不同针灸疗法治疗中风后痉挛性偏瘫的网状Meta分析

Objective:To perform a network meta-analysis on four commonly used acupuncture therapies(electroacupuncture,fire acupuncture,warm acupuncture,and filiform needling) and rehabilitation therapy in the treatment of post-stroke spastic hemiplegia so as to compare the differences in clinical therapeutic effect between acupuncture therapy and rehabilitation therapy as well as among different therapeutic methods of acupuncture.Methods:A computer-based retrieval was conducted in Chinese and English databases,i.e.CNKI,WanFang,VIP,SinoMed,PubMed,Embase,Web of Science and Cochrane library.The search period limit was from the database establishment to April 17,2020.Data analysis was performed through Revman 5.3,Gemtc 0.14.3 and Stata 14.2.Results:A total of 27 trials were finally eligible,including 1880 patients,943 patients of which were in observation group and 937 patients in control group.In terms of the improvement of effective rate,electroacupuncture,fire needling,warm acupuncture and filiform needling methods were all better than rehabilitation therapy,and among which,warm acupuncture was the highest in probability to be the optimal measure.Regarding the improvement in Fugl-Meyer Assessment(FMA) motor function score,fire needling,warm acupuncture and filiform needling methods were all better than rehabilitation therapy,and among which,fire needling method was the highest in probability to be the optimal measure.In view of the improvement of BI score,fire needling method was better than electroacupuncture and filiform needling method,while,warm acupuncture was better than electroacupuncture,thus,fire needling method may be the optimal measure.For the modified Ashworth muscular tension assessment,there was no significant differences in pairwise comparison among different interventions and warm acupuncture was probably the optimal measure.Conclusion:The overall therapeutic effect of 4 acupuncture therapies is better than rehabilitation therapy on post-stroke spastic hemiplegia,respectively,among which,the therapeutic effect of warm acupuncture and fire needling method is the best.However,because of a limitation of the varieties of acupuncturemoxibustion therapy and the number of included trials,it needs to conduct more rigorous and scientific randomized controlled trials so that this conclusion can be further confirmed.     

Traditional Chinese Herbal Medicine for Perimenopausal Depression of Chinese Women: A Meta‑analysis

Objective: The objective of this study is to evaluate the effectiveness and safety of traditional Chinese herbal medicine (TCHM) in treatment of perimenopausal depression (PD) in China. Methods: To identify randomized controlled trials, an electronic search has been conducted through databases as follows: PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese Biological Medicine Database, China National Knowledge Infrastructure Database, Chinese Scientific Journal Database, and WanFang Digital Periodicals Database. Methodological quality was evaluated by Cochrane Collaboration’s tool which is able to assess the risk of bias in Review Manager Software. What’s more, meta?analysis was performed by using Cochrane Collaboration’s RevMan 5.2 software, (Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen, and Denmark). Dichotomous data were analyzed by using relative risk (RR) and 95% confidence interval (CI). Continuous variables were analyzed using weighted mean differences (WMDs) and 95% CI. Subgroup analysis was performed by the type of medicine which was used in the experimental group. Results: This meta?analysis includes 11 randomized control trials with 818 patients. Compared to the control group (RR: 1.14, 95% CI: [1.03, 1.26], P = 0.009 and WMD: ?2.09, 95% CI: [ ?3.58, ?0.18]), the experimental group had a significant higher clinical efficacy rate and relatively lower Hamilton Depression Rating Scale (HAM?D) score. For clinical efficacy rate, the results varied depending on the detail treatment measures of the experimental group. In the experimental group with TCHM, no significant difference was observed (RR: 1.14, 95% CI: [0.97, 1.33]), while in the experimental group combined with western medicine, a significant difference in the clinical efficacy rate between the experimental group and control group showed up (RR: 1.15, 95% CI: [1.01, 1.32], P = 0.04). For the HAM?D score, subgroup analyses revealed that the pure TCHM therapy was not associated with significant HAM?D score reduction compared to the control group (WMD: ?2.48, 95% CI: [?6.00, 1.03], P = 0.17). However, in the experimental group where western medicine was added to, the HAM?D score decreased statistically compared to the control group (WMD: ?1.88, 95% CI: [?3.58, ?0.18], P = 0.03). There is no serious adverse event in both groups. Conclusions: Combination therapy of TCHM and western medicine is more effective in treating PD in terms of clinical efficacy rate. However, the results should be interpreted with caution due to the mediocre methodological quality of the included trials.     

