喹硫平致嗜酸性粒细胞增多症1例（英文）

概述:血液中嗜酸性粒细胞浓度增加可能会导致心内膜炎、心肌炎乃至心包炎。当嗜酸性粒细胞计数超过1.5×10~9/L时,心肌会受损,甚至会发生死亡。本文报告的病例关于一位患酒精所致精神障碍的47岁男性,经喹硫平50mg/d^200 mg/d的剂量治疗4周后发生嗜酸性粒细胞增多症。患者的嗜酸性粒细胞高达7.63x10^9/L(正常范围<0.5×10~9/L),但停用喹硫平4周后恢复正常,没有心肌受损的表现。该患者突发嗜酸性粒细胞增多症,并无任何相关的临床症状,只是在服用喹硫平数周后常规血液学检查时才发现的。这提醒所有医生在使用抗精神病药物治疗患者时要警惕这种罕见但会危及生命的不良反应。

Effects of ketamine in electroconvulsive therapy for major depressive disorder:meta-analysis of randomised controlled trials

Background The use of ketamine in electroconvulsive therapy(ECT)has been examined in the treatment of major depressive disorder(MDD);however,there has been no systematic review and meta-analysis of related randomised controlled trials(RCTs).Aim To examine the efficacy and safety of ketamine augmentation of ECT in MDD treatment.Methods Two reviewers searched Chinese(China National Knowledge Infrastructure and Wanfang)and English(PubMed,PsycINFO,Embase and Cochrane Library)databases from their inception to 23 July 2019.The included studies'bias risk was evaluated using the Cochrane risk of bias assessment tool.The primary outcome of this metaanalysis was improved d印ressive symptoms at day 1 after a single ECT treatment session.Data were pooled to calculate the standardised mean difference and risk ratio with their 95%CIs using RevMan V.5.3.We used the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach to assess the whole quality of evidence.Results Four RCTs(n=239)compared ketamine alone or ketamine plus propofol(n=149)versus propofol alone(n=90)in patients with MDD who underwent a single ECT session.Three RCTs were considered as unclear risk with respect to random sequence generation using the Cochrane risk of bias.Compared with propofol alone,ketamine alone and the combination of ketamine and propofol had greater efficacy in the treatment of depressive symptoms at days 1,3 and 7 after a single ECT session.Moreover,compared with propofol alone,ketamine alone and the combination of ketamine and propofol were significantly associated with increased seizure duration and seizure energy index.Compared with propofol,ketamine alone was significantly associated with increased opening-eye time.Based on the GRADE approach,the evidence level of primary and secondary outcomes ranged from very low(26.7%,4/15)to‘low'(73.3%,11/15).Conclusion Compared with propofol,there were very low or low evidence levels showing that ketamine alone and the combination of ketamine and propofol appeared to rapidly improve depressive symptoms of patients with MDD undergoing a single ECT session.There is a need for highquality RCTs.

Meta-analysis of the clinical efficacy and safety of Urinary Kallidinogenase in the treatment of acute cerebral infarction

Objective:To evaluate the clinical efficacy and safety of Urinary Kallidinogenase for Injection in the treatment of acute cerebral infarction.Methods:PubMed,The Cochrane Library,Embase,CNKI,VIP,Wan Fang and bibliographic database of Chinese medicine were searched by computer to collect randomized controlled trials of Urinary Kallidinogenase's treatment of acute cerebral infarction.The time limit was set up until September 2019.At the same time,the references and grey literature in the literature were manually screened.Two independent researchers were screened,evaluated and extracted according to inclusion and exclusion criteria.Meta-analysis was carried out by RevMan 5.3 software.Results:A total of 17 randomized controlled trials involving 2,066 patients,including 1,033 in the experimental group,and 1,033 in the control group.meta-analysis results showed that compared with the conventional treatment,Urinary Kallidinogenase had better effect in the treatment of acute cerebral infarction[OR=3.26,95%CI(2.56,4.16),P<0.00001];the national institule of Health Stroke Scale of the Urinary Kallidinogenase group was significantly better than that of the control group.Urinary Kallidinogenase group activity of daily living scale was better than the control group[OR=21.33,95%CI(6.64,36.01),P=0.004];a total of 7 articles reported adverse reactions,including 19 cases in the trial group and 21 cases in the control group,the main adverse reactions were blood pressure drop,other symptoms were chest tightness,facial redness,dizziness fever,nausea and vomiting,arrhythmia,and no other serious adverse reactions.It can recover itself.Conclusion:the available evidence shows that Urinary Kallidinogenase can effectively improve the symptoms of neurological deficits and improve the ability of daily living in patients with acute cerebral infarction,and is safe.However,the quality of the study is limited.

Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia:a metaanalysis

Background Hyperprolactinaemia is a common antipsychotic(AP)-induced adverse effect,particularly in female patients.Aims This meta-analysis examined the efficacy and safety of adjunctive aripiprazole in preventing AP-related hyperprolactinaemia in patients with first-episode schizophrenia.Methods PubMed,PsycINFO,EMBASE,Cochrane Library,WanFang and China Journal Net databases were searched to identify eligible randomised controlled trials(RCTs).Primary outcomes were the reductions of serum prolactin level and prolactin-related symptoms.Data were independently extracted by two reviewers and analysed using RevMan(V.5.3).Weighted/standardised mean differences(WMDs/SMDs)±95%Cis were reported.Results In the five RCTs(n=400),the adjunctive aripiprazole(n=197)and the control groups(n=203)with a mean of 11.2 weeks of treatment duration were compared.The aripiprazole group had a significantly lower endpoint serum prolactin level in all patients(five RCTs,n=385;WMD:-50.43 ng/mL(95%Cl:-75.05 to-25.81),p<0.00001;l2=99%),female patients(two RCTs,n=186;WMD:-22.58 ng/mL(95%Cl:-25.67 to-19.49),p<0.00001;l2=0%)and male patients(two RCTs,n=127;WMD:-68.80 ng/mL(95%Cl:-100.11 to-37.49),p<0.0001).In the sensitivity analysis for the endpoint serum prolactin level in all patients,the findings remained significant(p<0.00001;l2=96%).The aripiprazole group was s叩erior to the control group in improving negative symptoms as assessed by the Positive and Negative Syndrome Scale(three RCTs,n=213;SMD:-0.51(95%Cl:-0.79 to-0.24),p=0.0002;l2=0%).Adverse effects and discontinuation rates were similar between the two groups.Conclusions Adjunctive aripiprazole appears to be associated with reduced AP-induced hyperprolactinaemia and improved prolactin-related symptoms in first-episode schizophrenia.Further studies with large sample sizes are needed to confirm these findings.