Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials

BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory. AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients. METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data. RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.

Chemotherapy for patients with gastric cancer after complete resection: A network meta-analysis

AIM:To conduct a network meta-analysis to evaluate the effectiveness of different chemotherapy regimens for patients with gastric cancer.METHODS:PubMed(1966-2011.12),the Cochrane Library(2011 Issue 2)and EMBASE(1974-2011.12)were searched with the terms"gastric cancer"and"chemotherapy",as well as the medical subject headings.References from relevant articles and conferences were also included.Patients who had previous gastric surgery,radiation before or after surgery or chemotherapy before surgery were excluded.In this study,only randomized controlled trials(RCTs)were considered,and the end-point was the overall mortality.Direct comparisons were performed using traditional meta-analysis whereas indirect comparisons were performed using network meta-analysis.RESULTS:In total,31 RCTs with 7120 patients were included.Five chemotherapy regimens,fluorouracil(FU)+BCNU,FU+methyl-CCNU(mCCNU),FU+cisplatin,FU+anthracyclines and FU+mitomycin c(MMC)+cytarabine(Ara-c),were found to be less beneficial in terms of overall mortality.In contrast,four chemotherapy regimens were effective for the patients after surgery,including FU+MMC+adriamycin(FMA),FU+MMC(FM),Tegafur and MMC,There was no significant difference in terms of overall mortality among these regimens.The evidence for the FM regimen and MMC regimen was poor.Additionally,the FMA regimen,which includes a variety of chemotherapy drugs and causes many side effects,was not better than the Tegafur regimen.CONCLUSION:Although the four chemotherapy regimens were effective in patients with gastric cancer after surgery and the overall mortality revealed no significant difference among them in the network metaanalysis,thorough analysis of the results recommends Tegafur as the first-line adjuvant chemotherapy regimen for patients after complete resection.

Comparative efficacy and safety of cognitive enhancers for treating vascular cognitive impairment: systematic review and Bayesian network meta-analysis

Objective: To assess and compare the clinical efficacy and safety of cognitive enhancers(donepezil, galantamine, rivastigmine, and memantine) on cognition, behavior, function, and global status in patients with vascular cognitive impairment.Data sources: The initial literature search was performed with PubMed, EMBASE, the Cochrane Methodology Register, the Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health(CINAHL) from inception to January 2018 for studies regarding donepezil, galantamine, rivastigmine, and memantine for treatment of vascular cognitive impairment.Data selection: Randomized controlled trials on donepezil, galantamine, rivastigmine, and memantine as monotherapy in the treatment of vascular cognitive impairment were included. A Bayesian network meta-analysis was conducted. Outcome measures: Efficacy was assessed by changes in scores of the Alzheimer's Disease Assessment Scale, cognitive subscale, Mini-Mental State Examination, Neuropsychiatric Inventory scores and Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input, Activities of Daily Living, the Clinical Dementia Rating scale. Safety was evaluated by mortality, total adverse events(TAEs), serious adverse events(SAEs), nausea, vomiting. diarrhea, or cerebrovascular accidents(CVAs). Results: After screening 1717 citations, 12 randomized controlled trials were included. Donepezil and rivastigmine(mean difference(e) = –0.77, 95% confidence interval(CI): 0.25–1.32; MD = 1.05, 95% CI: 0.18–1.79) were significantly more effective than placebo in reducing Mini-Mental State Examination scores. Donepezil, galantamine, and memantine(MD = –1.30, 95% CI: –2.27 to –0.42; MD = –1.67, 95% CI: –3.36 to –0.06; MD = –2.27, 95% CI: –3.91 to –0.53) showed superior benefits on the Alzheimer's Disease Assessment Scale–cognitive scores compared with placebo. Memantine(MD = 2.71, 95% CI: 1.05–7.29) improved global status(Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input) more than the placebo. Safety results revealed that donepezil 10 mg(odds ratio(OR) = 3.04, 95% CI: 1.86–5.41) contributed to higer risk of adverse events than placebo. Galantamine(OR = 5.64, 95% CI: 1.31–26.71) increased the risk of nausea. Rivastigmine(OR = 16.80, 95% CI: 1.78–319.26) increased the risk of vomiting. No agents displayed a significant risk of serious adverse events, mortality, cerebrovascular accidents, or diarrhea.Conclusion: We found significant efficacy of donepezil, galantamine, and memantine on cognition. Memantine can provide significant efficacy in global status. They are all safe and well tolerated.

