中西医结合治疗2型糖尿病周围神经病变Meta分析

目的:Meta分析中西医结合治疗与单纯西医治疗2型糖尿病周围神经病变的疗效。方法:收集符合纳入标准的文献。由2名研究者独立选择试验、提取资料并交叉核对,而后评价纳入研究的质量并提取有效数据,再用RevMan5.0软件进行Meta分析,包括异质性检验、合并效应量、评估发表偏倚以及敏感性分析。结果:纳入研究的文献17篇,共有1569例患者。所纳入文献均为低质量研究,分析结果显示中西医结合治疗组与单纯西医治疗组比较在总有效率方面:[OR=4.29,95%CI(3.32,5.55)]差异具有统计学意义,其中5个研究腓总神经运动传导速度治疗组与对照组相比差异具有统计学意义[WDM=3.90,95%CI(3.21,4.58)]。结论:中西医结合治疗2型糖尿病周围神经病变疗效优于单纯西医治疗。但由于纳入试验的质量不高,待更高质量的文献进行进一步研究。     

Chinese Medicine for Alzheimer's Disease: A Meta-Analysis of Randomized Controlled Trials

Objective: To evaluate the efficacy of oral Chinese medicine(CM) in comparison with donepezil, a cholinesterase inhibitor(ChEI), for the treatment of Alzheimer's disease(AD). Methods: Randomized controlled trials(RCTs) have been searched, and the effect of CM compared with donepezil in AD has been investigated. An electronic search of MEDLINE, Excerpta Medica Database(EMBASE), Cochrane Library, Chinese Biological Medicine Database(CBMdisc), and China National Knowledge Infrastructure(CNKI) to identify articles in English and Chinese from the inception of the database until October 18, 2015. A modified Jadad score(7-points) to judge the methodological quality of studies, comprehensive meta-analysis was performed with Cochrane Collaboration Revman 5.3. Dichotomous data were analyzed by relative risk(RR) with a 95% confidence interval(CI), while continuous variables were analyzed by using mean differences(MD) with 95% CI for effect size. Results: Six studies involving 596 AD patients through Jadad assessment with low bias were included in the meta-analysis. No significant difference was observed in cognitive improvement and daily abilities of patients using the Mini Mental State Examination(MMSE)(MD: 0.69, 95% CI: –0.17 to 1.56) and Activities of Daily Living(ADL) scale(MD: 0.94, 95% CI: –1.54 to 3.43). There were no significant differences in status of illness or MD for mild-moderate AD patients at 24 weeks(MD: 0.62, 95% CI: –2.99 to 4.23) and 48 weeks(MD: –0.73, 95% CI: –5.02 to 3.56). Severe AD patients were also assessed at 24 weeks(MD: 3.13, 95% CI: –6.92 to 13.18) and 48 weeks(MD: 4.23, 95% CI: –6.38 to 14.84). Furthermore, compared with donepezil, Xin(Heart)-regulating CM and Shen(Kidney)-tonifying groups were observed(MD: –1.50, 95% CI: –3.08 to 0.08; MD: –1.92, 95% CI: –3.50 to –0.33; respectively). CM had fewer side effects in AD patients. Conclusion: Compared with donepezil, oral CM showed no significant difference in effectiveness in AD patients, and more evidence is needed to verify the findings.     

Application of Traditional Chinese Medicine injection in treatment of primary liver cancer:a review

OBJECTIVE:To investigate the application of Traditional Chinese Medicine Injections(TCMIs) for treatment of primary liver cancer(PLC).METHODS:A literature review was conducted using PubMed/Medline,Cochrane Library Controlled Clinical Trials Database,China National Knowledge Infrastructure(CNKI),China Scientific Journal Database(CSJD) and China Biology Medicine(CBM).Online websites including journal websites and databases of ongoing trials,as well as some Traditional Chinese Medicine journals that are not indexed in the electronic databases were also searched.RESULTS:The literature review showed that TCMIs as adjunctive medication for the treatment of PLC could regulate patient immunity,reduce bone marrow suppression,relieve clinical symptoms,and improve quality of life,as well as control disease progression and prolong survival time.CONCLUSION:Within the limitations of this review,we conclude that application of TCMIs as adjunctive medication may provide benefits for patients with PLC.Further large,high-quality trials are warranted.     

