体外冲击波治疗膝骨关节炎的系统评价及Meta分析

文题释义：体外冲击波疗法：是一种通过物理学机制介质传导的机械性脉冲压强波,该设备将气动产生的脉冲声波转换成精确的弹道式冲击波,通过治疗探头的定位和移动,可以对疼痛较广泛的疾病产生良好的治疗效果。 膝骨关节炎：是一种发病率较高的常见慢性退行性疾病,主要以关节软骨退化为主要发病机制,好发于中老年人群,主要临床症状包括膝关节疼痛伴活动功能受限,影响患者生活质量,目前主要治疗方式为非手术治疗(物理疗法、药物治疗)和手术治疗。背景：相关研究表明体外冲击波疗法对于膝骨关节炎的治疗具有积极作用,然而关于其治疗膝骨关节炎的有效性尚不十分清楚,各项相关研究最终结果不尽相同。 目的：Meta分析体外冲击波疗法治疗膝骨关节炎的的疗效。方法：详尽检索国内外中英文数据库,检索时间为建库至2019年12月。根据Prisma原则制定纳入标准,筛选体外冲击波疗法治疗膝骨关节炎的随机对照试验,试验组的治疗方式为单独体外冲击波疗法或是体外冲击波疗法联合药物、关节镜清理术中的一种,对照组的治疗方式为药物治疗、超声治疗、激光治疗、运动疗法、关节镜清理术中的一种,或是空白对照。依据Cochrane Handbook 5.1偏倚风险评价工具评价纳入文献的质量,运用RevMan v5.3软件对提取数据进行Meta分析。结果与结论：①纳入21篇随机对照试验,共1 736例膝骨关节炎患者,其中试验组895例,对照组841例;②Meta分析显示,试验组的目测类比评分低于对照组[SMD=-1.18,95%CI(-1.42,-0.95),Z=9.75,P < 0.000 01],关节活动度大于对照组[SMD=-1.69,95%CI(-2.01,-1.36),Z=10.16,P < 0.000 01],WOMAC评分低于对照组[SMD=-9.66,95%CI(-13.12,-6.20),Z=5.47,P < 0.000 01];③结果表明,体外冲击波疗法治疗膝骨关节炎对缓解疼痛、改善关节活动度有一定的积极作用。但研究纳入病例数较少,后续需大样本多中心研究进一步阐明相关效用。 ORCID: 0000-0002-6542-3288(皇甫志敏) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

微创切口和传统切口全髋关节置换临床疗效的系统评价

背景：目前对微创全髋关节置换的争议多集中在小切口术野有限,是否会增加股骨颈骨折、神经损伤等并发症及假体位置不良,影响手术远期疗效。 目的：采用系统评价方法比较微创切口与传统切口全髋关节置换的临床疗效及安全性。 方法：检索国内外微创切口与传统切口全髋关节置换的完全随机对照试验,严格评价纳入研究的方法学质量,并提取资料,采用RevMan5.1软件行Meta分析。 结果与结论：共纳入10个随机对照试验,1 001例患者。资料分析显示,微创切口与传统切口全髋关节置换在医源性神经损伤、髋臼杯外展角、股骨柄内翻和外翻发生率、置换后髋关节脱位率、再次手术率方面差异均无显著性意义。亚组分析表明：所有后侧入路的微创切口和传统切口全髋关节置换组在髋臼杯外展角、置换后髋关节脱位率和再次手术率方面差异无显著性意义。后外侧入路的微创切口和传统切口组置换后髋关节脱位率差异无显著性意义。表明微创切口和传统切口全髋关节置换两者疗效相当。     

