析。利用中医药整合药理学研究平台(TCMIP v2.0)获得骨折临床症状表型相关基因集,再利用GEO数据库获得临床骨折相关的差异表达基因集。同时,从TCMIP v2.0收集伤科接骨片所含化学成分及其候选靶标谱。构建“骨折相关基因-伤科接骨片候选靶标”互作网络,通过计算网络拓扑特征值,筛选核心网络靶标,并通过功能富集分析,解析该中成药品种各功效组的作用机制。结果Meta分析共纳入14篇文献,样本量共计1293例,提示伤科接骨片对骨折的总有效率(RR=1.24,95%CI:1.18~1.31,P<0.001);“病-症-方”关联网络分析结果显示,伤科接骨片候选靶标所参与的通路主要分布于骨损伤的愈合、神经、血液系统调节和“免疫-炎症”调节等功能模块,且方药中不同功效组的作用特点各有侧重。结论伤科接骨片具有良好的促进骨折愈合疗效,并可通过调节血液循环系统和神经系统、矫正“免疫-炎症”失衡、维持骨和能量代谢稳态而发挥其活血化瘀、消肿止痛、续筋接骨、清热解毒的综合功效。相关研究结果为明确伤科接骨片的优势疗效环节和临床定位奠定基础。

肿瘤坏死因子-α、超敏C反应蛋白与突发性耳聋关系的Meta分析

目的利用Meta分析方法分析肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)、超敏C反应蛋白(high sensitivity c-reactive protein,hs-CRP)与突发性耳聋(sudden sensorineural hearing loss,SSNHL)的关系。方法用计算机检索中国知网、万方数据、维普网、CBM、PubMed、Embase、Cochrane library、Web of Science等中英文数据库,搜集有关TNF-α、hs-CRP与SSNHL相关研究,时间范围为建库起至2022年4月。由2位独立评价者筛选文献、提取资料,采用RevMan5.3软件、Stata软件对符合质量标准的研究进行Meta分析。结果纳入16篇文献研究,SSNHL患者血清TNF-α、hs-CRP浓度均高于对照组,差异均有统计学意义(P<0.05)。结论SSNHL患者血清TNF-α、hs-CRP升高,对疾病诊疗有一定临床指导价值。

超声卵巢-附件影像报告和数据系统鉴别诊断卵巢肿瘤良恶性的Meta分析

目的 系统评价超声卵巢-附件影像报告和数据系统(O-RADS)鉴别诊断卵巢肿瘤良恶性的临床价值。方法 计算机检索Cochrane Library、Embase、Web of Science及Pubmed数据库,搜索O-RADS鉴别诊断卵巢肿瘤良恶性的相关文献,检索时间均为建库至2023年9月19日。由3名研究者独立筛查文献、提取资料,然后利用QUADAS-2量表对纳入文献质量进行评价;应用Stata 17.0、Meta-Disc 1.4及RevMan 5.3软件进行Meta分析。结果 最终纳入18篇文献,包括10 944例患者,共计11 189个肿瘤。Meta分析结果显示,O-RADS鉴别诊断卵巢肿瘤良恶性的合并灵敏度、特异度、阳性似然比、阴性似然比、诊断得分及诊断比值比分别为0.95[95%可信区间(CI):0.93~0.98]、0.79(95%CI:0.73~0.84)、4.59(95%CI:3.57~5.89)、0.05(95%CI:0.03~0.09)、4.52(95%CI:3.91~5.13)及91.79(95%CI:49.79~169.27);综合受试者工作特征曲线分析显示,O-RADS鉴别诊断卵巢肿瘤良恶性的曲线下面积为0.94(95%CI:0.92~0.96)。结论 O-RADS在鉴别诊断卵巢肿瘤良恶性方面具有较好的临床应用价值。