高渗盐水和甘露醇治疗颅内高压比较的系统评价

目的评价高渗盐水是否比甘露醇治疗脑水肿颅高压更安全有效。方法计算机检索MEDLINE（1966—2008年）、EMBASE数据库（1985—2008年）、Cochrane图书馆临床对照试验资料库（2008年第2期）、互联网上注册临床试验数据库、中国生物医学文献数据库（1980—2008年）,文献语种不限。纳入比较高渗盐水与甘露醇治疗颅内高压的随机对照试验．对纳入研究进行方法学和质量评价．并对其研究结果进行系统评价。结果共纳入6个随机对照试验,系统评价结果表明高渗盐水在降颅压幅度、起效时间、最大效应时间和维持时间上均优于甘露醇．不降低颅内灌注压且不增加全身副反应的发生率。结论高渗盐水减轻脑水肿、降低颅内压比甘露醇更安全有效,是一种可供选用的脱水剂。     

黛力新和阿米替林治疗脑卒中后抑郁疗效的系统评价

目的:系统评价黛力新和阿米替林治疗脑卒中后抑郁(PSD)的治疗效果。方法:应用Cochrane系统评价方法计算机检索Cochrane Library(2011年第3期)、PubMed(1966～2011年11月)、EMBASE(1974～2011年11月)、中国生物医学数据库(CBM,1978～2011年11月)、中国期刊全文数据库(CNKI,1979～2011年11月)和维普数据库(VIP,1989～2011年11月),收集黛力新对比阿米替林治疗PSD的所有随机对照试验(RCT)。根据Cochrane协作网推荐的"偏倚风险评估工具"进行偏倚风险,用RevMan5.0软件进行统计学分析。结果:最终纳入9个RCT,共650例患者。Meta分析结果显示,在不同报道时间的黛力新组HAMD评分均低于阿米替林组(2周:SMD=-0.66,95%CI:-1.28,-0.05;4周:SMD=-0.93,95%CI:-1.62,-0.25;6周:SMD=-1.20,95%CI:-1.45,-0.95;8周:SMD=-1.89,95%CI:-2.48,-1.30)。对6周和8周的HAMD疗效Meta分析结果显示黛力新组HAMD疗效优于阿米替林组(RR=1.16,95%CI:1.05,1.29)。在不良反应、临床神经功能缺损评分及生活治疗等方面,黛力新组均优于阿米替林。结论:目前证据表明,黛力新相比阿米替林治疗PSD在HAMD评价、不良反应和生活质量等方面显示较为有效的趋势,由于纳入研究数量少,存在一定的偏倚风险,使论证强度受到影响,需要更多高质量的随机对照试验提供高质量的证据。     

胸腔闭式引流术后注入榄香烯治疗恶性胸腔积液的疗效评价

目的：评价胸腔闭式引流术后胸膜腔内注入榄香烯治疗恶性胸腔积液的有效性.方法：检索MEDLINE（1996年1月至2010年10月）、中国生物医学文献数据库（1978年1月至2010年10月）、中国期刊全文数据库（1994年至2010年）、万方数据库（1980年至2010年）与重庆维普信息数据库（1989年至2010年）共5个数据库,同时从参考文献中追溯文献,并收集未发表的文献.纳入胸腔闭式引流术后,胸膜腔内注入榄香烯治疗恶性胸腔积液的随机对照试验,使用Cochrane中心推荐的方法进行文献质量评价,并用Rev Man 5.0软件进行统计分析.结果：共纳入17篇文献,16篇文献的方法学质量较低.其中12项独立研究对胸腔闭式引流术＋榄香烯与胸腔闭式引流术＋顺铂治疗的临床效果进行比较,合并分析结果显示榄香烯组的有效率高于顺铂组[RR合并=1.26,95%CI（1.13,1.39）].结论：胸膜腔闭式引流术后胸膜腔内注入榄香烯可以提高恶性胸腔积液治疗的有效率.     

