Omics-based biomarkers as useful tools in metabolic dysfunctionassociated steatotic liver disease clinical practice:How far are we?

Unmet needs exist in metabolic dysfunction-associated steatotic liver disease(MASLD)risk stratification.Our ability to identify patients with MASLD with advanced fibrosis and at higher risk for adverse outcomes is still limited.Incorporating novel biomarkers could represent a meaningful improvement to current risk predictors.With this aim,omics technologies have revolutionized the process of MASLD biomarker discovery over the past decades.While the research in this field is thriving,much of the publication has been haphazard,often using single-omics data and specimen sets of convenience,with many identified candidate biomarkers but lacking clinical validation and utility.If we incorporate these biomarkers to direct patients’management,it should be considered that the roadmap for translating a newly discovered omics-based signature to an actual,analytically valid test useful in MASLD clinical practice is rigorous and,therefore,not easily accomplished.This article presents an overview of this area’s current state,the conceivable opportunities and challenges of omics-based laboratory diagnostics,and a roadmap for improving MASLD biomarker research.

New perspectives on biology,disease progression,and therapy response of head and neck cancer gained from single cell RNA sequencing and spatial transcriptomics

Head and neck squamous cell carcinoma(HNSCC)is one of the most frequent cancers worldwide.The main risk factors are consumption of tobacco products and alcohol,as well as infection with human papilloma virus.Approved therapeutic options comprise surgery,radiation,chemotherapy,targeted therapy through epidermal growth factor receptor inhibition,and immunotherapy,but outcome has remained unsatisfactory due to recurrence rates of~50%and the frequent occurrence of second primaries.The availability of the human genome sequence at the beginning of the millennium heralded the omics era,in which rapid technological progress has advanced our knowledge of the molecular biology of malignant diseases,including HNSCC,at an unprecedented pace.Initially,microarray-based methods,followed by approaches based on next-generation sequencing,were applied to study the genetics,epigenetics,and gene expression patterns of bulk tumors.More recently,the advent of single-cell RNA sequencing(scRNAseq)and spatial transcriptomics methods has facilitated the investigation of the heterogeneity between and within different cell populations in the tumor microenvironment(e.g.,cancer cells,fibroblasts,immune cells,endothelial cells),led to the discovery of novel cell types,and advanced the discovery of cell-cell communication within tumors.This review provides an overview of scRNAseq,spatial transcriptomics,and the associated bioinformatics methods,and summarizes how their application has promoted our understanding of the emergence,composition,progression,and therapy responsiveness of,and intercellular signaling within,HNSCC.

Metabolomics and gene expression levels reveal the positive effects of teaseed oil on lifespan and aging process in Caenorhabditis elegans

As an irreplaceable dietary constituent,lipids play a vital important role in health,but their effects on aging process and longevity are still not well known yet.In this paper,the metabolic profiling and gene expression levels of Caenorhabditis elegans were investigated to explore the effects of different edible oils on senescence and lifespan.The results showed that teaseed oil(TO)could prolong the life expectancy and slow down the aging process of C.elegans.Compared to the control group,the intake of lard oil(LO)and TO increased the expression levels of genes related to inhibition of protein aggregation(akt-1,daf-16,hsf-1,hsp-16.2)and lipid metabolism(daf-7,daf-1,mdt-15,lipl-4,fat-5,fat-6,fat-7),with a more significant alteration in TO group.Metabolomics revealed that palm oil can upregulated plenty of fatty acids(palmitic acid,stearic acid,tetracosanoic acid),together with some amino acids(tryptophan,L-aspartate,L-valine)and carbohydrate(D-glucose),while the trend was opposite in TO group.Besides,moderate-to-strong correlations were found between differential metabolites and changed genes.In general,this paper claimed that TO could prolong lifespan and slow down aging process via regulating the lipids,amino acids and carbohydrates metabolism.