Kangfuxin (Periplaneta americana) Lotion for Adjunctive Treatment of Ulcerative Colitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: The objective of the study is to investigate the effect of Kangfuxin lotion as adjunctive therapy for treating ulcerative colitis(UC) through a systematic review and meta?analysis of randomized controlled trials(RCTs). Materials and Methods: RCTs comparing Kangfuxin lotion with no treatment, placebo, western medications or combination therapy for treatment of UC were included in this study. Two English and three Chinese electronic databases were searched. All searches ended in December 2017. Data and quality assessment carried out respectively. Rev Man 5.2 software(Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2014) was used to analyze with effect estimate presented as mean difference(MD), risk ratio(RR) and 95% confidence interval(CI). Results: Fifteen trials with 1050 participants were included in this review. Overall, 13 trials were eligible for meta?analysis. Kangfuxin lotion combined with Mesalazine was better than Mesalazine on clinical cure rate(RR 1.45, 95% CI 1.24–1.70, 7 trials), recurrence rate of UC(RR 0.22, 95% CI 0.07–0.72, 2 trials), or endoscopic mucosal recovery(RR 8.05, 95% CI 2.64–24.57, 2 trials). And Kangfuxin lotion combined with triple live bacteria tablets(Bifidobacterium-Lactobacillus? Streptococcus thermophilus)was superior with regard to symptoms remission rate(RR 5.36, 95% CI 1.73–16.60, 3 trials), endoscopic disease activity score(MD-2.30, 95% CI-2.64–-1.96, 1 trial). There were no reports on the serious adverse events of Kangfuxin lotion. Conclusion: Kangfuxin lotion as adjunctive treatment appears more effective than medications alone on clinical cure rate, recurrence rate, endoscopic mucosal recovery and improvement rate of related symptoms.     

Treatment of 60 Cases of Gouty Arthritis with Modified Simiao Tang

Objective： To observe the clinical effect of a modified Simiao Tang （加味四妙汤 Modified Decoction of Four Wonderful Drugs） for gouty arthritis and its influence on uric acid in blood. Methods： 120 cases of gouty arthritis were randomly divided into the treatment group and control group with 60 cases in each group. Modified Simiao Tang （MST） was orally administered to the patients in the treatment group and allopurinol tablet was orally administered to the patients in the control group. The clinical effects of two groups were evaluated after one-week treatment and uric acid （UA） and C-reactive protein （CRP） levels in blood were determined after 1-month treatment. Results： The total effective rate in the treatment group was significantly higher than in the control group, 86.7% vs. 68.3% （P〈 0.01）. And the treatment group was also significantly better than the control group in decreasing UA and CRP （P〈 0.05 or P〈 0.01）. Conclusions： MST can significantly improve the symptoms and signs of gouty arthritis and decrease the levels of UA and CRP. It is good for gouty arthritis.     

针刺加刺络与卡马西平治疗偏头痛效应差异的观察（英文）

Objective:To observe the clinical therapeutic effect on migraine treated with acupuncture combined with blood-letting therapy.Methods:A total of 90 patients of migraine were included in compliance with the requirement and divided into a blood-letting therapy group,a western medication group,an acupuncture plus blood-letting therapy group,30 cases in each one according to the random number table.In the two control groups,the simple blood-letting therapy was exerted at Dazhui(大椎 GV14) and the oral administration with carbamazepine were provided respectively.In the acupuncture plus blood-letting therapy group,acupuncture was exerted at Baihui(百会 GV20) and other points,with blood-letting therapy combined.The treatment was given once daily and 12 treatments were as one course.After 2 courses of treatment,the score of therapeutic effect on symptoms and signs,pain score of visual analogue scale(VAS) and clinical therapeutic effect were compared among the three groups before and after treatment.Results:At the end of treatment,the scores for symptoms and signs and VAS score were reduced obviously as compared with those before treatment in the three groups(all P 0.01).Compared with the blood-letting therapy group and the medication group,the scores for symptoms and signs and VAS score were all reduced more obviously in the acupuncture plus blood-letting therapy group respectively(all P0.01) and the differences were not significant between the blood-letting therapy group and the medication group(P 0.05).The total effective rate in the acupuncture plus blood-letting therapy group was higher obviously than either the blood-letting therapy group or the medication group(both P 0.05).Conclusion:Acupuncture combined with blood-letting therapy achieves a better clinical therapeutic effect on migraine as compared with either simple blood-letting therapy or medication.Such combined treatment obtains a satisfactory therapeutic results and deserves to be promoted in clinical application.     