Effects of Incretin-based Therapies on Weight-related Indicators among Patients with Type 2 Diabetes: A Network Meta-analysis

Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medline,Embase,the Cochrane Library,and clinicaltrials.gov(www.clinicaltrials.gov)were searched for randomized controlled trials(RCTs).Standard pairwise meta-analysis and network meta-analysis(NMA)were both carried out.The risk of bias(ROB)tool recommended by the Cochrane handbook was used to assess the quality of studies.Subgroup analysis,sensitivity analysis,meta-regression,and quality evaluation based on the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)were also performed.Results A total of 292 trials were included in this study.Compared with placebo,dipeptidyl-peptidase IV inhibitors(DPP-4 Is)increased weight slightly by 0.31 kg[95%confidence interval(CI):0.05,0.58]and had negligible effects on BMI and WC.Compared with placebo,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)lowered weight,BMI,and WC by-1.34 kg(95%CI:-1.60,-1.09),-1.10 kg/m2(95%CI:-1.42,-0.78),and-1.28 cm(95%CI:-1.69,-0.86),respectively.Conclusion GLP-1 RAs were more effective than DPP-4 Is in lowering the three indicators.Overall,the effects of GLP-1 RAs on weight,BMI,and WC were favorable.

Outcomes of 4 surgical adjuvants used for internal limiting membrane peeling in macular hole surgery: a systematic review and network Meta-analysis

AIM:To compare the outcomes of four adjuvants used for internal limiting membrane(ILM)peeling in macular hole surgery,including indocyanine green(ICG),brilliant blue G(BBG),triamcinolone(TA)and trypan blue(TB),through systematic review and random-effects Bayesian network Meta-analysis.METHODS:PubMed,Cochrane library databases and Web of Science were searched until August 2018 for clinical trials comparing the above four adjuvants.ORs for postoperative best corrected visual acuity(BCVA)improvement and primary macular hole closure rates were compared between the different adjuvants.RESULTS:Twenty-seven eligible articles were included.For postoperative BCVA improvement,results of BBGassisted peeling were significantly more favorable than those of ICG(WMD 0.08,95%credible interval 0.01-0.16)and TA ranked highest.No significant differences were found between any other two groups in postoperative BCVA improvement.For postoperative primary macular hole closure rates,BBG ranked highest.However,no significant differences were shown between any two groups.CONCLUSION:TA and BBG are the optimum adjuvants for achieving postoperative BCVA improvement macular hole surgery with adjuvant-assisted ILM peeling.Among all adjuvants,the use of BBG is associated with the highest postoperative macular hole closure rate.

Internal limiting membrane peeling with different dyes in the surgery of idiopathic macular hole: a systematic review of literature and network Meta-analysis

AIM: To evaluate the effect of internal limiting membrane(ILM) peeling with indocyanine green(ICG), brilliant blue G(BBG), triamcinolone acetonide(TA), trypan blue(TB), or without dye for the treatment of idiopathic macular hole(IMH). METHODS: A search was conducted using Pub Med, EMBASE, and CENTRAL(Cochrane Central Register of Controlled Trials) for related studies published before October 2018. RESULTS: A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. CONCLUSION: BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.