The advantages of multi-level omics research on stem cell-based therapies for ischemic stroke

Stem cell transplantation is a potential therapeutic strategy for ischemic stroke. However, despite many years of preclinical research, the application of stem cells is still limited to the clinical trial stage. Although stem cell therapy can be highly beneficial in promoting functional recovery, the precise mechanisms of action that are responsible for this effect have yet to be fully elucidated. Omics analysis provides us with a new perspective to investigate the physiological mechanisms and multiple functions of stem cells in ischemic stroke. Transcriptomic, proteomic, and metabolomic analyses have become important tools for discovering biomarkers and analyzing molecular changes under pathological conditions. Omics analysis could help us to identify new pathways mediated by stem cells for the treatment of ischemic stroke via stem cell therapy, thereby facilitating the translation of stem cell therapies into clinical use. In this review, we summarize the pathophysiology of ischemic stroke and discuss recent progress in the development of stem cell therapies for the treatment of ischemic stroke by applying multi-level omics. We also discuss changes in RNAs, proteins, and metabolites in the cerebral tissues and body fluids under stroke conditions and following stem cell treatment, and summarize the regulatory factors that play a key role in stem cell therapy. The exploration of stem cell therapy at the molecular level will facilitate the clinical application of stem cells and provide new treatment possibilities for the complete recovery of neurological function in patients with ischemic stroke.

Plant-associated fungal communities in the light of meta’omics

Approaches for the cultivation-independent analysis of microbial communities are summarized as meta’omics,which predominantly includes metagenomic,-transcriptomic,-proteomic and-metabolomic studies.These have shown that endophytic,root-associated and soil fungal communities are strongly shaped by associated plant species.The impact of plant identity on the composition of its litterssociated fungal community remains to be disentangled from the impact of litter chemistry.The composition of the plant community also shapes the fungal community.Most strikingly,adjacent plant species may share mycorrhizal symbionts even if the plants usually have different types of mycorrhizal fungi associated with them(ectomycorrhizal,ericoid and arbuscular mycorrhizal fungi).Environmental parameters weakly explain fungal community composition globally,and their effect is inconsistent at local and regional scales.Decrease in similarity among communities with increasing distance(i.e.distance decay)has been reported from local to global scales.This pattern is only exceptionally caused by spatial dispersal limitation of fungal propagules,but mostly due to the inability of the fungi to establish at the particular locality(i.e.environmental filtering or competitive exclusion).Fungal communities usually undergo pronounced seasonal changes and also differ between consecutive years.This indicates that development of the communities is usually not solely cyclic.Meta’omic studies challenge the classical view of plant litter decomposition.They show that mycorrhizal and(previously)endophytic fungi may be involved in plant litter decomposition and only partly support the idea of a succession from an Ascomycota to a Basidiomycota-dominated community.Furthermore,vertical separation of saprotrophic and mycorrhizal species in soil and sequential degradation from easily accessible to‘recalcitrant’plant compounds,such as lignin,can probably not be generalized.The current models of litter decomposition may therefore have to be eventually refined for certain ecosystems and environmental conditions.To gain deeper insights into fungal ecology,a meta’omic study design is outlined which focuses on environmental processes,because fungal communities are usually taxonomically diverse,but functionally redundant.This approach would initially identify dynamics of chemical shifts in the host and/or substrate by metametabolomics.Detected shifts would be subsequently linked to microbial activity by correlation with metatranscriptomic and/or metaproteomic data.A holistic trait-based approach might finally identify factors shaping taxonomic composition in communities against the dynamics of the environmental process(es)they are involved in.

基于meta分析研究土壤消毒对微生物群落演替的影响

微生物是土壤生态系统的重要组成部分,熏蒸剂作为广谱杀菌杀线虫剂,对土壤微生物群落产生了显著影响。采用meta分析对目前已公开发表的数据进行整合,系统分析了土壤消毒技术对土壤细菌和真菌群落的影响。结果表明,土壤消毒对微生物群落的影响因熏蒸剂种类、用量和时间而异。研究结果可为较全面地了解土壤消毒技术对土壤微生态效应的影响提供数据支撑。

丁酸甘油酯对断奶仔猪生长性能和腹泻率影响的Meta分析

研究旨在探讨丁酸甘油酯对断奶仔猪生长性能和腹泻率的影响,运用Meta分析方法进行系统评价。经检索万方、中国知网、维普、Pub Med和Web of Science数据库,搜索丁酸甘油酯对断奶仔猪生长性能影响的文献,按照纳入和排除标准筛选文献、提取资料,用Review Manager 5.4软件进行Meta分析。共纳入12个研究,样本838例。结果显示:丁酸甘油酯组的平均日增重显著高于空白组(P<0.0001,SMD=1.58,95%CI:0.80~2.36),平均日采食量与空白组差异不显著(P=0.30,SMD=-0.44,95%CI:-1.28~0.40),料重比显著低于空白组(P=0.0002,SMD=-0.85,95%CI:-1.29~-0.40),腹泻率显著低于空白组(P=0.0003,SMD=-2.78,95%CI:-4.27~-1.28)。说明饲料中添加丁酸甘油酯可显著提高断奶仔猪的平均日增重,降低料重比和腹泻率,建议丁酸甘油酯添加量为1%~2%。