Wrist–ankle acupuncture combined with pinching along the spine for children allergic rhinitis: A randomized controlled trial

Objective: To investigate the clinical effect of wrist–ankle acupuncture combined with pinching along the spine on allergic rhinitis(AR) in children.Methods: A total of 65 children with AR were collected from February 2017 through to December 2018 and they were randomly divided into a combined treatment group with wrist–ankle acupuncture, pinching along the spine and western medication(combined treatment group, 32 cases) and a western medication group(33 cases). In the western medication group, loratadine was prescribed for oral administration. In the combined treatment group, on the base of the medication as the western medication group,the wrist–ankle acupuncture was adopted in combination with pinching along the spine. Before and after treatment, the symptoms and physical signs were scored and the clinical effect was observed in the children of the two groups.Results: After the treatment and in the follow-up, the scores of the symptoms and physical signs in the combined treatment group were lower than those of the western medication group, indicating a statistical significance(all P 0.05). The total effective rate was 93.7% in the combined treatment group,which was higher than 63.63% in the western medication group, indicating a statistical significance(P 0.05).Conclusion: The combined treatment of wrist–ankle acupuncture combined with pinching along the spine and loratadine effectively relieves the clinical symptoms and the physical signs in AR children. The clinical effect of this combined treatment is better than the simple use of loratadine.     

Therapeutic observation on swift needling with fire needle plus medication for herpes zoster

Objective： To discuss the effectiveness and safety of swift needling with fire needle plus medication in treating herpes zoster and the change of substance P. Methods： Seventy-nine patients with herpes zoster were selected and randomized into a fire-acupuncture group （41 cases） and a Western- medication group （38 cases）. The fire-acupuncture group was intervened by swift needling with fire needle, and simultaneously prescribed with Valaciclovir Hydrochloride tablets and Vitamin B1; the Western-medication group was by the same oral medicines alone. The therapeutic efficacies were evaluated afterwards. Results： The total effective rate was 95.1% in the fire-acupuncture group versus 89.5% in the Western-medication group, and the difference was statistically significant （P〈0.05）. After treatment, the concentration of substance P and visual analogue scale （VAS） score dropped significantly in both groups （both P〈0.05）; the inter-group differences were statistically significant （both P〈0.05）. Conclusion： Swift needling with fire needle plus medication has better therapeutic efficacy than medication alone in treating herpes zoster.     

电针联合隔姜灸对多囊卵巢综合征不孕患者子宫内膜容受性的影响

Objective:To observe the effect of the combined therapy of electroacupuncture(EA) and ginger-isolated moxibustion on endometrial receptivity in the patients with polycystic ovarian syndrome(PCOS).Methods:A total of 70 subjects of PCOS were randomized into two groups,35 cases in each one.In the western medication group,letrozole and human chorionic gonadotropin(HCG) were administered.In the combined therapy group,on the base of the treatment as the western medication group,the artificial cycle therapy with EA and ginger-isolated moxibustion was provided.The treatment duration was 3 menstrual cycles in two groups.After treated for 3 menstrual cycles,the symptom score of traditional Chinese medicine(TCM),endometrial thickness,the number of ovulation cycle,endometrial morphology,bilateral uterine artery pulsatility index(PI),resistance index(RI),the sum of peak systolic velocity/end diastolic velocity(S/D) and pregnancy were compared in the patients between two groups.Results:(1) After treatment,the endometrial thickness was better(0.21 ± 0.13 vs 0.14 ± 0.08,P <0.01),TCM symptom score reducing range was larger(5.00 ± 2.24 vs 0.52 ± 1.66,P <0.01),the reducing degrees of bilateral uterine artery PI,RI and S/D sum were better(0.62 ± 0.26 vs 0.04 ± 0.15,0.08± 0.05 vs0.01±0.05,0.61±0.33 vs 0.07±0.17,0.11±0.05 vs 0.01 ± 0.05,4.80±1.14 vs 0.15 ± 0.89,all P <0.01) in the combined therapy group respectively as compared with the western medication group.After treatment,the number of ovulation cycle and the proportion of A+B type of endometrial morphological were higher in the combined therapy group(2.09 ± 0.78 vs 1.27 ± 0.84,87.5% vs 60.61%,P <0.01,P <0.05) as compared with the western medication group respectively.(2) The clinical pregnancy rate was56.25% in the combined therapy group,better than 30.30% in the western medication group(P <0.05).The early abortion rate was 10.53% in the combined therapy group,lower than 50.00% in the western medication group(P <0.05).Conclusion:The combined treatment of electroacupuncture and ginger-isolated moxibustion with western medication effectively improves endometrial receptivity,increases clinical pregnancy rate and reduces early abortion rate in the patients with PCOS.     

