【摘要】 目的 探讨IgA肾病肾血管病变的危险因素。 方法 回顾性分析2000年1月－2009年6月间经肾活检确诊的175例IgA肾病患者资料，其中有肾血管病变者93例，无肾血管病变者82例，进行对照研究。采用多因素非条件logistic回归模型分析影响IgA肾病肾血管病变的危险因素。 结果 高血压[OR=11.593，P=0.001，95%CI（2.800，47.991）]、24 h尿蛋白定量[OR=1.754，P=0.001，95%CI（1.270，2.424）]、血肌酐[OR=1.005，P=0.001，95%CI（1.002，1.008）]、肾小球硬化[OR=8.341，P=0.000，95%CI（2.716，25.610）]、肾间质纤维化[OR=4.880，P=0.014，95%CI（1.385，17.199）]对IgA肾病肾血管病变的影响有统计学意义。 结论 高血压、24 h尿蛋白定量、血肌酐、肾小球硬化和肾间质纤维化可能是影响IgA肾病肾血管病变的独立危险因素。积极控制以上危险因素对延缓IgA肾病病变的进展具有重要意义。【Abstract】 Objective To explore the risk factors for renal vascular lesions in patients with immunoglobulin A (IgA) nephropathy. Methods We retrospectively analyzed the clinical data of 175 IgA nephropathy patients diagnosed through renal biopsy from January 2000 to June 2009. Among them, there were 98 cases of renal vascular lesions and 82 cases without renal vascular lesion. Controlled study between the two groups of patients were carried out. A multivariate unconditional logistic regression model was employed to analyze the risk factors for renal vascular lesions in IgA nephropathy patients. Results The following factors had significant correlations with renal vascular lesions in IgA nephropathy patients: hypertension [OR=11.593,P=0.001,95%CI (2.800, 47.991)], 24-hour urine protein level [OR=1.754,P=0.001, 95%CI (1.270, 2.424)], serum creatinine [OR=1.005,P=0.001, 95%CI (1.002, 1.008)], glomerulosclerosis [OR=8.341,P=0.000,95%CI (2.716, 25.610)], and renal interstitial fibrosis [OR=4.880,P=0.014, 95%CI(1.385,17.199)]. Conclusion Hypertension, 24-hour urine protein, serum creatinine, glomerulosclerosis and renal interstitial fibrosis were risk factors for renal vascular lesions in IgA nephropathy patients. It will be very significant to actively control all the above risk factors to prevent occurrence of renal vascular lesions.
This paper used the application of health technology assessment (HTA) in medical insurance directory adjustment as an example, introduced NICE’s HTA in UK from seeking legislative support for HTA, established the system of HTA, improved the process of HTA and increasing awareness of using HTA among decision-maker, and provided suggestions for the development and advancement of HTA in China.
ObjectivesTo compare and analyze existing pharmaceutical economic evaluations quality assessment instruments, and to provide suggestions on how to choose the most appropriate instrument.MethodsPubMed, EMbase, ScienceDirect, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on existing pharmaceutical economic evaluations quality assessment instruments from inception to December, 2017. Two reviewers independently screened literature, extracted data and analyzed studies in terms of items, design methods, scopes and characteristics.ResultsTwelve original checklists with good reliability and validity were found. The first quality assessment method was designed in 1987 and the latest one was published in 2013. The number of checklist items ranged from 11 to 61.ConclusionThere is no consolidated method for assessing the quality of pharmaceutical economics evaluations. Evaluators can choose appropriate evaluation tools according to the purpose, type and operability of evaluation.