Surgery with adjuvant or neoadjuvant treatment vs surgery alone for resectable pancreatic cancer: A network meta-analysis

BACKGROUND Pancreatic cancer is one of the most common and lethal malignancies worldwide. The common treatment options for resectable pancreatic cancer include surgery alone, neoadjuvant chemotherapy (CT), neoadjuvant chemoradiotherapy (CRT), adjuvant CT, and adjuvant CRT. However, the optimal treatment is still controversial. AIM To identify the most effective approach for pancreatic cancer using network meta-analysis. METHODS Eligible studies were searched from PubMed, MEDLINE, EMBASE, Cochrane database, and Google scholar. We searched and included randomized controlled trials reporting on neoadjuvant and adjuvant therapies. For direct comparisons, standard pairwise meta-analysis was performed using the inverse variance DerSimonian-Laird random-effects model. For indirect comparisons, Bayesian network meta-analysis was used to combine direct and indirect evidence. We used relative hazard ratios (HRs) to estimate death difference of different treatments, and relative odds ratios (ORs) for toxic effects. Treatment effects were ranked based on their efficacy for improving survival or reducing toxicity using rankogram. The quality of evidence of estimates from direct comparison and network meta-analysis was evaluated following the GRADE approach. RESULTS We included 13 high quality trials with 1591 participants in this network metaanalysis. Compared with surgery alone [pooled HR = 0.7, 95% confidence interval (CI): 0.62-0.79] and surgery with adjuvant CRT (pooled HR = 0.6, 95%CI: 0.54-0.72), surgery with adjuvant CT had a higher rate of overall survival. In contrast, standard pairwise meta-analysis showed a statistically significant survival advantage of surgery with adjuvant CT compared with surgery alone (pooled HR = 0.75, 95%CI: 0.63-0.89;P < 0.001). Rankogram showed that surgery with adjuvant CT was most likely to rank the best in terms of overall survival (probability: 94.2%), followed by surgery alone (probability: 5.8%). No significant differences in overall toxicity or haematological toxicity were found between all the therapies. High quality evidence supported surgery with adjuvant CT over surgery alone for increasing overall survival. Moderate quality evidence supported surgery with adjuvant CT over surgery with adjuvant CRT for increasing overall survival. CONCLUSION Surgery with adjuvant CT prolongs overall survival compared with surgery alone and surgery with adjuvant CRT, suggesting surgery with adjuvant CT is the optimal treatment for resectable pancreatic cancer.

Antibiotics for eradicating meningococcal carriages:Network meta-analysis and investigation of evidence inconsistency

AIM To compare different antibiotics for eradicating the carriage of Neisseria meningitidis(N.meningitidis),and to investigate heterogeneity and evidence inconsistency.METHODS From a search of Pub Med and published systematic reviews,we identified 23 trials evaluating 15 antibiotics that could be connected in a trial network.The outcome of interest is the eradication of N.meningitidis.We used Win BUGS to conduct random-effects,mixed treatment comparisons.Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and interventions evaluated.RESULTS Rifampin,ciprofloxacin,minocycline,ceftriaxone,and azythromycin were statistically significantly(P<0.05)more effective than placebo.The probability of being the best was 67.0%for a combination of rifampin and minocycline,25.0%for ceftriaxone,1.7%for azythromycin,and below 1%for the remaining regimens.Significant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofloxacin(P<0.01),which may becaused by different types of carriers and different doses of ciprofloxacin.CONCLUSION A range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages,and treatment choice will depend on the individual priorities of the patients and physicians.In clinical situations where complete eradication is considered to be of the utmost importance,a combination of rifampin and minocycline seems to offer the highest likelihood of success.Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics(ciprofloxacin or rifampin)recommended by the current guidelines.

