[Objectives] To make a systematic evaluation on the therapeutic efficacy and safety of Yiqi Huoxue traditional Chinese drugs combined with western medicine in treatment of coronary heart disease( CHD) after coronary r...[Objectives] To make a systematic evaluation on the therapeutic efficacy and safety of Yiqi Huoxue traditional Chinese drugs combined with western medicine in treatment of coronary heart disease( CHD) after coronary revascularization. [Methods] The literatures were retrieved from China Knowledge Infrastructure( CNKI),Chinese science and technology journal full-text database( VIP database,VIP),Wanfang Data,the Chinese biomedical Database,Pub Med,Embase,and the Cochrane Library. The retrieval time was set to the creation of the database to January 2017. The randomized controlled trial( RCT) was conducted on the comparison between Yiqi Huoxue Chinese drugs combined with western medicine and the western medicine alone in the treatment of CHD after coronary revascularization. The literature information was extracted and the methodological quality of the included literature was evaluated according to the bias risk assessment tool developed by the Cochrane Collaboration. Meta-analysis was performed with the aid of Rev Man 5. 3 software. Coronary artery restenosis rate,angina pectoris treatment efficiency,left ventricular ejection fraction( LVEF),left ventricular end-diastolic volume( LVEDV),B-type natriuretic peptide( BNP),6-minute walk test( 6 MWT),and adverse reactions were analyzed. [Results] A total of 29 articles were included,a total of2 518 patients,the literature quality was low. Meta-analysis results showed that compared with the treatment by western medicine alone,Yiqi Huoxue Chinese drugs combined with western medicine could further reduce coronary restenosis rate[RR = 0. 45,95% CI( 0. 34,0. 60),P <0. 000 01],improve the angina pectoris treatment efficiency[RR = 1. 13,95% CI( 1. 05,1. 21),P = 0. 000 5],raise LVEF[WMD = 4. 25,95% CI( 3. 46,5. 04),P < 0. 000 01],reduce LVEDV[WMD =-10. 41,95% CI(-17. 88,-2. 95),P = 0. 006],decrease the plasma BNP level[WMD =-32. 32,95% CI(-44. 92,-19. 72),P < 0. 000 01],and increase 6 MWT distance(WMD = 62. 25,95% CI( 21. 71,102. 78),P = 0. 003)[Conclusions]Yiqi Huoxue Chinese drugs combined with western medicine can alleviate the symptoms of angina pectoris,reduce the rate of coronary restenosis,improve heart function and improve exercise capacity,thereby improving clinical efficacy in patients with CHD after coronary revascularization.展开更多
Background: Some depressed patients receive acupuncture as an adjunct to their conventional medications.Objective: This review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness ...Background: Some depressed patients receive acupuncture as an adjunct to their conventional medications.Objective: This review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness of antidepressants for treating depression, and explore whether acupuncture can reduce the adverse reactions associated with antidepressants.Search strategy: English and Chinese databases were searched for randomized controlled trials(RCTs)published until December 1, 2021.Inclusion criteria: RCTs with a modified Jadad scale score ≥ 4 were included if they compared a group of participants with depression that received acupuncture combined with antidepressants with a control group that received antidepressants alone.Data extraction and analysis: Meta-analysis was performed, and statistical heterogeneity was assessed based on Cochran’s Q statistic and its related P-value. Primary outcomes were the reduction in the severity of depression and adverse reactions associated with antidepressants, while secondary outcomes included remission rate, treatment response, social functioning, and change in antidepressant dose.The Grading of Recommendations Assessment, Development and Evaluation(GRADE) framework was used to evaluate the overall quality of evidence in the included studies.Results: This review included 16 studies(with a total of 1958 participants). Most studies were at high risk of performance bias and at low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias. Analysis of the 16 RCTs showed that, compared with antidepressants alone, acupuncture along with antidepressants reduced the Hamilton Depression Rating Scale-17(HAMD-17) scores(standard mean difference [SMD]-0.44, 95% confidence interval [CI]-0.55 to-0.33, P < 0.01;I^(2)= 14%), Self-rating Depression Scale(SDS) scores(SMD-0.53, 95% CI-0.84 to-0.23, P < 0.01;I^(2)= 79%), and the Side Effect Rating Scale(SERS) scores(SMD-1.11, 95% CI-1.56 to-0.66, P < 0.01;I^(2)= 89%). Compared with antidepressants alone, acupuncture along with antidepressants