本文针对二分类变量结局指标相对（而非绝对）治疗效果的不一致性。证据本身不会因不同研究结果具有一致性而升级，但可能因不一致而降低质量级别。衡量一致性的标准包括点估计值的相似性、可信区间的重叠程度以及统计学判定标准包括异质性检验和I2。系统评价作者应提出并检验少数几个与患者、干预措施、结局指标以及方法学相关的先验假设以探寻异质性来源。当不一致性很大且无法解释时，因不一致性而降低质量级别是恰当的，特别当某些研究显示有显著益处而其他显示无益甚至有害时（而非仅是疗效大与疗效小的比较）。明显的亚组效应可能不可靠。如果亚组效应满足以下条件，其可信度将会增加：基于少数几个有具体方向的先验假设、亚组比较来自研究内而非研究间、交互检验的P值小、结果有生物学意义。
Objective To investigate the changes and clinical relationship of plasma adrenomedullin( ADM) , atrial natriuretic polypeptide( ANP) , and heart rate variability( HRV) in patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Seventy-five inpatients with OSAHS were enrolled in this study. According to the apnea hypopnea index ( AHI) by polysomnography, the subjects were divided into a mild group, a moderate group, and a severe group. Meanwhile, HRV was screened bydynamic electrocardiogram in sleep laboratory. HRV parameters were obtained including LF ( low frequency power) , HF( high frequency power) , pNN50( percentage of NN50 in the total number of N-N intervals) ,SDNN( standard deviation of the N-N intervals) , rMSSD( square root of the mean squared differences of successive N-N intervals ) . Plasma levels of ADM/ANP were measured by radioimmunoassay. Results The levels of SDNN ( P lt;0. 05) , rMSSD, pNN50, LF ( P lt; 0. 05) and HF were gradually reduced, and the levels of ADM ( P lt;0. 05) and ANP ( P lt; 0. 05) were increased with increasing severity of OSAHS. Linear correlation analysis demonstrated that SDNN was negatively correlated with ADM( r = - 0. 423, P lt;0. 05)and ANP( r = - 0. 452, P lt; 0. 05) , and LF was also negatively correlated with ADM( r = - 0. 348, P lt;0. 05) . Conclusion Lower HRV is associated with more sever OSAHS, and it may be modulated neurohumorally by ADM and ANP.
Objective To investigate the clinical characteristics of upper airway cough syndrome ( UACS) and the relationship of UACS with upper airway diseases, cough variant asthma ( CVA) , and gastroesophageal reflux disease ( GERD) . Methods 92 subjects with chronic cough and throat symptoms and signs were included in the study. The medical records were collected fromall subjects, and 49 subjects suspected for CVA undertook bronchial provocation test. Then the efficacy was evaluated and etiology were analyzed based on the efficacy of targeted treatment. Results Bronchial provocation test yielded positive results in 14 subjects suspected of CVA, accounting for 15. 2% of all cases ( 14/92) . 18. 5% ( 17 /92) of patients had a history of chronic gastritis or combined symptoms of GERD, of whom anti-gastroesophagealreflux treatment was effective. The patients with rhinitis, sinusitis history and/ or symptoms accounted for 33. 7% of cases ( 31 cases) . 51. 1% ( 47/92) of patients had only signs and symptoms of chronic pharyngitis. Conclusions UACS is not only due to the rhinitis and/ or sinusitis but also chronic pharyngitis. Chronic pharyngitis may be secondary to chronic rhinitis/ sinusitis with post nasal drip and gastroesophageal reflux, also may be an independent cause of chronic cough.
Objective To assess the changes of cardiac autonomic nerves’s function in patients underwent bronchofiberscopy by observing the dynamic electrocardiogram ( DCG) and heart rate variability ( HRV) , and investigate the effect of different preoperative medications on heart function.Methods Eighty patients underwent bronchofiberscopy were randomly divided into three groups according to different anaesthesia. Group A ( n =30) were local anaesthetized by nebulized lidocaine, group B ( n = 30) received atropine 1 mg injection intramuscularly and nebulized lidocaine, group C ( n = 20) were anaesthetized bypropofol intravenously. The DCG and HRV of three groups were mornitored at pre-inductive point( T0 ) , post inductive point ( T1 ) , point during the operation ( T2 ) , and point after operation ( T3 ) .Results The incidences of ST-T change, tachycardia, and bearing premature in group A and B were increased. The incidence of tachycardia in group C was also increased, but lower than group A and B while the ST-T change and bearing premature were milder ( P lt;0. 05) . Episodes of bradycardia occurred 3 times in group A andnone in group B and C ( P lt;0. 01) . The low-frequency ( LF) , high-frequency ( HF) , total power ( TP) in group A and B were raised, but the LF was highly raised, and the LF/HF and HRV significantly decreased.The LF/HF and HRV decreased lightly in group C ( P gt; 0. 05) . Conclusions Bronchofiberscopy examination can decrease HRV and induce arrhythmia and ST-T change, but also excite vagus nerve. Atropine can inhibit the excitability of vagus nerve and have no influence on HRV. The propofol may obviously decrease the sympathetic nervous activation, balance sympathetic and vagus nerves, which is beneficial to the stability of hemodynamics.