Comparison of Efficacy and Safety of Artemisinin-Based Combination Therapies for Treating Uncomplicated Falciparum Malaria in Sub-Saharan African Countries: An Update on the Changes in Efficacy Using Network Meta-Analysis

Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A database of randomized controlled trials was retrieved from published papers. Network meta-analysis was used to compare efficacy on day 28 and day 42 after initiation of treatment. Age covariate effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated under the hypothesis of consistency in a meta-regression. Safety and adverse events were compared among different ACTs. A Bayesian analysis was performed to implement the consistency models using WinBUGS software. The results were compared to those of the frequentist approach using the R software. Results: Eighty-one articles, in which a total of 15 different ACTs were tested in more than 36,000 patients, were included. On day 28, dihydroartemisinin-piperaquine (DHPP) was more effective than artemether-lumefantrine (AL) before (odds ratio [OR], 1.83;95% confidence interval [CI], 1.31 - 2.56) and after age-covariate adjustment (OR, 1.70;95% CI, 1.20 - 2.43). The result was similar on day 42. DHPP occupied the top rank. The risk of having cough, diarrhoea or headache post-treatment was significantly lower with DHPP than AL. Artesunate-mefloquine (ASMQ) was associated with a significantly lower prevalence of vomiting or nausea (OR, 0.80;95% CI, 0.48 - 1.30) and headache (OR, 0.53;95% CI, 0.40 - 0.68) compared to AL. On the contrary, vomiting and nausea occurred more frequently after fixed-dose artesunate-amodiaquine formulation (ASAQf) than with AL (OR, 1.45;95% CI, 1.18 - 1.78). The risk of anaemia was higher with ASAQf and co-blistered artesunate-amodiaquine (ASAQc) than with AL. There was no significant difference in risk of anaemia (P > 0.05) between AL and different formulations of ASAQ. Conclusions: Based on the available evidence, this study demonstrated the superiority of DHPP, followed by AL, among currently recommended ACTs in terms of efficacy and tolerance. Network meta-analysis could be an alternative analytical tool but needs more data input from therapeutic efficacy studies. The determination of the best available therapy requires data triangulation and data science.

The optimal choice of chemotherapy regimens for patients with relapsed platinum-resistant epithelial ovarian cancer/primary peritoneal/fallopian tube cancer - protocol for a systematic review and network meta-analysis

目的：上皮性卵巢癌、原发性腹膜癌、输卵管癌预后较差,减瘤术联合紫杉醇加铂类化疗是目前的首选方案.由于其二线化疗方案的选择较多,目前并无标准首选方案,本计划书将对应用网状meta分析对铂类耐药的卵巢癌二线化疗方案的优化选择进行先期计划.方法：选取Medline, EMBASE, Cochrane Library and Cochrane Library databases, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, ClinicalTrials.gov数据库进行文献检索.纳入复发耐药型卵巢癌化疗,免疫治疗,生物治疗,靶向治疗的随机对照试验.应用CochraneRiskofBiasTool评估纳入的文献质量.主要观察指标为：中位生存期和整体生存率.次要观察指标为：有效性和安全性方面的评价.应用直接meta分析与间接meta分析（应用networkmeta-analysis（NMA））进行数据统计.结论：应用networkmeta分析,对复发性铂类耐药的随机对照试验提供的数据进行直接和间接比较,将可能对试验涉及的多种治疗方案的效果和安全性进行优化排序,为临床医师在实际工作中提供建议.