脑卒中患者心理弹性影响因素的Meta分析

目的通过Meta分析明确脑卒中患者心理弹性的影响因素。方法计算机检索PubMed、Embase、Web of Science、PsycInfo、SinoMed、知网、万方、维普等数据库中脑卒中心理弹性相关研究。采用RevMan 5.4和Stata 18软件进行Meta分析。结果共纳入33篇文献,提取到23个影响因素。脑卒中患者心理弹性受社会人口学因素、疾病因素、心理因素和环境因素的多元影响。结论医疗专业人员可根据上述因素识别出心理弹性较低的患者,并进行针对性干预。

地诺孕素治疗子宫腺肌病疗效与安全性meta分析

目的:系统评价地诺孕素治疗子宫腺肌病的疗效及安全性,为临床用药提供循证依据。方法:计算机检索PubMed、EMbase、Cochrane Library、中国生物医学文献数据库、CNKI和万方数据库,检索时限均为建库至2023年7月30日,纳入地诺孕素(试验组)对比阳性药物或安慰剂(对照组)治疗子宫腺肌病的随机对照研究(RCT)。筛选文献、提取资料后采用Cochrane 5.1.0偏倚风险评估工具对纳入文献质量进行评价,采用Rev Man 5.3统计软件进行meta分析。结果:纳入10篇RCT研究,共820例患者。Meta分析结果显示,试验组较对照组VAS评分显著降低(SMD=-2.50,95%CI为-4.73~-0.27,P=0.03),对于子宫体积变化疗效相当(MD=0.24,95%CI为-0.87~1.36,P=0.67),试验组的临床有效率显著高于对照组(RR=1.30,95%CI为1.19~1.41,P<0.01),患者的CA125水平两者差异不大(MD=-4.25,95%CI为-13.16~4.66,P=0.35),两者的潮热副反应发生率(RR=0.72,95%CI为0.03~15.53,P=0.83)、异常子宫出血发生率(RR=2.11,95%CI为0.87~5.15,P=0.10)相当。结论:地诺孕素组的疼痛缓解较安慰剂组有明显优势,与阳性对照组相比,疗效差别不大;临床有效率显著高于阳性对照组,子宫体积变化、CA125水平与阳性对照组和安慰剂组疗效均相当;安全性方面,潮热副反应发生率与阳性对照组和安慰剂组均相当,异常子宫出血的发生率与阳性对照组相当,但显著高于安慰剂组,因此应用地诺孕素时要警惕子宫出血的风险。未来仍需大规模随机对照研究去验证。

自体骨移植与骨替代物手术治疗胫骨平台骨折的Meta分析

目的:通过Meta分析系统评价自体骨移植和骨替代物治疗胫骨平台骨折的临床疗效。方法:计算机检索2005年1月至2022年8月PubMed、Web of Science、中国知网、万方等数据库已发表的关于自体骨移植和骨替代物治疗胫骨平台骨折的病例对照研究文献。根据纳排标准进行文献筛选及数据提取,对入选的随机对照研究(randomized controlled trial,RCT)采用Cochrane手册中的干预性Meta分析标准进行质量评价。采用RevMan 5.3软件对两种方法的关节凹陷、关节面二次塌陷率、失血量、手术时间和感染率进行Meta分析。结果:共纳入7项RCT研究,424例患者,其中骨替代物组296例,自体骨移植组128例。两组手术时间[MD=-16.79,95%CI(-25.72,-7.85),P=0.0002],出血量[MD=-70.49,95%CI(-79.34,-61.65),P<0.00001]比较,差异有统计学意义。而关节凹陷[MD=-0.17,95%CI(-0.91,0.58),P=0.66],关节面二次塌陷率[RR=-0.74,95%CI(0.35,1.57),P=0.43],感染率[RR=1.21,95%CI(0.31,4.70),P=0.78]比较,差异无统计学意义。结论:骨替代物与自体骨移植治疗胫骨平台骨折在关节凹陷、关节面二次塌陷率和感染率方面疗效相近。但骨替代物较自体骨移植,能减少失血量,缩短手术时间。