Systematic Review and Meta-Analysis of Hugan Tablets(护肝片)in the Treatment of Drug-Induced Liver Injury

Objective:To systematically evaluate the efficacy and safety of Hugan Tablets(护肝片)in the treatment of drug-induced liver injury.Methods:Totally seven Chinese and English databases,including CNKI,Wanfang,VIP,CBM,PubMed,EMbase,Web of Science were searched for randomized controlled trials(RCTs)of Hugan Tablets(护肝片)for the treatment of drug-induced liver injury,which were published from the date of establishment to April 20,2019.The meta-analysis software RevMan 5.3 software and Excel were used to build a database into combine and analyze the studies that met the standards and to draw a forest plot.Results:Forty five RCTs were included with 7478 patients.The quality of included studies was uneven.Meta-analysis showed that the outcome index of liver injury rate was divided into seven subgroups.Hugan Tablets(护肝片)were used in the treatment of anti-tuberculosis drugs was superior to the conventional western medicine treatment group(RR=0.27,95%CI[0.22,0.33],P<0.00001).Which was also better than the without Hugan Tablets(护肝片)treatment group(RR=0.32,95%CI[0.20,0.52],P<0.00001).For the role of drug-induced liver injury in the treatment of type 2 diabetes,the Hugan Tablet+conventional treatment group is better than the conventional treatment group(RR=0.16,95%CI[0.03,0.88],P=0.03).The effect of drug-induced liver injury in the treatment of hypertension was superior to the conventional western medicine treatment group(RR=0.07,95%CI[0.03,0.14],P<0.00001).The effect of drug-induced liver injury during the treatment of hyperlipidemia was not statistically significant(RR=0.57,95%CI[0.33,1.00],P=0.05).There was no statistical difference between the two groups in the effect of drug-induced liver injury during the treatment of coronary heart disease(RR=0.09,95%CI[0.01,1.61],P=0.10).There was no significant difference between the two groups in the treatment of cerebral thrombosis for drug-induced liver injury(RR=0.11,95%CI[0.01,2.01],P=0.14).The effect of anti-hyperthyroidism on liver injury was better than that of conventional western medicine treatment group(RR=0.45,95%CI[0.25,0.82],P=0.009).Outcome index of total effective rate was divided into two subgroups.The effect of drug-induced liver injury caused by the type of drug was not mentioned was superior to the conventional western medicine treatment group(RR=0.78,95%CI[0.70,0.88],P<0.0001).There was no significant difference between the two groups in the liver injury caused by antipsychotic drugs(RR=0.97,95%CI[0.81,1.16],P=0.72).Conclusion:When used in the treatment of tuberculosis and psychiatric drug treatment,combineduse of Hugan Tablets(护肝片)can significantly reduce the incidence of drug-induced liver damage,and can significantly improve clinical symptoms caused by liver damage.In the treatment of hypertension,the addition of Hugan Tablets(护肝片)can significantly reduce the incidence of drug-induced liver injury,improving the safety of medication.In the treatment of drug-induced liver injury caused by which drug is not mentioned,Hugan Tablet has a therapeutic effect.Slight adverse reactions were reported,including rash,headache,palpitations,hypoglycemia,flushing,fatigue,nausea,bowel sounds,flatulence,diarrhea,and gastrointestinal discomfort.All studies reported minor adverse reactions that were well tolerated by patients and recovered without treatment after discontinuation.Oral administration of Hugan Tablets(护肝片)has positive effects on druginduced liver injury,but this conclusion still needs further evidences delete.It is necessary to adopt a larger sample,more design,and accord with the international standards to improve the quality of evidence.     