SGLT-2抑制剂致2型糖尿病患者低血糖的网状Meta分析

目的评价钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂致2型糖尿病(T2DM)患者低血糖的发生风险。方法计算机检索PubMed、Web of Science、Cochrane图书馆、中国知网、维普网、万方数据、中国生物医学文献数据库,收集SGLT-2抑制剂治疗T2DM的随机对照试验(RCT),检索时限均为建库起至2022年10月15日。筛选文献、提取数据,采用Cochrane系统评价员手册推荐的5.1.0偏倚风险评估工具对纳入文献进行质量评价后,采用Stata 15.1软件进行网状Meta分析和发表偏倚分析。结果共纳入22项RCT,共计18734例患者。Meta分析结果显示,与埃格列净15 mg[RR=3.26,95%CI(1.13,8.11),P<0.05]及埃格列净25 mg[RR=3.08,95%CI(1.12,6.34),P<0.05]比较,使用卡格列净300 mg时患者的低血糖发生率显著升高;与埃格列净15 mg[RR=1.48,95%CI(1.24,6.93),P<0.05]及埃格列净25 mg[RR=6.74,95%CI(1.33,9.34),P<0.05]比较,使用卡格列净100 mg时患者的低血糖发生率显著升高;其他各组间比较,差异均无统计学意义(P>0.05)。网状Meta分析排序结果显示,低血糖发生率从低到高依次为:埃格列净15 mg>安慰剂>埃格列净25 mg>恩格列净25 mg>恩格列净10 mg>恩格列净1 mg>达格列净5 mg>达格列净10 mg>达格列净2.5 mg>卡格列净300 mg>埃格列净10 mg>埃格列净5 mg>恩格列净50 mg>卡格列净200 mg>卡格列净100 mg>卡格列净50 mg>埃格列净1 mg>恩格列净5 mg。发表偏倚分析结果显示,本研究存在发表偏倚的可能性较小。结论SGLT-2抑制剂治疗T2DM时,以使用埃格列净15 mg低血糖发生率最低,使用恩格列净5 mg最高。

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。

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。

口服中成药联合常规西药治疗稳定型心绞痛的网状Meta分析

目的:运用网状Meta分析方法系统评价中成药联合常规西药治疗稳定型心绞痛的有效性及安全性。方法:计算机检索PubMed、The Cochrane Library、Embase、Web of Science、万方、维普、知网和中国生物医学文献数据库,搜集中成药联合常规西药治疗稳定型心绞痛的随机对照试验,检索时限均为建库至2022年2月10日。采用RevMan5.3、STATA15.1软件进行数据统计分析。结果:共纳入70项随机对照试验,包括6 973例患者,涉及7种中成药。网状Meta分析结果显示:(1)在提高心绞痛疗效方面,排序依次为养心氏片+常规西药>麝香保心丸+常规西药>冠心舒通胶囊+常规西药>芪参益气滴丸+常规西药>丹蒌片+常规西药>心可舒片+常规西药>益心舒胶囊+常规西药>常规西药;(2)在提高心电图疗效方面,排序依次为芪参益气滴丸+常规西药>养心氏片+常规西药>麝香保心丸+常规西药>冠心舒通胶囊+常规西药>心可舒片+常规西药>益心舒胶囊+常规西药>丹蒌片+常规西药>常规西药;(3)在升高高密度脂蛋白胆固醇方面,排序依次为冠心舒通胶囊+常规西药>益心舒胶囊+常规西药>麝香保心丸+常规西药>心可舒片+常规西药>常规西药;(4)在降低低密度脂蛋白胆固醇方面,排序依次为养心氏片+常规西药>益心舒胶囊+常规西药>冠心舒通胶囊+常规西药>丹蒌片+常规西药>心可舒片+常规西药>麝香保心丸+常规西药>常规西药;(5)在安全性方面,中成药联合常规西药的不良反应整体少于对照组。结论:本研究表明,中成药联合常规西药治疗稳定型心绞痛可显著提高其心绞痛及心电图疗效,同时具有调脂作用且安全性更好。但部分纳入研究的方法学质量不佳,故此结论需进一步在更多高质量研究中予以验证。

含山楂中成药治疗动脉粥样硬化的网状Meta分析

目的:系统评价含山楂中成药治疗动脉粥样硬化的疗效及安全性。方法:检索数据库搜集中成药治疗动脉粥样硬化的RCT。按纳、排标准筛选,对结局指标行网状Meta分析。结果:共纳入40篇文献,试验组涉及6种含山楂中成药,结果显示银丹心脑通软胶囊联合他汀降低TC、TG,升高HDL-C效果更好。荷丹片联合他汀降低LDL-C、hs-CRP效果更好。蒲参胶囊联合他汀提高临床疗效有效率更优。试验组不良反应少于对照组。结论:他汀类药物联合含山楂类中成药可以提高临床疗效。但基于本研究存在不足,应谨慎参考本次排序结果。但需开展更多多中心、大样本、高质量RCT补充验证。