不同镇痛方法用于髋部或股骨干骨折患者椎管内麻醉摆放体位时镇痛效果的网状Meta分析

目的采用网状Meta分析系统评价不同镇痛方法用于髋部或股骨干骨折患者椎管内麻醉摆放体位时的镇痛效果。方法计算机检索PubMed、Cochrane Library、Web of Science、EMbase、中国生物医学文献数据库(CBM)、中国知网、维普、万方,检索时间为建库至2022年8月,纳入髋部或股骨干骨折患者摆放体位和椎管内麻醉时实施镇痛的随机对照研究。由两名研究员独立进行文献筛选、资料提取和偏倚风险评价,采用Stata 17.0和RevMan 5.3软件进行统计分析。结果共纳入28篇文献,患者1773例。累计排序概率曲线下面积(SUCRA)显示,降低摆放体位时VAS疼痛评分PENG阻滞(94.4%)效果最佳,其次是FIB联合IVA(83.8%)和FIB(71.1%);降低椎管内麻醉时VAS疼痛评分PENG阻滞(98.2%)效果最佳,其次是FIB(71.1%)和FNB(55.6%);缩短椎管内麻醉操作时间PENG阻滞(84.1%)效果最佳,其次是FNB(70.7%)和FIB(68.5%);升高体位摆放质量评分PENG阻滞(99.1%)效果最佳,其次是FIB(73.1%)和FNB(52.9%)。结论神经阻滞或神经阻滞联合IVA可降低髋部或股骨干骨折患者体位摆放和椎管内麻醉时VAS疼痛评分、缩短麻醉操作时间和升高体位摆放质量评分。PENG阻滞对髋部或股骨干骨折患者摆放体位和椎管内麻醉时实施镇痛的效果最佳。

吲哚布芬用于预防静脉血栓形成的有效性与安全性的系统评价与Meta分析

目的:评价吲哚布芬在预防静脉血栓形成中的有效性与安全性。方法:在PubMed、Embase、the Cochrane Library、ClinicalTrial.gov、中国知网、万方数据库和中国生物医学文献数据库中检索,纳入吲哚布芬用于预防静脉血栓形成的随机对照试验(干预措施为吲哚布芬单药或联合其他常规用药治疗;对照措施为其他阳性对照药单药或联合其他常规用药治疗),检索时间截至2023年5月。2名评价者按照事先制定的纳入与排除标准筛选文献,提取资料,并对纳入研究的方法学质量进行评价,采用RevMan 5.3软件进行Meta分析。结果:最终纳入15项RCT研究,共2164例患者,其中吲哚布芬组1117例,对照组1047例。有效性结局显示,吲哚布芬在心房颤动(AF)血栓预防、骨科大手术后血栓预防和特发性膜性肾病血栓预防方面有足够的循证证据进行Meta分析,结果均不劣于华法林或其他抗凝血药;在AF合并缺血性心脑血管疾病、肾病综合征和下肢浅静脉曲张术后血栓预防方面,吲哚布芬也具有一定的证据,但尚不足以进行定量分析。安全性结果显示,吲哚布芬在预防AF血栓形成中造成出血(RR=0.18,95%CI=0.09~0.38,P<0.00001)和轻微出血(RR=0.17,95%CI=0.05~0.52,P=0.002)的发生率显著低于华法林,差异均有统计学意义。结论:吲哚布芬在预防静脉血栓形成方面已积累了一定的循证证据,其临床有效性不劣于传统治疗方案,在安全性方面更优。