钠—葡萄糖协同转运蛋白-2抑制剂治疗2型糖尿病有效性和安全性的Meta分析

目的系统评价钠—葡萄糖协同转运蛋白-2抑制剂(SGLT2i)治疗2型糖尿病的有效性和安全性。方法计算机检索PubMed、Cochrane Library、Embase、Web of Science及中国知网、万方数据知识服务平台上公开发表的SGLT2i治疗2型糖尿病患者有效性及安全性的随机对照试验(RCTs),文献检索时限从建库至2022年5月1日。对照组给予安慰剂治疗,试验组给予SGLT2i治疗。根据Cochrane偏倚风险评价工具对纳入文献进行质量评价,采用RevMan 5.3软件和Stata软件进行Meta分析。结果最终纳入5篇文献,共包含40205例患者,文献整体质量较高。Meta分析结果显示,与对照组相比,试验组心血管死亡或首次心力衰竭住院风险[HR=0.75,95%CI(0.61,0.92),P=0.005]、首次心力衰竭住院风险[HR=0.70,95%CI(0.60,0.82),P<0.001]显著降低,但2组心血管死亡风险[HR=0.99,95%CI(0.84,1.16),P=0.86]、全因死亡风险[HR=0.92,95%CI(0.83,1.01),P=0.09]、严重不良反应发生率[HR=1.01,95%CI(0.93,1.09),P=0.84]、急性损伤发生率[HR=0.84,95%CI(0.63,1.12),P=0.24]比较差异无统计学意义。Egger检验结果显示,报道心血管死亡或首次心力衰竭住院风险、首次心力衰竭住院风险的文献无明显发表偏倚(P值分别为0.22、0.37)。结论基于现有证据表明,SGLT2i可降低2型糖尿病患者心血管死亡或首次心力衰竭住院综合风险和首次心力衰竭住院风险,且无严重不良反应和急性肾损伤发生。

Clinical trials comparing norepinephrine with vasopressin in patients with septic shock:A meta-analysis

Background: To compare the mortality rates and benefits of norepinephrine and vasopressin in patients with septic shock. Methods: PubMed, EMBASE, and the Cochrane Library database were searched from database inception to December 2013. We selected randomized controlled trials in adults with septic shock and compared norepinephrine with vasopressin. After assessing the heterogeneity of treatment effects across trials using the I2 statistic, we used a fixed effects model(P≥0.1) and expressed the results as risk ratios(RRs) for dichotomous outcomes or as standardized mean differences(SMDs) for continuous data with 95% confidence intervals(CIs). Meta-analysis was conducted using Review Manager 5.1 software.Results: Seven trials(n=2323) met the inclusion criteria. Overall, the mortality rate in these seven trials was 36.2%(840/2323). There was no difference in mortality following the use of norepinephrine or vasopressin(RR 1.07; 95%CI 0.97-1.20; P=0.19). Compared to norepinephrine, vasopressin had no significant effect on heart rate(HR)(SMD 0.21; 95%CI-0.08-0.50; P=0.15), mean arterial pressure(MAP)(SMD 0.15; 95%CI-0.15-0.44; P=0.33), cardiac index(CI)(SMD-0.10; 95%CI-0.64-0.44; P=0.73), systemic vascular resistance index(SVRI)(SMD 0.15; 95%CI-0.39-0.70; P=0.58), oxygen delivery(DO2)(SMD-0.06; 95%CI-0.62-0.49; P=0.82), oxygen consumption(VO2)(SMD 0.03; 95%CI-0.52-0.59; P=0.91) or lactic acid(SMD 0.07; 95%CI-0.23-0.36; P=0.66). No significant heterogeneity was found in these comparisons(P≥0.1).Conclusions: There is not sufficient evidence to prove conclusively that norepinephrine is superior to vasopressin in terms of mortality and hemodynamics. The effects of norepinephrine and vasopressin on patients with septic shock require further study in large randomized controlled trials.

Shenqi Fuzheng injection combined with GP chemotherapy in the treatment of advanced non-small cell lung cancer： a meta-analysis

Objective： To evaluate the clinical efficacy of Shenqi Fuzheng injection combined with gemcitabine plus cisplatin（GP） in the treatment of advanced non-small cell lung cancer （NSCLC）. Methods： we performed a systematicsearch in the electronic databases such as Cochrane Library, Pubmed, Embase, Chinese Journal Full-text Database,Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Full-text Database andWanfang Database up to 30 January 2017. Randomized controlled trials （RCT） of Shenqi Fuzheng Injectioncombined with GP chemotherapy in the treatment of advanced NSCLC were searched, and all the RCTs wereconducted on methodological quality assessment. Data extraction and data analysis were according to standards ofCochrane systematic review. Results： Eight trials were included including a total of 701 patients. Meta-analysisresults： Shenqi Fuzheng injection combined with GP chemotherapy could significantly improve the functionalstatus of patients with NSCLC （OR = 3.44, 95% CI [2.26, 5.25], P 〈 0.0001） and clinical treatment efficacy （OR =（OR = 0.31, 95%CI [0.20, 0.47], P 〈 0.0001. The rate of leukopenia （OR = .31, 95%CI [0.20,0.47], P 〈 0.0001）,thrombocytopenia （OR = 0.58, 95%CI [0.37, 0.91], P = 0.020）, hemoglobin decline （（OR = 0.31, 95%CI [0.16,0.59], P = 0.0004） and incidence of gastrointestinal reactions （OR = 0.58,P 〈 0.05） could be reduced. Conclusion：Shenqi Fuzheng injection combined with GP chemotherapy in the treatment of advanced NSCLC obtainedsignificantly clinical efficacy. The quality of the literature incorporated is low, the conclusion requires high-qualityresearch to further prove.