长期运动对健康老年人群血脂影响的系统评价及Meta分析

目的：评价长期运动对健康老年人群血脂的影响,探讨长期运动是否可以影响老年人群低密度脂蛋白。方法：检索Pub Med、Cochrane library、EBSCO、中国知网数据库,收集长期运动对健康老年人血脂影响的随机对照试验。应用Cochrane偏倚风险评估工具对纳入文献进行方法学质量评价,采用Stata 14.0软件进行异质性分析和潜在发表偏倚分析。结果：共纳入9篇文献,包括409名受试者,其中实验组226名,对照组183名。(1)Meta分析结果显示,与对照组相比,长期运动可以降低老年人三酰甘油(SMD=-0.67,95%CI:-1.14至-0.20,P=0.006)、总胆固醇(SMD=-0.42,95%CI:-0.82至-0.02,P=0.04),并提高高密度脂蛋白(SMD=0.71,95%CI:0.08-1.33,P=0.026),但运动干预后老年人低密度脂蛋白没有发生显著性变化(SMD=-0.17,95%CI:-0.36-0.02,P=0.085)。(2)亚组分析结果显示,每周运动时间≥150 min的运动可以有效改善血脂状况,并且总的效应量大于每周<150 min的运...     

中药与西药对照治疗偏头痛的Meta分析

目的评价中药治疗偏头痛的临床疗效和安全性。方法计算机检索中国期刊全文数据库、维普中文期刊数据库、万方学术期刊全文数据库、中国生物医学文献服务系统（CBM）、中国生物医学期刊引文数据库（CMCI/CMCC整合版）、中医药在线数据库,检索2000年1月—2009年12月10年间的相关文献,收集中药治疗偏头痛的随机对照试验（RCTs）。按纳入排除标准筛选试验、评价研究质量、提取有效数据,并采用RevMan5.0进行统计分析。结果最终纳入20个RCT评价中药与西药在偏头痛疗效方面的差异,Meta分析显示：有效率[RR=1.22,95%CI（1.15,1.29）,P〈0.01],差异有统计学意义。敏感性分析表明评价结果稳定。漏斗图显示不对称,提示纳入评价的文献存在发表性偏倚。结论中药治疗偏头痛有效,但由于本系统评价纳入研究的方法学质量较低,尚需开展更多设计合理、执行严格的多中心大样本且随访时间足够长的随机对照试验验证其疗效及安全性。     

地舒单抗治疗类风湿关节炎患者骨质疏松症有效性和安全性的Meta分析

目的:通过Meta分析评价地舒单抗治疗类风湿关节炎(RA)患者骨质疏松症(OP)的有效性及安全性。方法:检索PubMed、Web of Science、Embase、Cochrane Library、中国知网(CNKI)、万方(Wanfang)、维普(VIP)和中国生物医学文献数据库(CBM),查找从建库至2021年10月国内外正式期刊发表的有关地舒单抗治疗RA患者OP的随机对照试验(RCT)、前瞻性和回顾性比较研究,将检索到的文献由2名研究人员独立筛选,并按照Cochrane 5.1手册推荐的偏倚风险评估工具对纳入文献进行方法学质量评价,采用Revman 5.3软件进行数据统计分析。结果:最终纳入符合标准的文献8篇,共1399例患者,其中试验组735例,对照组664例。Meta分析结果显示,地舒单抗治疗12个月后,能够有效提高未接受过BPs类药物治疗的RA患者腰椎BMD水平(MD=3.08,95%CI:1.73~4.42,P<0.00001),但与BPs类药物相比,地舒单抗改善腰椎BMD效果无明显差异(MD=0.02,95%CI:-0.03~0.06,P=0.49);地舒单抗还可保护关节,降低Sharp评分(MD=-0.53,95%CI:-0.77~-0.29,P<0.0001)和关节间隙狭窄评分(MD=-0.12,95%CI:-0.17~-0.06,P<0.0001),抑制骨侵蚀,降低关节骨侵蚀评分(MD=-0.49,95%CI:-0.84~-0.15,P<0.0050),且安全性较好,不良事件发生率与对照组相似(一般不良事件:RR=1.05,95%CI:0.76~1.45,P=0.75;严重不良事件:RR=0.73,95%CI:0.52~1.04,P=0.08;死亡事件:P=0.36)。结论:地舒单抗能够显著提高腰椎BMD,降低关节损伤及骨侵蚀评分,缓解关节间隙狭窄,抑制骨侵蚀破坏,最大程度保护关节,维持关节功能且安全性较好,但本研究结论仍需更大样本量验证以及进一步延伸研究。     