天枢超声中药透入治疗阿片类所致肝郁脾虚型便秘的临床观察（英文）

Objectives:To observe the clinical effect on opioid-induced constipation of liver stagnation and spleen deficiency treated with the ultrasonic penetration of the No.1 constipation herbal formula at Tiānshū(天枢 ST25).Methods:A total of 126 patients that were in compliance with the inclusion criteria were randomized into an acupoint group(41 cases),a Chinese medication group(42 cases) and a western medication group(43 cases).In the acupoint group,the ultrasonic penetration of the No.1 constipation herbal formula at bilateral Tiānshū(天枢 ST25) were given.In the Chinese herbal medication group,the No.1 constipation herbal formula was prescribed for oral administration.In the western medication group,polyethylene glycol electrolyte powder was prescribed for oral administration.The treatment was given once a day,for 14 days totally.Before and after treatment,the constipation symptom score,the score of the patient assessment of constipation quality of life(PAC-QOL),the situation of nitric oxide synthetase(NOS) in serum were observed in each group.The safety indicators in the observation included diarrhea,allergic reaction,liver dysfunction,skin lesions,etc.Results:A total of 122 cases accomplished the trial.The total effective rate was 82.5% in the acupoint group,80.48% in the Chinese medication group and 78.04% in the western medication group.The constipation symptoms were all relieved in the three groups,indicating the statistical significance as compared with those before treatment(P0.01,P 0.05).In the acupoint group and the western medication group,the improvements in the three symptom items,i.e.distention or scurrying pain in the chest,hypochondriac region or the bilateral sides of the abdomen,depression or irritability and poor appetite,were better than the western medication group(P0.01,P 0.05).The improvements in all of the symptoms in the acupoint group were better than the Chinese medication group(all P0.05).The PACQOL score was improved in each group after treatment and it was different significantly in statistics as compared with that before treatment in each group.After treatment,the improvement of PAC-QOL score in the acupoint group and the Chinese medication group was better than that in the western medication group(both P 0.05),and the improvement in the acupoint group was better than the Chinese medication group(P 0.05).As to serum NOS,after treatment,it was different significantly as compared with that before treatment in each group(all P 0.05),the improvement in the acupoint group was better than that of either the Chinese medication group or the western medication group,indicating the statistical significance(both P0.05).The incidence of adverse reaction in the acupoint group was less and different significantly as compared with the western medication group(P0.01),and it was different statistically as compared with the Chinese medication group(P0.05).Conclusion:The ultrasonic penetration of the No.l constipation herbal formula at Tiānshū(天枢 ST25) is effective on opioid-induced constipation of liver stagnation and spleen deficiency.This therapy achieves the significant therapeutic effect and presents the good compliance in treatment.Hence,it deserves to be further promoted in clinical application.     

八段锦对糖尿病患者糖脂代谢干预效果的Meta分析＊

目的 系统评价八段锦对糖尿病患者糖脂代谢水平的影响。方法 系统检索国内外数据库，纳入有关八段锦治疗糖尿病的随机对照试验进行荟萃分析。结果 本研究共纳入16项研究，包括1185例糖尿病患者，其中试验组共591例，对照组共594例。Meta分析结果显示：①糖代谢方面：疗程不足6个月时，八段锦组糖尿病患者的FPG（MD = -0.60，95%CI[-0.98，-0.23]）、HbA1c（MD = -0.8，95%CI[-0.99，-0.61]）改善情况优于对照组；疗程达6个月时，八段锦组糖尿病患者的FPG（MD = -1.07，95%CI[-1.67，-0.47]）、P2hPG（MD = -1.2，95%CI[-2.31，-0.08]）、HbA1c（MD = -0.73，95%CI[-1.14，-0.32]）改善程度优于对照组。②脂代谢方面：疗程不足6个月时，八段锦组糖尿病患者的TC（MD = -0.79，95%CI[-1.13，-0.45]）、HDL（MD = 0.21，95%CI[0.12，0.29]）改善情况优于对照组；疗程达6个月时，八段锦组糖尿病患者的TC（MD = -0.46，95%CI[-0.71，-0.20]）、TG（MD = -0.60，95%CI[-1.14，-0.06]）、HDL（MD = 0.21，95%CI[0.09，0.33]）改善情况优于对照组。结论 作为辅助治疗手段，八段锦具有进一步改善糖尿病患者糖脂代谢水平的作用，尤其在FPG、HbA1c、TC、HDL方面的疗效较为稳定，同时安全性较好，具有良好的推广应用价值。     

中药外敷联合西药治疗痛风性关节炎Meta分析

目的：评价中药外敷联合西药对比单纯西药治疗痛风性关节炎的疗效与安全性。方法：从4个中文数据库检索文献,纳入中药外敷联合西药对比单纯西药治疗痛风性关节炎的随机对照试验。数据分析采用RevMan 5.3软件进行分析。结果：最终纳入13个研究。Meta分析结果显示中药外敷联合西药与单纯西药治疗痛风性关节炎比较,在治愈率[OR=2.47,95%CI（1.94,3.14）]、总有效率[OR=4.15,95%CI（2.88,5.99）]和不良反应[OR=3.60,95%CI（1.30,9.98）]方面具有统计学差异。结论：目前国内研究显示中药外敷联合西药治疗痛风性关节炎具有更好的疗效,但须注意预防相应的不良反应。     