非甾体类抗炎药直肠给药预防ERCP术后胰腺炎的系统评价

目的评价非甾体类抗炎药（NSAIDs）直肠给药预防ERCP术后胰腺炎的有效性和安全性。方法制定严格纳入和排除标准,计算机检索Coehrane图书馆临床对照试验、Medline、PubMed、Embase、OVID数据库、中国生物医学文献数据库（CBMDisc）、维普中文期刊数据库、中国期刊全文数据库、万方学位论文数据库）。并手工检索相关会议论文集及查阅检索到的所有参考文献,全面收集国内外关于非甾体类抗炎药直肠给药预防ERCP术后胰腺炎的随机对照试验。按照国际Cochrane协作网推荐的方法进行系统评价。结果共纳入10个试验2802例患者,Meta分析显示：①PEP发生率、轻症PEP发生率及中一重症PEP发生率：NSAIDs治疗组优于安慰剂组（均P〈0．001）。②术后高胰淀粉酶血症发生率及术后血胰淀粉酶水平：NSAIDs治疗组优于安慰剂组（均Pd0．001）。③PEP病死率及不良反应发生率：无病死率及NSAIDs治疗相关不良反应的报道。结论NSAIDs直肠给药可以预防ERCP术后胰腺炎的发生,且安全性好。     

水中分娩对新生儿影响的Meta分析

目的 系统评价水中分娩技术对新生儿的影响.方法 计算机检索中文科技期刊全文数据库、中国期刊全文数据库、中国生物医学文献数据库、中华医学会数字化期刊、PubMed、EMbase和Cochrane Library,纳入水中分娩与传统分娩方式比较的随机对照试验,由两位评价者进行资料提取和质量评价后,采用RevMan 5.1软...     

中成药治疗突发性耳聋随机对照试验的Meta分析与系统评价

目的：突发性耳聋的中医病因病机尚未完全统一,中成药治疗突发性耳聋有较多的文献报道,也取得了一定的疗效,因此,有必要对中成药治疗突发性耳聋进行系统评价,为今后临床上中成药治疗突发性耳聋提供依据。方法：采用Cochrane系统综述方法,检索1980—2010年维普数据库、中文期刊全文数据库、万方数据库和中国Cochrane协作网提供的RevMan 5.0软件进行meta分析,对异质研究进行描述性分析。结果：关于葛根素注射液、金纳多及复方丹参注射液治疗的3篇系统评价[2-4]已表明复方丹参注射液、葛根素注射液与金纳多可提高突发性耳聋治疗的有效率,临床上可优先考虑使用。共检索出210篇文献,符合纳入标准的只有101篇文献,其中针剂的90篇,口服剂型的11篇,采用Jadad评分标准对纳入研究的每篇文献的方法学质量进行评价。只有1篇文献[27]采用随机数字表进行随机分配,随机方法质量较高,其余100篇文献均未描述具体的随分配隐藏的方法,仅有5篇文献提及采用盲法,均为单盲,其余文献均未提及盲法,仅有1篇文献[28]提及随访,但随访结果未明确给出,其余100篇文献均未提及随访及退出病例,属于低质量文献。Meta分析结果显示川芎嗪、血栓通、银杏达莫、杏丁注射液及唇香草聪耳片治疗组有效率优于对照组,差异有统计学意义,其他中成药由于文献以及病例数不足,暂未能肯定其疗效。结论：现有临床证据表明,与对照组比较,中成药可以提高突发性耳聋的治疗有效率,临床可考虑选择中成药结合其他疗法治疗突发性耳聋,提高患者的治疗有效率。但本系统综述纳入的随机对照试验多属低质量文献,进一步证实其临床疗效尚须开展大规模的设计严谨、方法可靠的多中心临床研究以获得更高强度的证据。     