羟氯喹治疗骨关节炎疗效及安全性荟萃分析

目的:使用随机对照试验(RCT)的荟萃分析,阐明羟氯喹(HCQ)对骨性关节炎(OA)的影响。方法:以羟氯喹、骨性关节炎为关键词检索各数据库,纳入RCT研究,比较OA患者中的使用HCQ疗效和安全性,并通过评估的疼痛和功能量表等结果进行随机效应荟萃分析。用Revman5.3软件对纳入文献进行Meta分析。结果:最终纳入5项RCT研究,共纳入528例OA患者,随访时间3~24个月,结果分析,149例治疗组应用西安大略麦马斯特大学骨性关节炎可视化功能量表指数[ SMD=0.10,95% CI(-0.69,0.89), I2=0.85];106例治疗组视觉疼痛模拟(VAS)评分:[ SMD=0.02,95% CI(-2.69,2.73), I2=0.00]与对照组比较差异均无统计学意义。不良反应两组比较无统计学差异。 结论:羟氯喹治疗骨性关节炎的疗效和止痛效果各研究存在差异,有待进一步研究。     

云克治疗肿瘤骨转移的系统评价

目的评价云克治疗肿瘤骨转移的有效性和临床研究的质量。方法检索PubMed（1980．2010）,ScienceDirect（1982．2010）,Cochrane图书馆临床对照试验库（CCTR）、中国生物医学文献数据库（CBMdisc1980．2010）、中国学术期刊网专题全文数据库（CNKll980—2011）、中文科技期刊全文数据库（VIPl980—2010）、万方数据库（1980．2010）并根据文献中参考文献进行文献追溯,手工检索河北医科大学图书馆部分相关期刊,纳人随机对照临床试验研究。使用国际Cochrane中心推荐的方法进行文献质量评价,并用RevMan5．0软件进行统计分析。结果共纳入7篇低质量研究。骨痛缓解率方面,4项研究显示云克联合放射性核素89SRClz与单用胂SrClz的差异有统计学意义[OR=1．93,95％CI（2．05～6．54）];1项研究提示云克联合放射性核素”,Sm．EDTMP较单用”,Sm．EDTMP的差异无统计学意义[OR=2．46,95％叫（0．97～6．25）];1项研究显示云克联合鹕SrClz较单用s9SrClz在治疗前列腺癌骨转移引起骨痛方面差异有统计学意义[OR=3．46,95％CI（1．29～9．30）];1个研究显示云克联合-53Sm—EDTMP较单用,53Sm—EDTMP在治疗乳腺癌骨转移引起的骨痛方面差异有统计学意义[OR=2．70,95％C,（1．03—7．08）]。患者生活质量改善情况,1个研究提示云克联合鹕SrCl2与单用趵SrCl2的差异具有统计学意义[OR=2．73,95％C1（1．24～5．99）]。骨转移灶愈合情况,1项研究提示云克联合鹋SrCl2与单用。。SrCl2的差异具有统计学意义[OR=3．11,95％CI（0．91～10．64）]。结论云克对于治疗肿瘤骨转移可能具有一定的增效作用。     