γ-干扰素诱导蛋白10鉴别结核分枝杆菌不同感染状态效能的Meta分析

目的:评价γ-干扰素诱导蛋白10(IP-10)鉴别结核分枝杆菌不同感染状态的诊断效能.方法:检索Cochrane Library、PubMed、Web of Science、中国知网、维普、万方等数据库,检索自建库至2023年1月的相关文献,进行数据提取和质量评价,采用RevMan 5.3和Stata 17.0软件进行统计分析.结果:共纳入75篇文献,96项研究,共11116例患者.Meta分析结果为IP-10用于鉴别结核感染和非结核感染的合并敏感度为0.82(95%CI:0.79~0.84),特异度为0.87(95%CI:0.84~0.90),阳性似然比为6.40(95%CI:5.20~8.00),阴性似然比为0.21(95%CI:0.18~0.24),诊断比数比为31(95%CI:23~420),受试者工作曲线的曲线下面积为0.91(95%CI:0.88~0.93).结论:IP-10有助于鉴别结核不同感染状态,但最终确诊需要结合病史、症状等进行综合诊断.

基于网络Meta分析对比不同钠-葡萄糖协同转运蛋白2抑制剂对慢性心力衰竭患者预后的影响

目的运用贝叶斯网状Meta分析对比不同钠-葡萄糖协同转运蛋白2抑制剂(sodium-glucose cotransporter 2 inhibitor,SGLT2i)对慢性心力衰竭患者预后的影响。方法利用计算机全面检索CNKI、CBM、Wanfang、VIP、Pubmed、Web of Science、Embase、Cochrane Library。检索时间从建库至2022年12月1日。收集SGLT2i治疗心力衰竭的临床随机对照试验。由3名研究者独立进行筛选、提取数据。依据Cochrane系统评价手册进行偏倚风险评价。以RevMan 5.4软件进行异质性检验及直接Meta分析,ADDIS 1.16.6软件进行网状Meta分析。结果共纳入9项随机对照研究,包含3种不同的SGLT2i,共涉及23285例患者。与安慰剂相比,3种SGLT2i均能降低心血管死亡/心力衰竭住院复合终点的发生率,从优到劣排序为索格列净>达格列净>恩格列净>安慰剂。与安慰剂相比,3种SGLT2i中仅达格列净能降低心血管死亡或全因死亡发生率。3种SGLT2i与安慰剂在降低低血糖事件发生率方面差异无统计学意义。结论SGLT2i能降低慢性心力衰竭患者心血管死亡/心力衰竭住院复合终点发生率,且不增加低血糖事件发生率,而在降低心血管死亡和全因死亡方面,达格列净可能优于恩格列净和索格列净。

Systematic reviews and meta-analyses: Why are they clinically significant?

This review aims to clarify the clinical significance of systematic reviews and meta-analyses by illustrating several classical examples.Firstly,systematic reviews can provide the highest level of evidence for clinical decisions.Secondly,systematic reviews can propose unresolved issues and future directions.Thirdly,systematic reviews can avoid harm to the human body.Fourthly,systematic reviews can prevent a waste of resources.Generally speaking,clinical researchers should be encouraged to perform systematic reviews and metaanalyses.

体力活动、久坐与高尿酸血症风险关联及剂量-反应关系Meta分析

目的:探讨体力活动、久坐行为与成年人高尿酸血症(Hyperuricemia,HUA)风险关联及剂量-反应关系,为高尿酸血症的预防提供循证依据。方法:检索PubMed、Cochrane Library、EMbase、Web of Science、中国知网(CNKI)、万方(Wanfang)、中国生物医学文献服务系统(SinoMed)等数据库2023年7月15日前发表的体力活动、久坐行为与高尿酸血症风险关联性的相关文献,运用Cochrane偏倚风险评估工具进行文献质量评价、Stata 15.0软件进行Meta分析和剂量-反应关系Meta分析。研究结果:共纳入13项前瞻性队列研究或病例对照研究,包含750678名受访者,平均随访年限5.9年。风险关系Meta分析结果表明:①MVPA显著降低成年人发病风险。女性、≥45岁、亚洲人群HUA发病风险可能对MVPA更敏感。②久坐行为显著增加成年人发病风险。男性、≥45岁、欧美人群HUA发病风险可能对久坐行为最敏感。剂量-反应Meta分析发现:①MVPA与HUA发病风险存在负相关非线性剂量-反应关系。MVPA与罹患HUA的风险阈值为15MET-h/w。②久坐行为与HUA存在正相关非线性剂量-反应关系。久坐时间与罹患HUA的风险阈值为25h/w。研究结论:MVPA与HUA存在负相关“对数”剂量-反应关系,久坐行为与HUA存在正相关“指数”剂量-反应关系。