通心络胶囊辅治急性脑梗死有效性和安全性的系统评价

目的系统评价通心络胶囊治疗急性脑梗死的有效性和安全性。方法计算机全面检索Cochrane图书馆临床对照试验数据库(2009年第1期)、MEDLINE或PubMed(1978—2009)、EMbase(1978-2009)、Ovid(1978-2009)、中国生物医学文献数据库(1978—2009)、维普中刊数据库(1989-2009)、中国期刊全文数据库(1979—2009)、万方学位论文数据库(1978—2009)。手工检索相关中文期刊、相关会议论文集及所有检索到文献的参考文献。纳入通心络胶囊治疗急性脑梗死的所有随机对照试验(RCT),按Cochrane协作网推荐的方法进行系统评价。结果共纳入39个RCT,包括3262例患者。Meta分析显示:(1)总有效率:基础治疗+通心络胶囊组优于基础治疗组[OR=3.27,95%CI(2.61～4.11),P<0.01];通心络胶囊组优于复方丹参组[OR=3.31,95%CI(1.78～6.13),P<0.01];基础治疗+通心络胶囊治疗组优于基础治疗+维脑路通组[OR=4.69,95%CI(2.16～10.19),P<0.01]。(2)神经功能缺损评分:基础治疗+通心络胶囊组优于基础治疗组[WMD=-5.51,95%CI(-6.59～-3.71),P<0.01];(3)认知功能改善:基础治疗+通心络胶囊组优于基础治疗组[WMD=1.66,95%CI(1.05～2.27),p<0.01];(4)不良反应发生率:均无严重不良反应的报道。结论基于目前的证据,通心络胶囊治疗急性脑梗死具有较好的疗效和安全性。但由于纳入研究质量普遍不高,上述结果尚有待高质量大样本的随机双盲对照试验的证据。     

中药制剂对代谢综合征干预效应的Meta分析

目的 系统评价中药制剂治疗代谢综合征的有效性和安全性。方法 检索PubMed、VIP、WanFang date、CBM、CNKI等数据库,纳入中药制剂治疗代谢综合征的随机对照临床试验。按照纳排标准对文献进行筛选、资料提取,并根据《Cochrane干预措施系统评价手册》进行文献质量评价,采用RevMate5.3软件对空腹血糖、甘油三酯、胆固醇、收缩压、舒张压进行Meta分析,并进行安全性评价。结果 最终纳入12个RCT,共计纳入1129例患者。Meta分析结果显示,与西药标准化治疗或常规治疗相比,中药制剂在治疗代谢综合征过程中,可以改善甘油三酯水平（MD=-0.51,95% CI：-0.73~-0.28）、胆固醇（MD=-0.84,95% CI：-1.47~-0.21）、低密度脂蛋白水平（MD=-0.21,95% CI：-0.41~-0.01）、收缩压水平（MD=-4.12,95% CI：-7.29~-0.95）,表明联合中药制剂具有调节脂质代谢和降低收缩压的作用;对空腹血糖（MD=-0.045,95% CI：-0.95~0.05）及舒张压（MD=-2.58,95% CI：-5.86~0.69）的作用差异无统计学意义。12个研究中有4个研究报告了不良反应,1项研究报道了治疗组有5例在治疗开始后出现大便次数增多,减量或继续治疗3天后症状消失。1项研究报道了治疗组出现胃脘不适3例,改饭后服药或中药加减治疗后缓解。其余的文献未对不良反应做系统报告。结论 与西药标准化治疗相比,中药制剂在治疗代谢综合征方面有一定的干预效应,具有降低血压及调节脂质代谢的作用,安全性尚可,不良反应少见。但纳入的研究方法学质量偏低,上述结论需要后续开展更多高质量的研究予以验证。     

A Summary and Evaluation of Current Evidence for Myocardial Infarction with Chinese Medicine