替莫唑胺联合放疗治疗脑转移瘤的疗效及安全性的Meta分析

目的评价替莫唑胺(Temozolomide;TMZ)联合放疗(radiotherapy)治疗与单纯放疗相比,治疗脑转移瘤(Brain Metastasis)的有效性及安全性。方法计算机检索PubMed(2004年1月~2014年1月)、万方数据库(2004年1月~2014年1月)、中国知网数据库CKI(2004年1月~2014年1月)、维普医学数据库(2004年1月~2014年1月)参考文献。纳入替莫唑胺联合放疗治疗新诊断的脑转移瘤的临床随机对照试验(randomized control ed trial,RCT),纳入文献的方法学质量分析依据Cochrane评价手册5.0.0[3]随机对照试验质量评价标准。采用RevMan5.0软件进行Meta分析。结果共纳入10个RCT,共包括528例患者。Meta分析结果显示,替莫唑胺联合放疗组与单纯放疗组比较,其总有效率[RR=4.27,95%CI(2.64,6.92)]差异有统计学意义。替莫唑胺联合放疗治疗引发的副反应,如院白细胞减少与单纯放疗相比,差异有统计学意义,而胃肠道反应与单纯放疗相比,差异无统计学意义。结论目前国内的有限证据表明,与单纯放疗相比,替莫唑胺联合放疗能提高脑转移瘤的总有效率,但由于纳入研究样本量小且质量较低,上述结论尚需要高质量、大样本的随机双盲对照试验加以证实。     

喜炎平注射液治疗社区获得性肺炎临床疗效的Meta分析

目的 评价喜炎平注射液治疗成人社区获得性肺炎的临床疗效。方法 检索国内外公开发表的有关喜炎平注射液治疗社区获得性肺炎的随机对照试验研究,观察指标包括临床总有效率、咳嗽消失时间、啰音消失时间、退热时间、白细胞计数、降钙素原）、C-反应蛋白。结果 最终纳入13篇文献,Meta分析结果显示:喜炎平注射液组与对照组相比,临床总有效率提高:比值比为4.24,95%置信区间2.93~6.14,P＜0.00001;咳嗽消失时间缩短:加权均数差为-2.67,95CI:-3.91~-1.44,P＜0.0001;啰音消失时间缩短:标准化均数差为-0.91,95%CI:-1.16~-0.66,P＜0.0001;退热时间缩短:WMD为-1.83,95%CI:-2.92~-0.74,P=0.001;WBC水平无明显变化: WMD为-1.14,95%CI:-2.77~0.48,P=0.17;PCT水平降低:SMD为-1.86,95%CI:-3.02~-0.70,P=0.002;CRP水平降低: SMD为-1.86,95%CI:-2.82~-0.89,P=0.0002。结论 在常规西医治疗基础上加用喜炎平注射液治疗CAP可以明显提高患者临床总有效率,缩短咳嗽、啰音、发热持续时间,降低患者体内PCT、CRP水平,但对降低患者体内的WBC,无明显临床意义;喜炎平注射液治疗CAP患者有较好的疗效,且无严重不良反应,值得临床应用。     

膝关节镜术使用止血带必要性的Meta分析

目的研究止血带的使用对膝关节镜手术视野、手术时间等的效果,分析膝关节镜术使用止血带的必要性。方法计算机检索MEDLINE、EMBASE、Cochrane图书馆临床对照试验注册中心、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、数字化期刊全文数据库（WANGFANGDATA）,并手工检索相关领域其他杂志。检索不受语种限制,时间截止至2013年9月。以通过膝关节镜术治疗的各种类型疾病的患者为研究对象、比较使用止血带和不使用止血带的效果随机对照试验,评价纳入研究的质量,并用RevMan5.1软件进行Meta分析,并采用GRADE系统评价证据质量评价。结果纳入6个随机对照试验,包括531例患者。膝关节镜术不使用止血带仍能获得不错的手术视野,且能使患者尽早恢复到功能状态,术后疼痛也较轻;使用止血带手术视野虽有提高但并不能缩短手术时间。基于上述系统评价结果,采用GRADE系统评价证据质量及推荐等级,证据总体质量评级为低质量,推荐强度为弱推荐。结论不使用止血带可减轻患者术后早期疼痛及肿痛程度,对减少手术并发症、提高患者手术耐受力、早期功能恢复有积极的作用,值得推广。     