不同ACEI药物治疗高血压干咳不良事件的网络Meta分析

目的利用网络Meta分析系统评价咪达普利及其他血管紧张素转换酶抑制剂(ACEI)类药物治疗高血压降压总有效率及干咳不良事件发生率。方法检索至2023年6月30日前在PubMed、EMBASE、Cochrane Library、中国知网、维普、万方数据库国内外公开发表的使用咪达普利片等ACEI类药物治疗原发性或肾实质性高血压的随机对照试验(RCTs)文献。采用STATA 14.0软件进行网络Meta分析,评价不同ACEI药物治疗高血压干咳不良事件发生率和降压总有效率,效应指标以比值比(OR)及95%置信区间(CI)表示。结果本研究共纳入15项RCTs,共2545例研究对象,包含咪达普利、贝那普利、卡托普利、培哚普利、依那普利、西拉普利6种不同ACEI药物。9项研究报告了降压总有效率,与卡托普利治疗高血压相比,咪达普利(OR=2.09,95%CI:1.36~3.22)降压治疗总有效率高;而其余药物间降压总有效率差异无统计学意义。15项研究报告了干咳不良事件发生率,与依那普利(OR=2.74,95%CI:1.68~4.47)、西拉普利(OR=2.55,95%CI:1.38~4.74)、卡托普利(OR=2.68,95%CI:1.74~4.15)、贝那普利(OR=3.14,95%CI:2.07~4.75)相比,咪达普利干咳不良事件发生率较低;与贝那普利相比,培哚普利治疗干咳不良事件发生率较低(OR=0.40,95%CI:0.16~0.96)。降压总有效率累积概率从高到低排序依次为咪达普利、培哚普利、西拉普利、卡托普利、依那普利、贝那普利。结论在采用ACEI药物治疗高血压时,可考虑选择咪达普利,亟待更大样本多中心RCTs研究进一步证实。

大鼠急性血瘀证模型造模方法的网状Meta分析

目的:采用网状Meta分析评价不同急性血瘀证模型造模方法的效果,为中医实验研究急性血瘀证动物模型的制备提供循证依据。方法:检索中国期刊全文数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)中有关急性血瘀证模型的建模方法,应用Stata软件进行网状Meta分析。结果:最终纳入32项研究,共纳入9种造模方案。各项指标最优前3位概率排序分别为:1)全血黏度:1 S^(-)1切变率右旋糖酐>高脂>氢化可的松+肾上腺素,10 S^(-)1切变率冰水浴>肾上腺素>高脂+力竭游泳,30 S^(-)1切变率多因素刺激>右旋糖酐>肾上腺素,60 S^(-)1切变率多因素刺激>右旋糖酐>肾上腺素,150 S^(-)1切变率肾上腺素>冰水浴>高脂+力竭游泳,200 S^(-)1切变率右旋糖酐>氢化可的松+肾上腺素>角叉莱胶+内毒素;2)血浆黏度:右旋糖酐>多因素刺激>肾上腺素;3)红细胞聚集指数:冰水浴>多因素刺激>高脂+力竭游泳。受纳入研究质量和数量的限制,所得结论仍待进一步验证。结论:右旋糖酐、冰水浴、多因素刺激、肾上腺素造模效果更显著。