Objective: To provide evidence-based recommendations for clinical application and provoke thoughts for future researchers by conducting a comprehensive summary and evaluation of the current evidence profile for the role of Chinese medicine(CM) in treating myocardial infarction(MI). Methods: Online databases including Pub Med, EMBase, Cochrane Library, Chinese National Knowledge Infrastructure(CNKI), Chinese Biomedical Medicine(CBM), VIP Journal Integration Platform, and Wanfang database were systematically searched for literatures on CM in treating MI. After screening, studies were categorized into 5 types, i.e. systematic review(SR), randomized controlled trial(RCT), observational study, case report and basic research. General information was abstracted, and the quality levels of these studies and their conclusions were summarized and assessed. Results: A total of 452 studies including 10 SRs, 123 RCTs, 47 observational studies, 28 case reports, and 244 basic researches were selected. Clinical studies centered primarily on herbal decoction and mostly were not rigorously performed. High-quality studies were predominantly on Chinese patent medicines(CPMs) such as Danshen Injection(丹参注射液), Shenmai Injection(参麦注射液), Shengmai Injection(生脉注射液) and Qishen Yiqi Dripping Pills(芪参益气滴丸). The most frequently observed pattern of drug combination was decoction plus injection. Results of SRs and clinical studies showed that CM may reduce mortality, decrease risk of complication, reduce myocardial injury, improve cardiac function and inhibit ventricular remodeling. Findings from basic researches also supported the positive role of CM in reducing infarct size and myocardial injury, promoting angiogenesis, preventing ventricular remodeling and improving cardiac function. According to the current evidence body, CM has proven effects in the prevention and treatment of MI. It is also found that the effects of CPMs vary with indications. For instance, Shenmai Injection has been found to be especially effective for reducing the incidence of acute clinical events, while CPMs with qi-nourishing and bloodcirculating properties have been proven to be effective in inhibiting ventricular remodeling. High quality evidence supports the use of CM injection for acute MI and CPM for secondary prevention. Reports on adverse events and other safety outcomes associated with CM for MI are scarce. Conclusions: Sufficient evidence supported the use of CM as an adjuvant to Western medicine for preventing and treating MI. The choice of drug use varies with disease stage and treatment objective. However, the quality of the evidence body remains to be enhanced.     

Ginkgo Biloba Extract for Angina Pectoris: A Systematic Review

Objective: To evaluate the efficacy and safety of Ginkgo Biloba extract for patients with angina pectoris according to the available evidence. Methods: Electronic databases were searched for all of the randomized controlled trials (RCTs) of angina pectoris treatments with Ginkgo Biloba extract, either alone or combined with routine Western medicine (RWM), and controlled by untreated, placebo, Chinese patent medicine, or RWM treatment. The RCTs were retrieved from the following electronic databases: PubMed/MEDLINE, ProQuest Health and Medical Complete, Springer, Elsevier, and ProQuest Dissertations and Theses, Wanfang Data, China National Knowledge Infrastructure (CNKI), VIP database, China Biology Medicine (CBM), Chinese Medical Citation Index (CMCI), from the earliest database records to December 2012. No language restriction was applied. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. RevMan 5.1.0 provided by Cochrane Collaboration The data were analysed by using. Results: A total of 23 RCTs (involving 2,529 patients) were included and the methodological quality was evaluated as generally low. Ginkgo Biloba extract with RWM was more effective in angina relief and electrocardiogram improvement than RWM alone. Reported adverse events included epigastric discomfort, nausea, gastrointestinal reaction, and bitter taste. Conclusions: Ginkgo Biloba extract may have beneficial effects on patients with angina pectoris, although the low quality of existing trials makes it difficult to draw a satisfactory conclusion. More rigorous, high quality clinical trials are needed to provide conclusive evidence.     

超前镇痛对开胸术后疼痛综合征发生影响的Meta分析

目的：对超前镇痛能否预防开胸术后疼痛综合征的发生进行系统评价。方法：计算机检索MEDLINE（1990-2006.6）、EMBASE（1989-2006.6）及中国生物医学文献数据库（CBM）（1978-2006.6）,手工检索纳入试验的所有中文及外文文献及相关文献,收集所有对有关超前镇痛与开胸术后疼痛综合征的随机对照临床试验,对其逐个进行方法学质量评价,并用RevMan4.2.8进行Meta分析。结果：共纳入2个随机对照试验,99例应用超前镇痛行开胸手术的患者;均为高质量研究,Meta分析结果显示：超前镇痛组与对照组比较在随访时间内其效应间差异无统计学意义,开胸术后慢性痛合并优势比为0.51[95%CI（0.19,1.34）,P=0.17]。结论：目前无足够证据证明超前镇痛能够有效预防和降低开胸术后慢性痛的发生,尚需要更多设计严谨、方法科学的高质量随机对照试验。     