对比MRI与超声对唇腭裂的产前诊断价值:Meta分析

目的:采用Meta分析比较磁共振成像(MRI)与超声(US)对唇腭裂产前诊断的临床应用价值。方法:检索Embase、PubMed、Web of Science、Cochrane Library、万方、维普、中国知网及中国生物医学文献等数据库,查找比较MRI及US对胎儿唇腭裂产前诊断的相关研究,检索时限为2000年1月至2022年12月。计算汇总诊断比值比、灵敏度、特异度、阳性似然比、阴性似然比、受试者工作特性曲线下面积(AUC)、验前验后概率及95%CI。结果:纳入文献6篇,共235例。MRI和US合并灵敏度分别为0.98(95%CI:0.94~0.99)和0.70(95%CI:0.35~0.91),差异有统计学意义(P<0.05)。MRI和US合并特异度分别为0.84(95%CI:0.76~0.90)和0.59(95%CI:0.21~0.89),差异有统计学意义(P<0.05)。MRI的AUC显著高于US的AUC(0.98 vs.0.84,P<0.05)。结论:对于胎儿唇腭裂的产前诊断,MRI较US诊断效能更高,可作为产前US诊断的首要补充方法。

自体细胞移植治疗稳定期白癜风疗效的Meta分析

目的 系统评价培养与非培养自体黑色素细胞移植及联合其他方法治疗稳定期白癜风的疗效。方法检索PubMed、Embase、Web of Science、The Cochrane Library、中国期刊全文数据库(CNKI)、维普中文科技期刊全文数据库(VIP)、万方数据库,纳入研究为自体细胞移植治疗稳定期白癜风的临床研究。计数资料以合并后相对危险度(RR)值为效应指标,用Revman5.4软件对符合分析的研究进行Meta分析。结果 最终纳入文献14篇,Meta分析显示:自体培养黑色素细胞移植(CMT)与黑色素细胞+角质细胞、CMT与自体非培养混悬液移植(NCES)治疗稳定期白癜风疗效差异无统计学意义(P>0.05);CMT与CMT+光疗治疗稳定期白癜风疗效差异有统计学意义(P<0.01);NCES与NCES+其他成分、NCES与NCES+其他疗法、NCES与NCES+光疗治疗稳定期白癜风疗效差异无统计学意义(P>0.05);细胞移植与细胞移植+其他疗法、细胞移植与细胞移植+光疗、细胞移植与细胞移植+窄谱中波紫外线(NBUVB)治疗稳定期白癜风疗效差异有统计学意义(P<0.01)。结论 NCES和CMT移植治疗稳定期白癜风都有较好的疗效,与混悬液中所含成分无直接关系。黑色素细胞移植联合其他治疗方式治疗白癜风疗效要优于单一用黑色素细胞移植治疗白癜风。受纳入研究数量和质量限制,上述结论有待更多设计合理的随机对照临床研究证实。

基于雷达图再评价浮针治疗痛症的系统评价/Meta分析

目的基于雷达图再评价浮针治疗痛症的系统评价/Meta分析的文献质量,以期为浮针疗法的临床工作提供全面的证据。方法检索中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献(CBM)等中文数据库及PubMed、Cochrane Library、Embase等外文数据库自建库至2022年10月10日浮针治疗痛症的系统评价/Meta分析。提取纳入文献的数据后,基于系统评价方法学质量评价(A measure tool to assess systematic reviews 2,AMSTAR 2)、系统评价报告质量评价(Preferred reporting items for systematic reviews and meta-analyses,PRISMA)、发表年份、研究类型、同质性以及发表偏倚6个维度进行评估,并采用Excel 2019和Adobe Illustrator 2021软件绘制并优化雷达图直观显示再评价结果。再辅以GRADE证据质量评价工具,对纳入文献的结局指标进行质量评分。结果最终纳入11篇文献,主要结局指标39个;AMSTAR 2量表评价结果显示,4篇文献为低质量,其余7篇为极低质量;PRISMA量表评价得分在15~20;6个维度秩数平均分为3.83~9.17;GRADE评价结果显示,39个主要结局指标的证据质量中无高质量,只有1个中等质量,其余为低或极低质量。结论基于雷达图分析发现浮针治疗痛症的系统评价/Meta分析质量仍有待提升,因此临床上使用这些证据辅助临床决策时需注意甄别。