围刺法治疗急性痛风性关节炎疗效对比观察

目的:观察围刺法与药物治疗急性痛风性关节炎的临床疗效差异,寻找治疗急性痛风性关节炎的较佳方法.方法:将60例急性痛风性关节炎患者随机分为围刺组(30例)和西药组(30例).围刺组采用局部多针浅刺法为主,同时酌情选配4～5个远端腧穴,每日治疗1次;西药组口服吲哚美辛及别嘌呤醇,每日3次.两组均治疗15日为一疗程.观察两组的临床疗效、血清尿酸变化及不良反应.结果:围刺组总有效率为93.3%,优于西药组的80.0%,差异有统计学意义(P＜0.01);围刺组血清尿酸含量治疗前后分别为(516.85±48.63)μmol/L、(293.77±68.45)μmol/L,西药组分剐为(509.66±51.11)μmol/L、(333.66±89.22)μmol/L,两组血清尿酸含量较治疗前差异均有统计学意义(P＜0.05),围刺组治疗后血尿酸含量与西药组比较差异有统计学意义(P＜0.01).围刺组未出现不良反应,西药组不良反应率为46.7%,两组比较差异有统计学意义(P＜0.01).结论:围刺法治疗急性痛风性关节炎疗效优于西药治疗,是一种治疗急性痛风性关节炎安全、有效的方法.     

中西医结合治疗原发性高血压并发心房颤动有效性和安全性的Meta分析

目的系统评价中西医结合治疗原发性高血压并发心房颤动的有效性和安全性。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Cochrane Library、EMbase 8个数据库,同时通过手工检索等其他途径补充文献,筛选中西医结合治疗原发性高血压并发房颤的随机对照试验。采用CochraneReviewers Handbook 5.1.0偏倚风险评估工具对文献进行质量评价,借助Review Manager 5.3软件进行Meta分析。结果最终纳入11篇文献,包含1124例患者。Meta分析结果显示,中西医结合治疗能进一步提高原发性高血压并发房颤患者的治疗总有效率(RR=1.29,95%CI [1.20,1.40],P0.000 01),减小P波离散度(MD=-4.54,95%CI [-5.67,-3.40],P0.000 01),减小左房内径(MD=-3.06,95%CI [-4.53,-1.60],P0.000 1),提高射血分数(MD=5.13,95%CI [4.71,5.55],P0.000 01),降低收缩压(MD=-7.48,95%CI [-14.65,-0.31],P=0.04),降低舒张压(MD=-4.36,95%CI [-5.45,-3.27],P0.000 01),具有较好的安全性(RR=0.65,95%CI [0.42,0.99],P=0.04)。结论中西医结合治疗对原发性高血压并发房颤患者有较好的疗效和安全性,但由于纳入研究质量普遍偏低,结论仍需更多高质量的临床研究加以证实。     

血必净注射液辅助治疗老年重症肺炎随机对照研究的Meta分析

目的评价血必净注射液辅助治疗老年重症肺炎的有效性及安全性。方法检索中国知网(CNKI)、万方数据数据库(Wanfang Data)、维普数据库(VIP)、中国生物医学文献数据库(SinoMed)以及PubMed,收集血必净注射液辅助治疗老年重症肺炎的随机对照研究。采用NoteExpress软件进行文献的筛选,RevMan 5.2软件进行数据分析,二分类变量和连续性变量分别采用比值比(Relative risk,RR)和均数差(Mean Differences,MD)及其95%的可信限(CI)作为统计量。结果纳入18个研究,共1503例患者。Meta分析显示,血必净注射液联合西医常规治疗在提高有效率[RR=1.21,95%CI(1.16,1.27),P<0.00001]、降低病死率[RR=0.34,95%CI(0.16,0.72),P=0.005]、缩短住院时间[MD=-3.78,95%CI(-5.38,-2.35),P<0.00001]、提高氧分压[MD=10.80,95%CI(5.78,15.82),P<0.00001]、提高血氧饱和度[MD=4.24,95%CI(2.34,6.14),P<0.00001]、降低二氧化碳分压[MD=-7.32,95%C(I-10.36,-4.27),P<0.00001]方面疗效均优于西医常规治疗,但对提高氧合指数差异无统计学意义[MD=30.54,95%C(I-7.89,69.05),P=0.12]。所有纳入研究未见严重不良反应。结论血必净注射液联合西医常规疗法治疗老年重症肺炎疗效优于西医常规治疗,安全性较好。但由于纳入研究的质量偏低,需要高质量的研究为血必净注射液治疗重症肺炎提供明确的证据。     