血管紧张素转换酶抑制剂所致咳嗽机制研究结果的回顾分析

目的：按照循证医学标难，对国内外血管紧张素转换酶抑制剂(ACEI)所致咳嗽机制研究的结果予以总结和评价，指导临床工作。方法：检索近13a来5种中文医学杂志、并登录美国国立医学图书馆网站检索关于ACEI所致咳嗽机制的临床研究文章，从实验设计方法、观察指标等多方面进行逐篇分析。结果：共检出13篇文章，均为国外学者研究，涉及基因多态性、P物质、缓激肽、气道反应性、血清血管紧张素转换酶、血栓素等多种因素与咳嗽的关系研究，4项研究为随机对照试验(RCT)，除一项为大样本研究外，其余均为小样本研究，存在基线资料、纳入及排除标难不全，交叉对照实验无洗脱期等问题。结论：我国需开展一些大样本RCT临床研究，对可能导致咳嗽的因素进行前瞻性观察，以明确ACEI导致咳嗽的机制所在。     

小儿推拿治疗多发性抽动症的Meta分析

目的:系统评价推拿或推拿联合其他疗法与药物治疗在治疗小儿多发性抽动症临床疗效的区别。方法:通过数据库[主要包括中国生物医学文献数据库(CBM)、中国维普全文数据库(VIP)、中国期刊全文数据库(CNKI)、万方数据库、Pubmed、Cochrane Library、Web of Science和EMbase等]检索,搜集有关推拿或推拿联合其他疗法治疗小儿多发性抽动症的随机对照试验(RCT)。由2名评价者独立提取资料并进行方法学的质量评估,质量评价参照Cochrane系统评价员手册5.0.1标准,数据分析采用Stata 15.1软件。结果:最终纳入25项RCTs,其Meta分析结果显示,治疗组小儿抽动症的临床总有效率、中医症候疗效、复发率、不良反应率均优于药物疗法对照组,差异具有统计学意义(P<0.05)。结论:推拿或推拿联合其他疗法治疗小儿多发性抽动症较药物治疗有一定优势,但确切的结论尚需要设计更为严谨的大样本临床试验进行验证。     

Efficacy and safety of puerarin injection in treatment of diabetic peripheral neuropathy: a systematic review and Meta-analysis of randomized controlled trials

ObjectiveTo systematically evaluate the clinical efficacy and safety of puerarin injection in the treatment of diabetic peripheral neuropathy (DPN).MethodsRandomized controlled trials investigating the efficacy of puerarin injection on DPN were searched for in China National Knowledge Infrastructure Database, Chinese Scientific Journals Database, Wanfang Database, Chinese Biomedical Literature Database, PubMed, and Cochrane Library from establishment to April 30. Two reviewers independently retrieved and extracted the information. The included studies were assessed by the Cochrane risk of bias and analyzed by Review Manager 5.2 software.ResultsTwenty-two studies involving 1664 participants were included. The quality of the studies was found to be relatively low. Meta-analysis showed that puerarin injection combined with western medication was more effective than conventional therapy for DPN in terms of total effective rate, nerve conduction velocity (NCV), and hemorheology index. Six adverse drug reactions (ADRs) from puerarin injection were reported in two studies. Reactions included facial flushing, palpitations, and pain at infusion locations. However, no serious ADRs were reported.ConclusionsPuerarin injection was effective for the treatment of DPN. Puerarin can improve the total effective rate, correct NCV that was decreased by diabetes, and improve the hemorheology index. Puerarin was also relatively safe clinically. However, since the articles included in the study were not high-quality, more studies should be conducted to strengthen their findings.     

2000~2014年中医药干预化疗所致消化道毒性反应临床试验的方法学质量评价?