真武汤加减治疗扩张型心肌病临床疗效的Meta分析

目的观察真武汤加减治疗扩张型心肌病(Dilated cardiomyopathy,DCM)的临床疗效。方法检索2000年1月1日—2023年10月31日期间万方、维普、中国学术期刊全文数据库(CNKI)及PubMed数据库收录的真武汤加减治疗DCM的研究。同质性研究采用固定效应模型、异质性研究采用随机效应模型进行荟萃分析。采用Revman 5.3软件评价文献质量,应用Stata15.1软件合并分析数据,并用TSA 0.9软件对治疗有效率进行序贯分析。结果最终纳入12项研究,共666例患者,Meta分析结果显示,真武汤加减联合西药治疗可更有效的提高DCM患者左室射血分数(Left ventricular ejection fraction,LVEF)(SMD=4.27,95%CI:2.07~6.48,P<0.0001);更大程度缩小左室舒张末期内径(Left ventricular end diastolic dimension,LVEDd)(SMD=-7.74,95%CI:-8.37~-7.11,P<0.00001);显著提高治疗有效率(OR=3.62,95%CI:2.16~6.08,P<0.0001)。结论真武汤加减联合西药常规治疗DCM,在提高总有效、改善LVEF、缩小LVEDd方面优于常规西药治疗。

不同运动对老年人骨密度影响的网状Meta分析

目的通过网状Meta分析法比较太极、八段锦、五禽戏、易筋经、核心稳定训练、振动训练、抗阻训练、健步走、广场舞、毽球运动、综合训练对老年人骨密度的干预效果。方法检索数据知识服务平台搜集应用运动对老年人骨密度影响的随机对照试验(RCT),搜集建库至2023年4月1日发表的不同运动方式对老年人骨密度影响的相关文献。收集第一作者、发表时间、总样本量、年龄、运动干预措施、运动干预时间、运动干预周期、结局指标(腰椎BMD、股骨颈BMD、Ward三角BMD)等信息。采用Revman 5.3和Stata 16软件进行统计学分析。结果共纳入了37个研究,涉及研究总样本量2922人。网状Meta分析结果显示,与对照组相比易筋经(MD=-0.13,95%CI:-0.18~-0.07,P<0.05)改善腰椎BMD和股骨颈BMD最有效,其次为核心稳定训练(MD=-0.08,95%CI:-0.12~-0.04),P<0.05);振动训练(MD=-0.10,95%CI:-0.14~-0.06),P<0.05)改善Ward三角BMD最有效,其次为太极(MD=-0.03,95%CI:-0.05~-0.02),P<0.05)。聚类分层结果显示,易筋经、核心稳定训练、振动训练是改善老年人骨密度最优运动干预。结论30~60 min易筋经、30~60 min核心稳定训练、10~30 min振动训练对老年人骨密度改善更为显著。

儿童重症肺炎支原体肺炎危险因素的Meta分析

背景近年来,儿童肺炎支原体肺炎的发病率持续上升,重症肺炎支原体肺炎的发病人数也相应升高,引起了临床医师的广泛关注。了解与重症肺炎支原体肺炎相关的危险因素,以判断患儿病情的严重程度、预防重症发生和减少后遗症,一直是研究的热点。虽然已经有许多关于重症肺炎支原体肺炎危险因素的研究,但这些研究在时间和地理区域上存在差异,因此需要进行系统综述及分析以对其进行全面了解。目的系统评价重症肺炎支原体肺炎的危险因素。方法计算机检索中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、维普网(VIP)、中国生物医学文献数据库(CBM)、独秀学术搜索数据库(Duxiu)、中华医学期刊全文数据库(Yiigle)、Cochrane Library、PubMed、Embase、Web of Science、Science Direct和BioMed Central,检索涉及儿童重症肺炎支原体肺炎危险因素的相关研究,检索时限均从建库至2023年8月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 14.0和RevMan 5.4软件进行Meta分析。结果共纳入22个研究,均为回顾性病例对照研究,包括4531例患儿。Meta分析结果显示,C反应蛋白(CRP)(OR=1.92,95%CI=1.72~2.15,P<0.00001)、红细胞沉降率(ESR)(OR=2.61,95%CI=2.12~3.22,P<0.00001)、降钙素原(PCT)(OR=2.60,95%CI=1.43~4.75,P=0.002)、D-二聚体(OR=4.36,95%CI=2.93~6.50,P<0.00001)、白细胞计数(WBC)(OR=1.98,95%CI=1.66~2.36,P<0.00001)、肺下叶病变(OR=5.70,95%CI=3.48~9.35,P<0.00001)、肺大片状病变(OR=6.37,95%CI=4.09~9.92,P<0.00001)、高肺炎支原体抗体滴度(OR=2.83,95%CI=1.78~4.49,P<0.0001)、乳酸脱氢酶(LDH)(OR=1.03,95%CI=1.00~1.05,P=0.05)、发热时间(OR=8.33,95%CI=3.38~20.56,P<0.00001)是儿童重症肺炎支原体肺炎的影响因素。结论炎性标志物(CRP、ESR、PCT、LDH、WBC)的升高、出现影像学特征性改变(大片状实变、下叶病变)、高肺炎支原体抗体滴度、D-二聚体升高以及发热时间延长可能为儿童重症肺炎支原体肺炎的危险因素。未来需要更高质量的研究来进一步探讨其他临床、影像学和实验室结果与儿童重症肺炎支原体肺炎之间的关系,并基于发现的危险因素建立预后模型。