Effect of Aidi injection plus transarterial chemoembolization on primary hepatic carcinoma: a systematic review and Meta-analysis

OBJECTIVE: To assess the efficacy and safety of Aidi injection plus transarterial chemoembolization(TACE) in patients with primary hepatic carcinoma.METHODS: A comprehensive research of seven electronic databases was performed for comparative studies evaluating Aidi injection combined with TACE for primary hepatic carcinoma until September 2016. Two authors independently extracted data and assessed the methodological quality of the included trials using the Cochrane risk of bias tool from the Cochrane Handbook version 5.1.0. Data was synthesized by using Rev Man 5.3 software.RESULTS: Forty-nine studies involving 3435 patients met the inclusion criteria, most of which were low methodological quality. Compared with TACE alone, Aidi injection plus TACE can significantly improve the efficiency rate [RR = 1.33, 95% CI(1.24, 1.43), P 0.000 01], clinical beneficial rate[RR = 1.25, 95% CI(1.17, 1.33), P 0.000 01], survival rate [6 months, RR = 1.19, 95% CI(1.09, 1.29), P 0.0001], 12 months, [RR = 1.37, 95% CI(1.24, 1.52),P 0.000 01], 18 months, [RR = 2.00, 95% CI(1.26,3.20), P 0.004], 24 months, [RR = 1.44, 95% CI(1.22, 1.70), P 0.0001], 36 months, [RR = 1.50, 95%CI(1.07, 2.11), P = 0.02 0.05], quality of life [RR =1.84, 95% CI(1.64, 2.05), P 0.000 01] and immune function [CD3+, MD = 11.12, 95% CI(7.93, 14.30),P 0.000 01], CD4 +, [MD = 10.37, 95% CI(7.29,13.45), P 0.000 01], CD4+/CD8+, [MD = 0.30, 95%CI(0.07, 0.53), P = 0.01 0.05], NK, [MD = 7.49, 95%CI(6.64, 8.34), P 0.000 01]. A significant improvement was also found in improvement of symptoms[RR = 1.64, 95%CI(1.38, 1.94), P 0.000 01], leukopenia [RR = 0.60, 95% CI(0.54, 0.66), P 0.000 01],thrombocytopenia [RR = 0.46, 95% CI(0.34, 0.61),P 0.000 01], nausea and vomiting incidence [RR =0.66, 95% CI(0.54, 0.81), P 0.0001), liver damage rate [RR = 0.57, 95% CI(0.42, 0.77), P = 0.0003 0.05), and kidney damage rate [RR = 0.18, 95% CI(0.05, 0.68), P = 0.01 0.05].CONCLUSION: The results suggested that Aidi injection plus TACE significantly improve the clinical effect of TACE, and reduce the incidence of adverse events. However, rigorous multicenter trials with larger size are warranted to further confirm the findings.     

四妙散为主方治疗痛风性关节炎疗效与安全性的系统评价

目的:评价四妙散为主方治疗痛风性关节炎的临床疗效及安全性。方法:计算机检索中国生物医学文献数据库(CBM),中国学术期刊全文数据库(CNKI),中文科技期刊数据库(VIP),万方数据库,Pub Med,EMbase,搜集四妙散为主方的中药方剂与西药对比治疗痛风性关节炎的随机对照试验;采用Cochrance系统评价的方法评价纳入文献的质量,使用Revman5.2统计软件对纳入的文献进行Meta分析。结果:共纳入13个随机对照试验,涉及1 017例患者,Meta分析结果显示,以四妙散为主方的中药方剂治疗痛风性关节炎的总有效率优于西药组,合并的OR值分别为2.28,95%CI(1.54,3.37);不良反应发生率少于西药组,合并的RR值为0.12,95%CI(0.07,0.23)。结论:四妙散为主方治疗痛风性关节炎的临床疗效及安全性较西药均有一定优势。由于纳入研究的方法学质量存在中度选择性偏倚的可能性,可能影响结果真实性,因此上述结论还有待开展更多高质量、大样本、随机双盲临床对照试验来验证。     