improved World Health Organization Quality of Life-BREF scores(SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01;I^(2)= 15%), decreased the number of participants who increased their antidepressant dosages(relative risk[RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01;I^(2)= 0%), and resulted in significantly higher remission rates(RR1.52, 95% CI 1.26 to 1.83, P < 0.01;I^(2)= 0%) and treatment responses(RR 1.35, 95% CI 1.24 to 1.47, P < 0.01;I^(2)= 19%) in terms of HAMD-17 scores. The HAMD-17, SDS and SERS scores were assessed as low quality by GRADE and the other indices as being of moderate quality.Conclusion: Acupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants. These findings must be interpreted with caution, as the evidence was of low or moderate quality and there was a lack of comparative data with a placebo control.Systematic review registration: INPLASY202150008.展开更多
AIM: To evaluate the relationship between thiopu- rine S-methyltransferase (TPMT) polymorphisms and thiopurine-induced adverse drug reactions (ADRs) in inflammatory bowel disease (IBD). METHODS: Eligible articles that...AIM: To evaluate the relationship between thiopu- rine S-methyltransferase (TPMT) polymorphisms and thiopurine-induced adverse drug reactions (ADRs) in inflammatory bowel disease (IBD). METHODS: Eligible articles that compared the frequency of TPMT polymorphisms among thiopurine-tolerant and-intolerant adult IBD patients were included. Statistical analysis was performed with Review Manager 5.0. Sub-analysis/sensitivity analysis was also performed. RESULTS: Nine studies that investigated a total of 1309 participants met our inclusion criteria. The inci- dence of TPMT gene mutation was increased 2.93-fold (95% CI: 1.68-5.09, P = 0.0001) and 5.93-fold (95% CI: 2.96-11.88, P < 0.00001), respectively, in IBD patients with thiopurine-induced overall ADRs and bone marrow toxicity (BMT), compared with controls. The OR for TPMT gene mutation in IBD patients withthiopurine-induced hepatotoxicity and pancreatitis was 1.51 (95% CI: 0.54-4.19, P = 0.43) and 1.02 (95% CI: 0.26-3.99, P = 0.98) vs controls, respectively. CONCLUSION: This meta-analysis suggests that the TPMT polymorphisms are associated with thiopurine-induced overall ADRs and BMT, but not with hepatotoxicity and pancreatitis.展开更多
基金Supported by Project of National Natural Science Foundation of China(81460675)
文摘[Objectives] To make a systematic evaluation on the therapeutic efficacy and safety of Yiqi Huoxue traditional Chinese drugs combined with western medicine in treatment of coronary heart disease( CHD) after coronary revascularization. [Methods] The literatures were retrieved from China Knowledge Infrastructure( CNKI),Chinese science and technology journal full-text database( VIP database,VIP),Wanfang Data,the Chinese biomedical Database,Pub Med,Embase,and the Cochrane Library. The retrieval time was set to the creation of the database to January 2017. The randomized controlled trial( RCT) was conducted on the comparison between Yiqi Huoxue Chinese drugs combined with western medicine and the western medicine alone in the treatment of CHD after coronary revascularization. The literature information was extracted and the methodological quality of the included literature was evaluated according to the bias risk assessment tool developed by the Cochrane Collaboration. Meta-analysis was performed with the aid of Rev Man 5. 3 software. Coronary artery restenosis rate,angina pectoris treatment efficiency,left ventricular ejection fraction( LVEF),left ventricular end-diastolic volume( LVEDV),B-type natriuretic peptide( BNP),6-minute walk test( 6 MWT),and adverse reactions were analyzed. [Results] A total of 29 articles were included,a total of2 518 patients,the literature quality was low. Meta-analysis results showed that compared with the treatment by western medicine alone,Yiqi Huoxue Chinese drugs combined with western medicine could further reduce coronary restenosis rate[RR = 0. 45,95% CI( 0. 34,0. 60),P <0. 000 01],improve the angina pectoris treatment efficiency[RR = 1. 13,95% CI( 1. 05,1. 21),P = 0. 000 5],raise LVEF[WMD = 4. 25,95% CI( 3. 46,5. 04),P < 0. 000 01],reduce LVEDV[WMD =-10. 41,95% CI(-17. 88,-2. 95),P = 0. 006],decrease the plasma BNP level[WMD =-32. 32,95% CI(-44. 92,-19. 72),P < 0. 000 01],and increase 6 MWT distance(WMD = 62. 25,95% CI( 21. 71,102. 78),P = 0. 003)[Conclusions]Yiqi Huoxue Chinese drugs combined with western medicine can alleviate the symptoms of angina pectoris,reduce the rate of coronary restenosis,improve heart function and improve exercise capacity,thereby improving clinical efficacy in patients with CHD after coronary revascularization.
