目的 系統評價納洛酮治療病毒性腦炎的療效與安全性。 方法 計算機檢索Medline、Cochrane圖書館、EMbase、CBM、CNKI、萬方從建庫至2012年2月收錄的相關中英文文獻，收集所有關于在抗病毒、腎上腺皮質激素以及脫水、止驚、降溫等綜合治療的基礎上，輔助應用納洛酮治療病毒性腦炎對照試驗。根據納入與排除標準篩選文獻、評價質量、提取資料，采用RevMan 5.1軟件進行Meta分析。 結果 共納入5個對照試驗，包括279例病毒性腦炎患者。Meta分析結果顯示：納洛酮的應用對13歲以上病毒性腦炎患者的總有效率[RR=1.15，95%（0.94，1.42），P=0.18]及死亡率[RR=0.45，95%（0.17，1.16），P=0.10]并無影響，但可以縮短退熱時間[WMD=?0.85，95%（?1.74，0.03），P=0.06]、頭痛消失時間[WMD=?0.40，95%（?0.55，0.25），P＜0.000 01]、抽搐停止時間[WMD=?0.87，95%（?1.09，?0.66），P＜0.000 01]、意識恢復時間[WMD=?1.10，95%（?2.05，?0.15），P=0.02]、腦膜刺激征消失時間[WMD=?0.15，95%（?0.73，0.29），P＜0.000 01]、呼衰糾正時間[WMD=?1.22，95%（?2.11，?0.33），P=0.007]及病程[WMD=?1.38，95%（?2.65，?0.11），P=0.03]。 結論 現有證據表明，納洛酮不能提高病毒性腦炎的療效，但對改善癥狀有一定幫助。受本系統評價納入研究數量和質量的限制，上述結論尚需更多高質量的隨機對照試驗驗證。
Objective To assess the efficacy and safety of adalimumab on plaque psoriasis. Methods We searched the MEDLINE (1966 to December 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 12, 2009), EMbase (1980 to December 2009), CBM (1978 to December 2009), and CNKI (1979 to December 2009) to collect randomized controlled trials (RCTs) of adalimumab for plaque psoriasis. The language was confined to English and Chinese. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses by using the Cochrane Collaboration’s RevMan 4.2 software. Results Three RCTs involving 1?630 patients with chronic moderate or severe plaque psoriasis were included and assessed. At the end of 4th, 8th, 12th and 16th week, the PASI 75s of subcutaneous injection every other week in adalimumab (EOW) group were obviously higher than that of placebo group and methotrexate group. While at the end of 24th week and 60th week, the PASI 75s showed no difference between adalimumab EOW and placebo group. Twelve weeks after subcutaneous injection each week with adalimumab (QW), PASI 75 was obviously higher than those of placebo and EOW groups. However, at the end of 24th week and 60th week, there was no significant difference between adalimumab QW and placebo followed by adalimumab EOW. At end of week 12-16, there was no difference between adalimumab EOW group and placebo group in the incidence of adverse effects, with the exception of pain on injection site and upper respiration viral infection. At week 12-60, there was no difference between adalimumab QW and EOW groups in the incidence of adverse effects, with the exception of all serious adverse effects. Conclusion The limited evidence indicates that subcutaneous injection of adalimumab every other week for 12-16 weeks is safe and efficient for patients with moderate or severe plaque psoriasis. The efficacy can’t be enhanced when the treatment is prolonged to 24 weeks. The once-a-week protocol has no obvious advantage over every other week protocol. More RCTs are required to verify these conclusions owing to the limitations of the present study.