ObjectivesTo systematically review the efficacy and safety of pegylated interferon α-2a (Peg-IFNα-2a) combined with entecavir (ETV) versus Peg-IFNα-2a alone in treatment of HBeAg-positive chronic hepatitis B (CHB) patients.MethodsThe Cochrane Library, PubMed, Web of Science, EMbase, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on Peg-IFNα-2a combined with ETV for HBeAg-positive CHB from inception to March, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 12 RCTs involving 1 130 patients were included. The results of meta-analysis showed that: compared with Peg-IFNα-2a monotherapy, Peg-IFNα-2a combined with ETV could improve the rate of serum HBV-DNA clearance (RR=2.55, 95%CI 1.83 to 3.55, P<0.000 01), ALT normalization (RR=2.37, 95%CI 1.76 to 3.20, P<0.000 01) and HBeAg seroconversion (RR=2.88, 95%CI 1.18 to 7.03, P=0.02) after 12 weeks of treatment. Additionally, it could improve the rate of serum HBV-DNA clearance (RR=2.10, 95%CI 1.74 to 2.53, P<0.000 01), AST normalization (RR=1.87, 95%CI 1.15 to 3.04, P=0.01), ALT normalization (RR=1.70, 95%CI 1.46 to 1.99, P<0.000 01), serum HBeAg clearance (RR=2.14, 95%CI 1.62 to 2.83, P<0.000 01), HBeAg seroconversion (RR=2.51, 95%CI 1.65 to 3.82, P<0.000 01) and serum HBsAg clearance (RR=2.78, 95%CI 1.06 to 7.31, P=0.04) after 24 weeks of treatment. It could also improve the rate of serum HBV-DNA clearance (RR=1.63, 95%CI 1.32 to 2.02, P<0.000 01), AST normalization (RR=2.75, 95%CI 1.82 to 4.16, P<0.000 01), ALT normalization (RR=1.47, 95%CI 1.33 to 1.63, P<0.000 01), serum HBeAg clearance (RR=1.65, 95%CI 1.42 to 1.91, P<0.000 01), HBeAg seroconversion (RR=1.91, 95%CI 1.51 to 2.41, P<0.000 01) and serum HBsAg clearance (RR=1.57, 95%CI 1.07 to 2.31, P=0.02) after 48 weeks of treatment. There was no statistically significance of adverse reactions in groups.ConclusionsCurrent evidence shows that Peg-IFNα-2a combined with ETV is superior to Peg-IFNα-2a monotherapy in the treatment of HBeAg-positive CHB, and does not increase the incidence of adverse reactions. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
ObjectiveTo systematically review the efficacy of irbesartan combined with metoprolol plus conventional treatment compared with single drug (irbesartan, metoprolol) plus conventional treatment or conventional treatment for elderly patients with severe heart failure.MethodsPubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on irbesartan combined with metoprolol in the treatment of elderly patients with severe heart failure from January 2009 to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Network meta-analysis was then performed using gemtc package of R software.ResultsA total of 58 RCTs involving 5 064 patients were included. The results of meta-analysis showed that the efficiency, left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) of combination group were significantly superior to single drug group.ConclusionsThe current evidence shows that under the premise of conventional treatment, the combination of irbesartan and metoprolol is more effective than irbesartan or metoprolol alone in the treatment of elderly patients with severe heart failure. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectivesTo compare the common application methods of meta-analysis results used in economic evaluations so as to provide reference and suggestions for similar economic evaluations in future.MethodsFour methods were used to calculate the effectiveness deriving from meta-analysis of omeprazole and esomeprazole in the treatment of peptic ulcer, then substituted into the decision tree model to perform cost-effectiveness analysis.ResultsMethod 1 used the risk difference as the incremental effectiveness. The ICER was ￥2 420, and the equal probability point of the cost-effectiveness acceptability curve (CEAC) in the probability sensitivity analysis was approximately ￥2 600. Method 2 used the effective rate of the study group in high-quality literatures as the benchmark, calculated the effective rate of the control group according to the RR. The ICER was ￥2 016, and the equal probability point of the CEAC was approximately￥2 000. Method 3 was based on the effective rate of the control group in high-quality literatures to calculate the effective rate of the study group according to RR. The ICER was ￥2 420 and the equal probability point of the CEAC was approximately￥2 200; Method 4 used literature weights to calculate the effectiveness, the ICER is ￥2 420, and the equal probability point of the CEAC was about ￥2 400.ConclusionsThe results of the four methods share little difference, and the sensitivity analysis results show that the base case analysis results are more robust. However, in the application process, method 1 lacks specific effectiveness of the two groups and underestimate the variation range of the effectiveness difference when one-way sensitivity analysis was performed. Relevant assumptions are further required to limit the possibility of effectiveness calculated greater than 1 in sensitivity analysis among method 2 and 3. Comprehensively, method 4 can be recommended in the economic evaluations for fewer defects of calculating effectiveness.
ObjectiveTo explore the factors that affect the accuracy of percutaneous thermal ablation of lung metastases and coping strategies.MethodsWe retrospectively analyzed the clinical data of 31 patients who met the conditions for thermal ablation of lung metastases in Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine between October 2019 and December 2020. There were 19 males and 12 females with a mean age of 40-81 (62.8±10.3) years. A total of 33 metastases tumors were thermally ablated, 12 were radiofrequency ablation and 19 were microwave ablation.ResultsOf the 33 metastatic tumors, 5 targets showed significant puncture deviation, 4 of them completed the ablation after adjustment and 1 failed. The result of the univariate logistic regression showed the distance within the lung parenchyma (P=0.043) and the maximum diameter of the tumor (P=0.025) were independent risk factors for the accuracy of percutaneous thermal ablation. In terms of correlation, there was a positive correlation between the accuracy of percutaneous thermal ablation and the distance within the lung parenchyma (P=0.033), and a negative correlation between the maximum diameter of metastases tumor (P=0.004) and hemoptysis (P=0.015). Complete ablation rate was 87.8% (29/33).ConclusionWhen we perform CT-guided percutaneous thermal ablation of lung metastases, we must fully prepare the deviation plan for the small diameter tumor, the long travel distance in the lung parenchyma, and hemoptysis during puncture. Complete ablation can be achieved by fully identifying the anatomical features of the tumor and its surrounding structures, shortening the travel distance in the lung parenchyma and increasing the ablation range.