Meta分析经股动脉穿刺介入术后穿刺部位出血的危险因素

目的探讨股动脉穿刺介入术后穿刺部位出血的危险因素。方法检索从建库至2022年12月31日中国知网、万方、维普、中国生物医学文献服务系统数据库(CBM)、PubMed、Medline、The Cochrane Library、EMbase、Web of Science数据库中关于经股动脉穿刺介入术后穿刺部位出血危险因素的观察性研究,包括横断面研究、病例对照和队列研究文献。采用Newcastle-Ottawa量表(NOS)评分对纳入研究的文献质量进行评价,应用RevMan 5.3软件对文献数据进行Meta分析。结果最终纳入文献8篇(总样本量35250例),术后出血组患者1410例,非出血组33840例。Meta分析结果显示,高龄(OR=2.71,95%CI=2.17~3.38)、女性(OR=4.26,95%CI=1.08~16.89)、高血压(OR=2.48,95%CI=1.69~3.63)、肥胖(OR=2.33,95%CI=1.59~3.42)、使用溶栓剂/抗凝剂/血小板拮抗剂(OR=2.95,95%CI=2.24~3.89)、人工按压(OR=6.78,95%CI=1.34~34.43)是股动脉穿刺介入术后穿刺部位出血的危险因素。结论高龄、女性、高血压、肥胖、使用溶栓剂/抗凝剂/血小板拮抗剂、人工按压是股动脉穿刺介入术后穿刺部位出血的危险因素。

坤宝丸治疗更年期综合征临床疗效和安全性Meta分析

目的系统评价坤宝丸治疗更年期综合征的有效性和安全性。方法采用计算机检索PubMed,EMbase,The Cochrane Library,Web of Science及中国知网(CNKI)、万方(WanFang)、维普(VIP)数据库自建库起至2022年12月的相关文献。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用RevMan 5.3软件对纳入研究进行Meta分析。结果共纳入13项研究,涉及1590例更年期综合征患者,其中观察组803例,对照组787例。按对照组的用药种类进行亚组分析,坤宝丸单用组的临床疗效显著高于氟桂利嗪+谷维素+维生素B1组[RR=1.75,95%CI(1.38,2.22),P<0.00001],坤宝丸联用组临床疗效显著高于戊酸雌二醇+甲羟孕酮组[RR=1.18,95%CI(1.03,1.34),P=0.01]和刺五加组[RR=1.20,95%CI(1.08,1.33),P=0.0007];坤宝丸单用组对更年期临床症状调查表(Kupperman)评分显著低于替勃龙组[MD=-6.00,95%CI(-7.72,-4.28),P<0.00001];坤宝丸联用组卵泡刺激素(FSH)显著低于刺五加组[MD=-25.70,95%CI(-33.22,-18.18),P<0.00001];坤宝丸联用组促黄体素(LH)显著低于刺五加组[MD=-11.20,95%CI(-12.05,-10.35),P<0.00001];坤宝丸单用组雌二醇(E2)显著高于替勃龙组[MD=-7.00,95%CI(-11.44,-2.56),P=0.002]。药品不良反应主要为腹胀、便秘、头晕、阴道出血、体质量增加等,患者均能耐受。结论坤宝丸对更年期综合征患者的临床疗效、Kupperman评分、激素指标等的改善效果与激素类药物相当,甚至更优。但由于纳入研究的质量不高,尚需更严格、高质量的临床研究进一步证实。