ER+/HER2-转移性乳腺癌内分泌治疗联合靶向治疗方案的定量评估:基于模型的meta分析

目的定量比较CDK4/6抑制剂与PI3K/AKT/mTOR抑制剂治疗ER+/HER2-转移性乳腺癌的疗效和安全性。方法采用参数化生存函数模型分析总生存期(OS)和无进展生存期(PFS)的时间进程,在单臂meta分析中使用随机效应模型汇总任意级别和3~5级不良事件发生率。结果本研究纳入48篇文献,包括7881例患者。结果显示,CDK4/6抑制剂的中位OS为40.7个月,中位PFS为14.8个月;而PI3K/AKT/mTOR抑制剂的中位OS为29.8个月,中位PFS为8.3个月。此外,内脏转移患者的比例和联合使用的内分泌治疗药物类型显著影响疗效。在不良事件方面,CDK4/6抑制剂表现出相对较高的血液学不良事件发生率。结论CDK4/6抑制剂的疗效显著优于PI3K/AKT/mTOR抑制剂。本研究为CDK4/6抑制剂在ER+/HER2-转移性乳腺癌临床诊疗指南中的一线推荐使用提供了可靠的定量证据。

Treatment of Atherosclerotic Disease of the Femoral Artery: Randomized Controlled Trials and Meta-Analyses. Should You Be Sceptical?

A narrative review of the data provided by Randomised Controlled clinical trials and meta-analyses was undertaken to assess how much reliance a clinician could place on these in selecting a treatment for patients with disease of the Femoral artery. An attempt was made to detect and review every clinical trial and meta-analysis published on treatments relating to disease of the femoral artery but not relating to drug treatment. Disease of the femoral artery in >65 years age group occurs in approximately 20% of the population but symptomatology was present in 40%. In almost all trials the predominant (>90%) indication for treatment was intermittent claudication. In this setting, clinical benefit was limited and did not extend beyond 12 months. Mortality, from co-morbidities was high. The Basil Trial was the only one to examine intervention for critical limb ischemia. The results for Bypass surgery and Percutaneous transarterial balloon angioplasty (PTA) were equivalent. There is little evidence to support the use of PTA or stenting other than in the treatment of patients with critical limb ischemia.

含ω-3多不饱和脂肪酸的肠外营养对胃癌病人免疫功能影响的Meta分析

目的:探讨含ω-3多不饱和脂肪酸(PUFA)的肠外营养对胃癌病人免疫功能的影响。方法:计算机检索1996年1月至2014年5月国内外数据库中研究择期手术后补充ω-3 PUFA对胃癌病人免疫功能影响的文献,同时进行手工检索和参考文献回溯。采用偏倚风险评估标准对纳入随机对照试验的质量进行评价。采用RevMan 5.1软件进行Meta分析,研究ω-3 PUFA对胃癌病人免疫功能(Ig A,Ig G,Ig M,CD4,CD8,CD4/CD8)的影响。结果:共检索到1 176篇相关文献,剔除数据重复、抄袭和无法获得方法学资料的文摘,最终纳入5个随机对照研究,共计217例病人。Meta分析结果显示,含ω-3 PUFA的肠外营养与对照组比,CD4/CD8、CD4、Ig G、Ig A、Ig M等差异均有统计学意义。结论:适当剂量和一定干预时间的ω-3 PUFA能增强胃癌病人应激状态下的免疫功能。

脉络宁注射液治疗缺血性中风急性期随机对照试验的Meta-分析

目的:系统评价脉络宁注射液治疗缺血性中风急性期的疗效及安全性。方法:搜集脉络宁注射液治疗缺血性中风急性期随机对照试验文献,筛选合格研究,应用Jadad评分法进行质量评价,运用异质性检验、Meta-分析、漏斗图分析、敏感性分析等方法统计相关数据。结果:10项符合纳入标准,采用Jadad评分标准对每篇文章的方法学质量进行评价,得分均为1分,属低质量文献;Meta-分析结果显示,与空白对照组比较,总有效率比较RR合并=1.17,99%CI为(1.09,1.25)。结论:本系统评价显示脉络宁注射液治疗缺血性中风急性期有效,且无严重不良反应。纳入研究质量普遍较低等因素降低了上述结论的可靠性,尚需进行设计合理、执行严格、多中心大样本且随访时间足够的随机对照试验,以进一步验证脉络宁注射液治疗缺血性中风急性期的疗效及安全性。