中成药治疗慢性阻塞性肺疾病稳定期的网状Meta分析

目的:采用网状Meta分析评价口服中成药治疗慢性阻塞性肺疾病(COPD)稳定期的有效性及安全性。方法:计算机检索国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、PubMed、Embase、Web of Science、Cochrane library数据库中不同中成药治疗COPD稳定期的临床随机对照试验(RCT),检索时限为建库至2022年05月11日。采用R 4.1.1、Stata 16.0、Review manager 5.3软件进行数据分析。结果:共纳入70项RCT,包括6652例患者,涉及5种中成药。依据累计概率值排序,网状Meta分析结果显示,改善COPD自我评估测试(CAT)问卷评分方面,百令胶囊+常规治疗(>常规治疗;改善第一秒用力呼气容积占预计值百分比(FEV_(1)%)方面,百令胶囊+常规治疗>金水宝胶囊+常规治疗>补肺活血胶囊+常规治疗>玉屏风颗粒+常规治疗>常规治疗);改善六分钟步行距离(6MWD)方面,金水宝胶囊+常规治疗>补肺活血胶囊+常规治疗>百令胶囊+常规治疗>常规治疗;降低二氧化碳分压方面(PaCO_(2)),补肺活血胶囊+常规治疗>金水宝胶囊+常规治疗>百令胶囊+常规治疗>常规治疗;降低年急性发作次数方面,百令胶囊+常规治疗>常规治疗。5种中成药均未产生严重不良反应。结论:5种中成药治疗稳定期COPD均能提高临床综合疗效,但各有侧重,其中百令胶囊组综合疗效较好。

基于网状Meta分析对8个经典名方治疗不稳定型心绞痛的临床疗效评价

目的:运用网状Meta分析方法系统评价8种经典名方联合西医常规治疗不稳定型心绞痛(UAP)的临床疗效,并分别进一步比较不同经典名方治疗实证和虚证(包括虚实夹杂)2大证型的疗效。方法:检索并筛选中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、中国国家知识基础设施数据库(CNKI)与中国学术期刊数据库(CSPD)等数据库中关于8个经典名方(血府逐瘀汤、补阳还五汤、四妙勇安汤、丹参饮、炙甘草汤、枳实薤白桂枝汤、瓜蒌薤白半夏汤、化痰祛瘀通脉汤)联合西医常规治疗UAP的随机对照试验(RCT),检索时限从各数据库建库至2022年1月14日,采用Stata 16.0软件进行网状Meta分析。结果:共纳入60个RCT,总计5088例UAP患者,涉及9种干预措施。其中,UAP属实证的有41个RCT,UAP患者共3432例,涉及5种干预措施;虚证或虚实夹杂共13个,共1130例患者,涉及4种干预措施。网状Meta分析结果提示,枳实薤白桂枝汤+西医常规治疗总有效率最优,UAP属实证者,四妙勇安汤+西医常规治疗最佳;虚证或虚实夹杂者,补阳还五汤+西医常规治疗最佳;心电图改善方面,四妙勇安汤疗效最佳;枳实薤白桂枝汤+西医常规在降低超敏C反应蛋白(hs-CRP)改善炎症反应方面更优。结论:与西医常规治疗UAP比较,枳实薤白桂枝汤联合西药常规治疗疗效较显著。但仍需要纳入更多高质量的RCT证实。

非药物康复干预对乳腺癌患者化疗相关认知障碍影响的网状Meta分析

目的:评价非药物康复干预措施对乳腺癌患者化疗相关认知障碍的治疗效果。方法:检索Pubmed,Cochrane library,Embase,Web of science,中国知网,万方,维普,CBM数据库符合研究目的的随机对照试验,检索时限截止到2022年2月,应用Stata 16.0软件进行网状Meta分析。结果:纳入研究22项,共10种非药物干预方法,并且纳入的研究均未报告显著不良事件,表明这10种非药物干预措施对于治疗化疗相关认知障碍是安全的。网状结果显示,相比于常规护理,最有效的干预措施排序为正念疗法、认知训练。结论:非药物康复干预对乳腺癌化疗相关认知障碍的治疗安全有效,其中正念疗法和认知训练的干预效果可能最佳,这一结果为临床决策提供了循证数据支持,未来需进行更多高质量研究探索最佳性价比的干预措施。