Patient education interventions for colorectal cancer patients with stoma: A systematic review

ObjectivesTo describe the various types of patient education interventions for colorectal cancer patients with stoma and to examine their effects on quality of life, psychosocial skills and self-management skills.MethodsA systematic review was performed. Six electronic databases were searched. Inclusion criteria were: studies about patient education applying quantitative methods including digestive stoma adults with colorectal cancer. The primary outcome was quality of life. Secondary outcomes were psychosocial and self-management skills.ResultsThirteen studies were identified and included. Five studies examined quality of life and three reported improvements. Patient education improved some psychosocial and self-management skills. Contrasting findings were reported for specific-disease quality of life, emotional distress, length of hospital stay, stoma complications and readmission rate.ConclusionsPatient education has a positive impact on some psychosocial and self-management skills, indicating that this area should be developed. Contrasting findings were reported for quality of life. Methodologies are heterogeneous making it difficult to produce evidence-based guidelines. This article proposes tools to carry out further studies on this subject and to improve understanding.Practice implicationFurther education intervention for stoma patients with colorectal cancer should be standardized in terms of intervention, duration and outcome measures to compare intervention and determine best practice.     

Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life

Background  

Exercise is widely recommended to reduce osteoporosis, falls and related fragility fractures, but its effect on whole bone strength has remained inconclusive. The primary purpose of this systematic review and meta-analysis was to evaluate the effects of long-term supervised exercise (≥6 months) on estimates of lower-extremity bone strength from childhood to older age.     

Efficacy of empowerment strategies for patients with hypertension: A systematic review and meta-analysis

BackgroundCardiovascular disease has caused heavy health care burdens in many countries, and hypertension (HTN) is a well-known independent cardiovascular risk factor.ObjectiveTo assess the efficacy of empowerment strategies that affect systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), quality of life, and self-management behaviours for patients with hypertension.MethodsA literature search of the Cochrane Library, PubMed, MEDLINE, Embase, Web of Science, and several Chinese medical databases was performed. Study screening, quality assessment, data extraction, and meta-analysis were conducted according to Cochrane standards.ResultsEleven randomised controlled trials with 988 subjects were identified. Relative to control groups, the empowerment strategies showed significant decreases in SBP (the mean difference [MD] = 9.46, 95 % confidence interval [CI] = 6.36–12.55, p < 0.00001) and DBP (MD = 6.68, 95 % CI = 3.07–10.29, p = 0.0003). However, no significant difference was found in BMI (p = 0.05). Subgroup analysis showed significant differences in the improvement of both SBP and DBP among the various groups, regardless of the duration and type of interventions.DiscussionEmpowerment strategies can decrease both SBP and DBP in hypertension patients. However, its influence on patients’ BMI, quality of life, and self-management behaviour remains unclear.Practical valueEmpowerment strategies are useful for controlling the blood pressure of hypertension patients.     

Thyroid disorders in patients with myasthenia gravis: A systematic review and meta-analysis