柴胡加龙骨牡蛎汤治疗肿瘤相关性抑郁的有效性及安全性系统评价与Meta分析

目的:对柴胡加龙骨牡蛎汤治疗肿瘤相关性抑郁的有效性与安全性进行评价。方法:检索CNKI、VIP、PubMed等数据库筛选出柴胡加龙骨牡蛎汤治疗肿瘤相关性抑郁的随机对照试验,运用RevMan5.3软件进行分析。结果:总有效率方面,柴胡加龙骨牡蛎汤优于草酸艾司西酞普兰片[RR=1.23,95%CI(1.22,1.36),P<0.0001];柴胡加龙骨牡蛎汤+草酸艾司西酞普兰片优于草酸艾司西酞普兰片[RR=1.24,95%CI(1.10,1.40),P=0.0005];柴胡加龙骨牡蛎汤优于氟西汀[RR=1.15,95%CI(1.07,1.23),P<0.0001];柴胡加龙骨牡蛎汤优于盐酸帕罗西汀片[RR=1.10,95%CI(1.01,1.21),P=0.004]。HAMD评分方面,柴胡加龙骨牡蛎汤优于草酸艾司西酞普兰片[MD=-6.01,95%CI(-7.04,-4.97),P<0.00001];柴胡加龙骨牡蛎汤+草酸艾司西酞普兰片优于草酸艾司西酞普兰片[MD=-5.44,95%CI(-9.75,-1.12),P=0.01];柴胡加龙骨牡蛎汤+氟西汀优于氟西汀[MD=-6.13,95%CI(-9.45,-2.81),P=0.0003]。不良反应率方面,柴胡加龙骨牡蛎汤优于草酸艾司西酞普兰片[RR=0.19,95%CI(0.10,0.35),P<0.00001];柴胡加龙骨牡蛎汤优于氟西汀[RR=0.19,95%CI(0.10,0.35),P<0.00001];柴胡加龙骨牡蛎汤+草酸艾司西酞普兰片优于草酸艾司西酞普兰片[RR=0.21,95%CI(0.08,0.52),P=0.0008];柴胡加龙骨牡蛎汤+氟西汀优于氟西汀[RR=0.21,95%CI(0.08,0.59),P=0.003]。结论:柴胡加龙骨牡蛎汤或联合西药治疗肿瘤相关性抑郁可提高总有效率,降低HAMD评分,减少不良反应发生率。因纳入研究的质量不高,仅作临床参考。     

心可舒治疗不稳定型心绞痛有效性及安全性的系统评价

目的系统评价心可舒联合常规西药治疗不稳定型心绞痛的有效性及安全性。方法检索PubMed数据库、维普数据库、中国知网、万方数据库等数据库自建库以来至2020年4月收录的关于心可舒联合常规西药治疗不稳定型心绞痛的临床随机对照试验,根据纳入及排除标准筛选文献,使用Rev Man5.3软件进行Meta分析。结果共纳入19项随机对照试验,合计1 569例患者,Meta分析结果显示,:心可舒联合常规西药在减少心绞痛发作频率(SMD=-1.16,95%CI[-1.75,-0.57],P=0.000 1),降低心绞痛持续时间(MD=-2.75,95%CI [-3.77,-1.73],P0.000 01),减少硝酸甘油用量(MD=-0.67,95%CI [-0.78,-0.56],P0.000 01),改善心电图疗效(RR=1.26,95%CI [1.18,1.35],P0.000 01)、心绞痛疗效(RR=1.26,95%CI [1.20,1.33],P0.000 01),降低三酰甘油(MD=-0.57,95%CI [-1.02,-0.12],P=0.01)、总胆固醇(MD=-0.78,95%CI [-1.15,-0.41],P0.000 1)、低密度脂蛋白胆固醇(MD=-0.58,95%CI [-0.80,-0.36],P0.000 01),提高高密度脂蛋白胆固醇(MD=0.24,95%CI [0.08,0.40],P=0.004)、降低全血黏度(MD=-1.32,95%CI [-2.25,-0.39],P=0.005)、血浆黏度(MD=-0.29,95%CI [-0.38,-0.21],P0.000 01)、纤维蛋白原(MD=-1.06,95%CI [-1.29,-0.83],P0.000 01)、降低C-反应蛋白(MD=-1.70,95%CI [-2.33,-1.06],P0.000 01)、内皮素-1(MD=-7.81,95%CI [-10.05,-5.57],P0.000 01)、同型半胱氨酸(MD=-2.35,95%CI [-2.63,-2.07],P0.000 01),改善一氧化氮(MD=8.74,95%CI [7.00,10.47],P0.000 01)方面的作用优于单纯西药组,且亚组分析结果显示治疗疗程大于等于3个月的治疗效果更好,不良反应发生率方面差异无统计学意义(P=0.56),各研究均未出现肝肾功异常。结论临床应用心可舒联合常规西药治疗不稳定型心绞痛的疗效明确,推荐临床应用。