ObjectiveTo systematically review the efficacy and safety of N-acetylcysteine (NAC) for patients with idiopathic pulmonary fibrosis (IPF). MethodsWe electronically searched PubMed, EMbase, The Cochrane Library (Issue 2, 2014), CNKI, WanFang Data and VIP databases from the date of establishment to February 2014 for all randomized controlled trials (RCTs) on the use of NAC in patients with IPF. Manual search in relevant journals were also performed. The data extraction and quality assessment of included RCTs were conducted by two reviewers independently. Then, meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 13 RCTs involving 713 patients were included. The results of meta-analysis indicated that the NAC group was better than the control group in clinical effectiveness (RR=1.34, 95%CI 1.19 to 1.51, P < 0.000 1). After treatment, the lung function was also improved in the NAC group than in the control group in the following index:PaO2 (MD=6.06, 95%CI 3.79 to 8.32, P < 0.000 01), vital capacity (VC) (%) (MD=4.79, 95%CI 0.35 to 9.24, P=0.03) and diffusing capacity of carbon monoxide (Dlco) (%) (MD=5.74, 95%CI 2.67 to 8.81, P=0.000 2). However, no significant difference was found between groups in total lung capacity (TLC) (%) (MD=5.56, 95%CI-1.73 to 12.86, P=0.14). No serious or frequently-happened adverse effect was reported in the NAC group. ConclusionThe current evidence suggests that NAC in long term use could improve clinical conditions, PaO2 and lung function of IPF patients, with less adverse effects.
ObjectiveTo explore the value of T-SPOT.TB test in the diagnosis of active tuberculosis and its influencing factors. MethodsFrom July 2010 to November 2012, a total of 289 suspected active tuberculosis patients were enrolled in the study and underwent T-SPOT.TB test. All the patients enrolled were from West China Hospital of Sichuan University. The diagnostic value of T-SPOT.TB applied in determining active tuberculosis was then evaluated. ResultsAccording to the diagnostic criteria, 84 patients diagnosed with active tuberculosis were eligible for analysis and enrolled as a tuberculosis group, and 156 patients were enrolled as a control group. The sensitivity of T-SPOT.TB test was 83.3%, while the specificity was 80.1%. Both univariate and multivariate analyses showed the characteristics of patients such as general conditions (eg. age, sex) and basic diseases (eg. immunosuppression condition, malignant tumour) were not the risk factors of false-positive or false-negative result of T-SPOT.TB. ConclusionT-SPOT.TB test for the diagnosis of active tuberculosis has high sensitivity and specificity, with important value referred for diagnosing suspected active tuberculosis patients.
ObjectiveTo analyze the status of systematic reviews/meta-analyses on tuberculosis. MethodsThe Web of Science was searched for systematic reviews/meta-analyses on tuberculosis up to February 4th, 2015. According to the inclusion and exclusion criteria, two reviewers screened literature and extracted data. Then SPSS 11.0 software was used to analysis data including publication year, country, institution, journal and citation situation. ResultsA total of 461 systematic reviews/meta-analyses were included. The publication numbers was increasing from 1 in 1997 to 82 in 2014. Among them, China ranked the top country (113 studies), followed by the USA and Canada. The area with the most number of countries where studies were published was Europe, followed by Asia and Africa. In terms of institution, McGill University in Canada ranked the top, followed by University of London in England and Sichuan University in China. As for the number of papers in journals, the International Journal of Tuberculosis and Lung Disease ranked the top, followed by PLOS One and European Respiratory Journal. In the terms of citation, the citation ranged from 0 to 591, and the median citation frequency was 8. ConclusionThe systematic reviews/meta-analyses on tuberculosis is gradually increasing; the developed countries are still important output areas; and China is playing more and more important role in this research field.
ObjectiveTo systematically review the efficacy and safety of respiratory fluoroquinolones monotherapy versus β-lactams plus macrolides combination therapy for non-ICU hospitalized community acquired pneumonia (CAP) patients. MethodsWe searched databases including PubMed, the Cochrane Library (Issue 3, 2015), EMbase, CNKI, WanFang Data, VIP and CBM to identify randomized controlled trials (RCTs) involving the comparison of fluoroquinolones monotherapy with β-lactams plus macrolides combination treatment for the non-ICU hospitalized patients with CAP up to April 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed the risk bias of included studies, and then meta-analysis was performed using the RevMan 5.0 software. ResultsA total of 17 RCTs involving 5 423 patients were included. The results of meta-analysis showed that there was no significant difference between the two therapy groups on the mortality. For the clinical treatment success rates, no significant differences between the two groups were found based on the data of intention-to-treat (ITT) and per-protocol (PP) analyses. However, respiratory fluoroquinolones monotherapy was associated with higher clinical treatment success rates based on the data that it was unclear whether ITT or PP analysis was used (RR=1.08, 95% CI 1.01 to 1.18, P=0.02), especially in Asians (RR=1.10, 95%CI 1.02 to 1.18, P=0.01). Additionally, respiratory fluoroquinolones monotherapy was associated with less adverse events (RR=0.81, 95%CI 0.73 to 0.90, P<0.000 1), especially in Caucasians (RR=0.64, 95%CI 0.36 to 1.14, P=0.13). ConclusionCurrent evidence shows that the efficacy of respiratory fluoroquinolones monotherapy may be similar to β-lactams plus macrolides combination treatment for non-ICU hospitalized CAP patients. Since the limitation of quantity and quality of included studies, large-scale high-quality RCTs are needed to verify the above conclusion.