基金supported by a grant from National Natural Science Foundation of China (grant number 82104983)Scientific Research Program by Traditional Chinese Medicine Bureau of Guangdong Province,China (grant number 20201103)Fundamental Research Funds for the Central Universities,China (grant number 21620362)。
文摘Background: Some depressed patients receive acupuncture as an adjunct to their conventional medications.Objective: This review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness of antidepressants for treating depression, and explore whether acupuncture can reduce the adverse reactions associated with antidepressants.Search strategy: English and Chinese databases were searched for randomized controlled trials(RCTs)published until December 1, 2021.Inclusion criteria: RCTs with a modified Jadad scale score ≥ 4 were included if they compared a group of participants with depression that received acupuncture combined with antidepressants with a control group that received antidepressants alone.Data extraction and analysis: Meta-analysis was performed, and statistical heterogeneity was assessed based on Cochran’s Q statistic and its related P-value. Primary outcomes were the reduction in the severity of depression and adverse reactions associated with antidepressants, while secondary outcomes included remission rate, treatment response, social functioning, and change in antidepressant dose.The Grading of Recommendations Assessment, Development and Evaluation(GRADE) framework was used to evaluate the overall quality of evidence in the included studies.Results: This review included 16 studies(with a total of 1958 participants). Most studies were at high risk of performance bias and at low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias. Analysis of the 16 RCTs showed that, compared with antidepressants alone, acupuncture along with antidepressants reduced the Hamilton Depression Rating Scale-17(HAMD-17) scores(standard mean difference [SMD]-0.44, 95% confidence interval [CI]-0.55 to-0.33, P < 0.01;I^(2)= 14%), Self-rating Depression Scale(SDS) scores(SMD-0.53, 95% CI-0.84 to-0.23, P < 0.01;I^(2)= 79%), and the Side Effect Rating Scale(SERS) scores(SMD-1.11, 95% CI-1.56 to-0.66, P < 0.01;I^(2)= 89%). Compared with antidepressants alone, acupuncture along with antidepressants improved World Health Organization Quality of Life-BREF scores(SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01;I^(2)= 15%), decreased the number of participants who increased their antidepressant dosages(relative risk[RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01;I^(2)= 0%), and resulted in significantly higher remission rates(RR1.52, 95% CI 1.26 to 1.83, P < 0.01;I^(2)= 0%) and treatment responses(RR 1.35, 95% CI 1.24 to 1.47, P < 0.01;I^(2)= 19%) in terms of HAMD-17 scores. The HAMD-17, SDS and SERS scores were assessed as low quality by GRADE and the other indices as being of moderate quality.Conclusion: Acupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants. These findings must be interpreted with caution, as the evidence was of low or moderate quality and there was a lack of comparative data with a placebo control.Systematic review registration: INPLASY202150008.
文摘AIM: To evaluate the relationship between thiopu- rine S-methyltransferase (TPMT) polymorphisms and thiopurine-induced adverse drug reactions (ADRs) in inflammatory bowel disease (IBD). METHODS: Eligible articles that compared the frequency of TPMT polymorphisms among thiopurine-tolerant and-intolerant adult IBD patients were included. Statistical analysis was performed with Review Manager 5.0. Sub-analysis/sensitivity analysis was also performed. RESULTS: Nine studies that investigated a total of 1309 participants met our inclusion criteria. The inci- dence of TPMT gene mutation was increased 2.93-fold (95% CI: 1.68-5.09, P = 0.0001) and 5.93-fold (95% CI: 2.96-11.88, P < 0.00001), respectively, in IBD patients with thiopurine-induced overall ADRs and bone marrow toxicity (BMT), compared with controls. The OR for TPMT gene mutation in IBD patients withthiopurine-induced hepatotoxicity and pancreatitis was 1.51 (95% CI: 0.54-4.19, P = 0.43) and 1.02 (95% CI: 0.26-3.99, P = 0.98) vs controls, respectively. CONCLUSION: This meta-analysis suggests that the TPMT polymorphisms are associated with thiopurine-induced overall ADRs and BMT, but not with hepatotoxicity and pancreatitis.