目的：评价2000~2014年中国中医药干预化疗致消化道毒性反应临床试验的方法学质量。方法计算机检索知网、万方、维普、中国生物医学文献数据库及中国中医药数据库(2000年1月至2014年12月),并辅以手工检索。采用 Cochrane偏倚风险评估表对纳入的随机对照试验、半随机对照试验进行方法学质量评价。结果最终筛选研究291篇,符合 Cochrane 偏倚风险评估表“低风险”标准至少一条的随机对照试验及半随机对照试验仅76个,总体方法学质量欠佳。结论近14年来,中医药疗法干预化疗致消化道毒性反应的临床试验发表呈逐年上升趋势,但总体研究设计存在缺陷。     

重复经颅磁刺激对血管性认知障碍疗效的Meta分析

背景　血管性认知障碍（VCI）不仅影响患者的生活质量，还给患者的全面功能康复带来较大困难。重复经颅磁刺激（rTMS）在神经系统和精神性疾病治疗方面的应用受到越来越多的关注，研究rTMS对VCI的疗效，对寻找非药物手段治疗VCI具有重要意义。目的　系统评价rTMS对我国VCI患者的疗效。方法　2019年10月-2020年1月，使用Cochrane协作网提供的系统评价方法，系统全面检索PubMed、Embase、EBSCO、Web of Science、Cochrane Library和中国知网数据库。同时筛查纳入文献的参考文献，结合手工检索相关期刊及灰色文献，检索时间截至2019-12-30，纳入关于rTMS治疗VCI的临床随机对照研究。由两名评价者采用Cochrane偏倚风险评估工具进行文献质量评价，采用RevMan 5.3软件进行Meta分析。结果　共纳入12篇临床随机对照文章，包括837例患者。Cochrane偏倚风险评估结果显示，12篇文献中，5篇报道了具体的随机分组方法，2篇进行了分配隐藏，2篇报道了避免测量偏倚的方法。Meta分析结果提示rTMS能够提高脑卒中患者的蒙特利尔认知评估量表（MoCA）、简易智力状态检查量表（MMSE）及Loewenstein认知功能评定表（LOTCA）评分。进行敏感性分析后，MoCA评分和MMSE评分结果采用固定效应模型，其总体效应值分别为：WMD=2.52，95%CI（2.04，3.00），P<0.05；WMD=1.55，95%CI（1.04，2.07），P<0.05。LOTCA评分因文献数量限制而采用定性分析，结果显示rTMS对其改善具有积极作用（P<0.05）。结论　rTMS对VCI患者的认知功能具有一定改善作用。但目前仍存在临床试验不够规范和研究样本量较小等问题，未来还需要更多高质量、大样本、多中心的随机对照研究来观察rTMS对VCI的疗效。     

羟苯磺酸钙治疗非增殖性糖尿病视网膜病变的系统评价

目的评估羟苯磺酸钙治疗非增殖性糖尿病视网膜病变的有效性和安全性。方法检索关于羟苯磺酸钙治疗非增殖性糖尿病视网膜病变的随机或半随机对照试验，包括：Cochrane图书馆临床对照试验数据库、MEDLINE、EMBASE数据库以及中国生物医学文献数据库。两位研究者独立地进行研究的选择、质量评价和资料提取。结果共有16个试验903例非增殖性糖尿病视网膜病变患者符合纳入标准。全部试验的方法学质量评价为B级（简单方法）。Meta分析结果显示：羟苯磺酸钙能改善非增殖性糖尿病视网膜病变的临床症状和眼底病变，能改善视网膜出血情况和视力。根据目前证据不能认为羟苯磺酸钙可以改善和减少非增殖性糖尿病视网膜病变患者的微血管瘤病变、眼底毛细血管闭塞情况和视野情况；不能认为其能降低非增殖性糖尿病视网膜病变合并青光眼患者的眼压。已报道的不良反应包括药物过敏、胃肠道不适、轻度胃痛、轻度恶心和食欲下降。结论羟苯磺酸钙可能是一种相对安全和有效的治疗非增殖性糖尿病视网膜病变的药物。由于纳入试验少，样本含量低，方法学质量不高，证据的强度不足，有待大样本、多中心的高质量临床试验进一步证实。