BackgroundOur purpose was to determine the prevalence of thyroid disorders in myasthenia gravis (MG) or whether MG was associated with an increased risk of thyroid disorders.MethodsPubmed, Embase, Web of Science, Cochrane database, Google Scholar and the Chinese Biomedical Databases were searched about the relationship between thyroid disorders and myasthenia gravis up to November 30, 2018, without language restrictions. The prevalence and relative risk (RR) for thyroid disorders were pooled by the R and STATA software.Results39 papers with 24,927 MG patients were ultimately included for analysis in this meta-analysis. The pooled estimate of thyroid autoimmunity prevalence in MG patients was 10.1% (95%CI 6.7%–15.1%). Subgroups in patients with thyroid autoimmunity showed the prevalence of positive TGAb was the highest in MG patients (12.6%, 95%CI 8.1%–19.1%), followed by GD (6.0%, 95%CI 4.2%–8.5%), HT (4.6%, 95%CI 1.9%–10.5%). Moreover, the pooled estimated prevalence of thyroid dysfunction in MG patients was 6.8% (95%CI 4.6%–9.8%). After stratification, the results showed the prevalence of hyperthyroidism and hypothyroidism in MG cases were 5.6% (95%CI 3.9%–8.0%) and 2.6% (95%CI 1.7%–4.1%), respectively. In addition, meta-analysis of 2 studies showed that MG was significantly associated with the increased risk of thyroid autoimmunity (OR = 2.86; 95%CI 1.54–5.28, P = .001).ConclusionsThis systemic review and meta-analysis provides reliable evidence that thyroid disorders are prevalent in MG, especially TGAb positivity, GD, hyperthyroidism, and HT, and MG is associated with increased risk for thyroid autoimmunity.     

A systematic review of computer-based softwares for educating patients with coronary heart disease

OBJECTIVE: To evaluate the use of computer-based softwares for educating patients with coronary heart disease. METHODS: A systematic electronic search for randomised controlled trials and comparison studies published from 1999 to the end of 2005 using the MEDLINE (1999-2005), EMBASE (1999-2005) and CINAHL (1999-2005) was carried out. Articles including the reference lists in the following journals were hand-searched: Patient Education and Counselling and Patient Counselling and Health Education. RESULTS: A total of 487 articles were identified. Based on a review of abstracts, five studies fulfilled the inclusion criteria of the review. A scoring sheet was used to assess the papers' quality. All studies reported significantly increased knowledge in patients using the educational software when compared to standard education. The difference in knowledge between the intervention and control groups remained high even at 6 months follow up. Furthermore, patients reported high satisfaction with the educational programs. CONCLUSION: Despite there only being five studies that met the inclusion criteria, this review supports the successful use of computer software to increase knowledge in patients with coronary heart disease. The reviewed articles reveal that computer-based education has an important role in increasing patients' knowledge about their condition. PRACTICAL IMPLICATIONS: It is commonly reported that patients want more information about their illness. This study shows that computer-based education can be a useful, acceptable to patients and effective way to deliver education about coronary heart disease.     

Asthma in patients with coronavirus disease 2019: A systematic review and meta-analysis

BackgroundIt is unclear whether asthma has an influence on contracting coronavirus disease 2019 (COVID-19) or having worse outcomes from COVID-19 disease.ObjectiveTo explore the prevalence of asthma in patients with COVID-19 and the relationship between asthma and patients with COVID-19 with poor outcomes.MethodsThe pooled prevalence of asthma in patients with COVID-19 and corresponding 95% confidence interval (CI) were estimated. The pooled effect size (ES) was used to evaluate the association between asthma and patients with COVID-19 with poor outcomes.ResultsThe pooled prevalence of asthma in patients with COVID-19 worldwide was 8.3% (95% CI, 7.6-9.0) based on 116 articles (119 studies) with 403,392 cases. The pooled ES based on unadjusted effect estimates revealed that asthma was not associated with reduced risk of poor outcomes in patients with COVID-19 (ES, 0.91; 95% CI, 0.78-1.06). Similarly, the pooled ES based on unadjusted effect estimates revealed that asthma was not associated with the reduced risk of mortality in patients with COVID-19 (ES, 0.88; 95% CI, 0.73-1.05). However, the pooled ES based on adjusted effect estimates indicated that asthma was significantly associated with reduced risk of mortality in patients with COVID-19 (ES 0.80, 95% CI 0.74-0.86).ConclusionThe pooled prevalence of asthma in patients with COVID-19 was similar to that in the general population, and asthma might be an independent protective factor for the death of patients with COVID-19, which suggests that we should pay high attention to patients co-infected asthma and COVID-19 and take locally tailored interventions and treatment. Further well-designed studies with large sample sizes are required to verify our findings.