ObjectiveTo systematically review the efficacy of lamivudine (LAM) plus adefovir (ADV) versus entecavir (ETV) monotherapy for LAM-resistant chronic hepatitis B patients. MethodsWe electronically searched databases including PubMed, The Cochrane Library (Issue 12, 2013), CBM, CNKI, VIP, WanFang Data from their inception to December 2013, to collect randomized controlled trials (RCTs) or cohort studies of LAM+ADV versus ETV for LAM-resistant chronic hepatitis B. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 13 RCTs and 5 cohort studies involving 1 336 patients were included. The results of meta-analyses of RCTs showed that:there were no significant differences between the LAM+ADV group and the ETV group in the negative rates of serum HBV-DNA (RR=1.00, 95%CI 0.91 to 1.10, P=0.94), HBeAg (RR=0.90, 95%CI 0.70 to 1.17, P=0.43), serum ALT recovery rate (RR=0.97, 95%CI 0.90 to 1.05, P=0.45) and serum HBeAg conversion rate (RR=0.71, 95%CI 0.40 to 1.24, P=0.22) at the 48th week. The results of meta-analyses of cohort studies showed that:there were no significant differences between the two groups in the negative rates of serum HBV-DNA (RR=1.37, 95% CI 0.91 to 2.06, P=0.13) and serum ALT recovery rate (RR=0.99, 95%CI 0.87 to 1.12, P=0.87), but the ETV group had higher serum HBeAg conversion rate (RR=0.24, 95% CI 0.07 to 0.79, P=0.02). ConclusionCurrent evidence shows that the efficacy of LAM+ADV is similar to ETV at the 48th week for LAM-resistant chronic hepatitis B patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
目的总结完全腹腔镜下胆管空肠Roux-en-Y吻合的适应证、禁忌证、技术要点、安全性、并发症的预防及治疗效果。 方法回顾性分析2008年6月至2013年12月期间于笔者所在医院科室接受腹腔镜下胆管空肠Roux-en-Y吻合术的67例患者的临床资料。 结果67例患者中，66例完全在腹腔镜下完成手术，1例于放置蓝蝶后在手助下完成。手术时间144～253 min，平均152 min；术中出血30～220 mL，平均70 mL；术后住院时间6～11 d，平均8.1 d；住院费用2.0～2.5万元，平均2.1万元。术后发生漏胆3例，均经引流后痊愈；术后无肠瘘、出血、腹腔感染、肠梗阻等发生。术后20例患者获访，随访时间5～20个月，中位数为13个月。随访期间发生胆管炎2例，无吻合口狭窄发生。 结论对胆总管囊肿、胆总管下端良性狭窄、胆总管结石伴胆管扩张、壶腹部周围癌等需行胆肠吻合患者施行腹腔镜胆总管空肠Roux-en-Y吻合术是可行的，其手术费用稍高，但患者术后恢复快，且具有微创优势。
ObjectiveTo systematically evaluate the safety of dipeptidyl peptidase-4 (DPP-4) inhibitors on the risk of cardiovascular events in type 2 diabetes mellitus (T2DM) patients. MethodsDatabases such as the Cochrane Library, PubMed, Elsevier ScienceDirect and EMbase were searched to collect randomized controlled trials (RCTs) about DPP-4 inhibitors for T2DM patients from inception to February 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan5.2 software. ResultsA total of 20 RCTs involving 10 402 patients were included. The results of meta-analysis showed that:there were no significant differences between the DPP-4 inhibitors group and the control group in the cardiovascular adverse events (RR=0.86, 95%CI 0.62 to 1.20, P=0.38) and acute coronary syndrome (RR=0.66, 95%CI 0.37 to 1.17, P=0.15). Subgroup analyses by type of liptins and durations showed there were lower risks of adverse cardiovascular events in the DPP-4 inhibitors group of the sitagliptin subgroup (RR=0.49, 95%CI 0.29 to 0.82, P=0.007) and the duration of ≥52 weeks subgroup (RR=0.62, 95%CI 0.39 to 0.97, P=0.04). No significant difference was found between the two groups in hypertension events (RR=1.09, 95%CI 0.84 to 1.40, P=0.52). ConclusionThe DPP-4 inhibitors are relatively safe. In the long-term treatment of T2DM, the sitagliptin could not only effectively control the level of blood sugar but also might obtain benefits in cardiovascular aspects.
ObjectiveTo systematically review the efficacy of coenzyme Q10 as adjuvant therapy for patients with heart failure. MethodsDatabases including PubMed, The Cochrane Library (Issue 7, 2015), EMbase, CBM, CNKI, WanFang Data and VIP were searched to collect randomized controlled trials (RCTs) about coenzyme Q10 in the treatment of heart failure from inception to June 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 24 RCTs involving 2883 patients were included. The results of meta-analysis showed that:compared with the control group, the coenzyme Q10 group had the lower mortality (RR=0.62, 95%CI 0.47 to 0.83, P=0.001), higher eject fraction (EF) level (MD=3.81, 95%CI 1.22 to 6.40, P=0.004), lower NYHA cardiac function classification (MD=-0.31, 95%CI -0.35 to -0.26), P<0.00001), and higher exercise tolerance (SMD=0.70, 95%CI 0.31 to 1.09, P=0.0005). ConclusionCurrent evidence shows that, coenzyme Q10 can reduce mortality, NYHA cardiac function classification and improve EF and exercise tolerance in patients with heart failure. Due to the limited quality of included studies, the above conclusion still needs to be verified by more high quality studies.