【摘要】 目的 探讨急性脑梗死对心脏自主神经活性的影响。 方法 Wistar大鼠32只随机分为正常组、假手术组和脑梗死组，脑梗死组用线栓法行右侧大脑中动脉阻塞。脑梗死组和假手术组于术前及术后24 h作心率变异性（HRV）检测，同时检测正常组HRV，将3组的HRV指标进行比较。实验终点取各组心肌组织检测儿茶酚胺和神经肽Y（NPY），进行组间比较。 结果 术后24 h脑梗死组和正常组、假手术组相比，窦性心搏间期标准差、均方根，总功率谱、高频功率谱（HF）、低频功率谱（LF）降低，差异有统计学意义。3组比较LF/HF和分数维无明显差异。脑梗死组心肌组织去甲肾上腺素（NA）和NPY高于正常组和假手术组。 结论 脑梗死引起心脏自主神经总活性降低、自主神经功能受损，自主神经末梢去甲肾上腺素和NPY的异常分泌可能是重要的原因。【Abstract】 Objective To investigate the effect of acute cerebral infarction on cardiac autonomic nervous activity. Methods A total of 32 Wistar rats were divided into normal group, sham operation group and infarction group by random. Experimental cerebral infarction in Wistar rats was induced by intraluminal occlusion of middle cerebral artery. About 24 hours after the occlusion or 24 hours after sham operation, the heart rate variability (HRV) sequences were measured, and the HRV values in the three groups were compared. The levels of catecholamine and neuropeptide (NPY) in myocardium were measured. Results At the 24th hour after the occlusion, the standard deviation and root mean square standard deviation of R-R interval, the total power, high frequency (HF) and low frequency (LF) in infarction group were lower than those in normal and sham operation group. LF/HF and fractal dimension did not differ much among the three groups. The levels of noradrenaline and NPY in myocardium in infarction group were higher than those in the other groups. Conclusion It is suggested that acute cerebral infarction may cause the decrease of autonomic nervous activity and damage of the autonomic nervous function; the abnormal secretion of noradrenalin in autonomic nerve ending and NPY may be the important reasons.
目的：观察卡介菌多糖核酸注射液在小儿咳嗽变异性哮喘治疗应用的疗效。方法：将本科40例咳嗽变异性哮喘患儿，随机分为治疗组和对照组(各20例)。治疗组给予BCG-PSN+必可酮气雾剂，对照组：给予单用必可酮气雾剂吸入，连续吸入6周，观察疗效，并进行统计学处理。结果：治疗组总有效率为95%，对照组总有效率为70%，统计学处理总有效率有显著差异(Plt;0.01)。结论：卡介菌多糖核酸(polysaccharide nucleic acidfraction of BCG，BCG-PSN)能有效地控制咳嗽变异性哮喘(CVA)的呼吸道的反复感染，提高免疫功能；与必可酮配合，能有效地控制CVA的复发。
目的:了解阻塞性睡眠呼吸暂停综合征患者的心率变异改变。方法:对67例睡眠打鼾患者同步进行24小时动态心电图及多导睡眠图监测。根据PSG检测结果分为OSAS组和单纯鼾症组,比较组间低频峰(LF),高频峰(HF),低频峰与高频峰的比值(LF/HF),正常RR间期平均值及其标准差值(SDNN),正常RR间期差值均方根(rMSSD)。结果:OSAS组中,频域分析指标:LF,HF,均低于单纯鼾症组,LF/HF高于对照组,时域分析指标:SDNN,rMSSD均低于对照组。结论:OSAHS患者心率变异性降低。
目的:研究老年患者依托咪酯靶控输注时不同BIS值(脑电双频指数)的HRV(心率变异性)的变化情况,探讨不同镇静深度与HRV之间的关系。方法:选择65岁以上行门诊胃镜检查患者30例,随机分为3组,A组BIS45~55,B组55~65,C组65~75,各组均在麻醉前、麻醉诱导后,术中、术毕监测BIS、HRV及血液动力学指标。结果:A组各监测HRV明显降低(Plt;0.05),B组仅有轻度下降(Pgt;0.05),C组明显升高(Plt;0.05)。结论:患者镇静深度BIS55~65时,即可明显抑制内镜操作刺激所致的HRV变化,是临床较为合适的镇静深度,可显著降低老年患者交感神经活性、交感/迷走神经均衡性和自主神经总张力,利于机体血液动力学稳定。
ObjectiveTo investigate the correlation between intima-media thickness (IMT) of carotid artery in color ultrasonography and the heart rate variability. MethodsA retrospective analysis was performed in 64 patients from West China Hospital of Sichuan University between March and May 2013. Carotid intima-media thickness was measured with color ultrasonography and dynamic electrocardiogram, and the heart rate variability was assayed at the same time. ResultsIMT in the cardiovascular disease group, combination group, coronary heart disease group and hypertension group was significantly thicker than the control group (P<0.05). The differences of SDNN and SDANN were statistically significant (P<0.05) between the combination group and the control group. There were 23 cases with IMT ≥ 1.0 mm in the cardiovascular disease group including 8 cases in the combination group, 10 cases in the coronary heart disease group and 5 cases in the hypertension group. IMT in those groups were all significantly higher than that in the control group with only 2 cases having IMT ≥ 1.0 mm (P<0.05). There were 18 cases with SDNN<100 ms in the cardiovascular disease group including 7 cases in the combination group, 6 cases in the coronary heart disease group and 5 cases in the hypertension group, but there was no statistically significant difference compared with that in the control group with only 11 cases (P>0.05). Negative correlation was found between IMT and SDNN, SDANN in the cardiovascular diseases group (r=-0.574, -0.544; P<0.01) and negative correlation was found between IMT and SDANN in the control group (r=-0.392, P<0.05). ConclusionThe carotid artery lesions and autonomic nerve especially sympathetic nerve dysfunction are obvious in patients with cardiovascular diseases and there is a negative correlation between them.