目的 報道臨床藥師參與抗結核藥物致結核性胸膜炎待診患者多形紅斑型藥疹的臨床藥學實踐的經驗。 方法 1例結核性胸膜炎待診患者在2011年11月3日出現皮疹后，臨床藥師根據患者的用藥情況及病情變化，提供咨詢意見，與臨床醫師共同制定不良反應的臨床處理措施。 結果 推斷為鏈霉素所致的多形紅斑型藥疹，積極處理后患者病情好轉。 結論 臨床藥師參與藥學監護，有利于處理藥物不良反應。
Objective To systematically review the effectiveness and safety of erlotinib for the elderly with Non-small-cell lung cancer (NSCLC). Methods Databases including The Cochrane Library, PubMed, EMbase, CBM, VIP, CNKI and WanFang Data were electronically searched for relevant randomized controlled trails (RCTs). Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results Totally 5 studies were included. The results of meta-analysis showed that, the objective response rate and stable disease rate was similar between the erlotinib group and the control group with no significant difference (RR=0.99, 95%CI 0.34 to 2.93, P=0.99; RR=1.17, 95%CI 0.95 to 1.43, P=0.14). The incidences of Grade Ⅲ-Ⅳ neutropenia and thrombocytopenia were lower in the erlotinib group than those in the control group (OR=0.12, 95%CI 0.03 to 0.52, P=0.005; OR=0.19, 95%CI 0.04 to 0.91, P=0.04); and the incidences of nausea and vomiting as wel as liver impairments were alike between the two groups (OR=0.93, 95%CI 0.12 to 7.08, P=0.95; OR=0.80, 95%CI 0.24 to 2.68, P=0.71); the incidences of diarrhea and skin rashes in the erlotinib group were higher (OR=5.96, 95%CI 1.28 to 27.88, P=0.02; OR=6.77, 95%CI 1.52 to 30.10, P=0.01). Conclusion Current evidence shows that, erlotinib is effective and safe in treating the elderly with NSCLC with better effects and no serious adverse reaction. However, due to the limited quantity and quality of the included studies, more high quality studies with large sample size and long-term follow-up are still needed to verify the above conclusion.
【摘要】 目的 探討非諾貝特致藥品不良反應（ADRs）的一般規律和特點。 方法 檢索PubMed（1978年-2009年8月）、中國期刊全文數據庫CNKI（1980年-2009年8月）、中國生物醫學文獻數據庫CBMDise（1980年-2009年8月）非諾貝特所致ADRs文獻，進行統計、分析。 結果 非諾貝特致ADRs多發生在gt;40歲年齡段，與性別無顯著關聯；64例ADRs主要涉及骨骼肌肉系統、消化系統、泌尿生殖系統、過敏反應，及時處理者預后良好。 結論 臨床上應重視非諾貝特所致ADRs，及時處理。【Abstract】 Objective To analyse the clinical features, correlation factors, preventions and cures of (adverse drug reactions, ADRs) caused by fenofibrate. Methods The cases of ADRs caused by fenofibrate were collected and analyzed from Pubmed (1978 - August 2009), CNKI (1980 - August 2009) and CBMDise (1980 - August 2009). Results Fenofibrate-induced ADRs were mostly seen in patients over 40 years old, but which was independent for sex. Totally, 64 ADRs were involved in the skeletal musculature system, digestive system, urinogenital system, and allergic response. The prognosis was favorable. Conclusion More attention should be given to patients with fenofibrate and ADRs should be treated as soon as possibile.
ObjectivesTo systematically review the efficacy and safety of bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma.MethodsPubMed, EMbase, the Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were searched to obtain randomized controlled trials (RCTs) of bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma patients from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 6 RCTs involving 2 835 patients were included. The results of meta-analysis showed that: the bevacizumab combined with STUPP regimen group was superior to the control group on PFS (HR=0.69, 95%CI 0.62 to 0.77, P<0.000 01). But the adverse events rate at the three and above three levels was significantly higher than the control group (P<0.05).ConclusionsCurrent evidence shows that bevacizumab combined with STUPP regimen for newly diagnosed glioblastoma can significantly prolong the PFS. The treatment group performs not as well as the control group on adverse event rate. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To evaluate the efficacy and safety of saxagliptin in type 2 diabetes patients. Methods The following databases as The Cochrane Library (Issue 2, 2011), PubMed (1978 to May 2011), EMbase (1974 to May 2011), CNKI (1978 to May 2011), VIP (1989 to May 2011) and CBM (1978 to May 2011) were searched. The quality of included randomized controlled trials (RCTs) was assessed according to the Cochrane Collaboration system review, and then meta-analysis was performed using RevMan 5.0. Results A total of 7 RCTs were included. The results of meta-analyses showed that HbA1c was significantly reduced in the saxagliptin group than that in placebo group (MD= –0.69, 95%CI –0.78 to –0.60, Plt;0.000 01). There was no significant difference in the incident rate of adverse reaction between two groups (RR=1.02, 95%CI 0.98 to 1.06, P=0.26). Conclusion Saxagliptin is effective and safe for type 2 diabetes. But its long-term efficacy and safety still need to be confirmed by performing more high quality, large sample RCTs with long-term follow-up.
ObjectiveTo summarize the research progress of risk factors related to early recurrence and late recurrence of hepatocellular carcinoma (HCC) after radical resection.MethodsReviewed and summarized recent literatures on factors related to early and late recurrence of HCC after radical resection.ResultsRadical resection was the most effective treatment for HCC, but the postoperative recurrence rate was high, which seriously affected the treatment effect. Current research divided the recurrence after radical resection of HCC into early recurrence (≤2 years) and late recurrence (>2 years). Early recurrence was considered to be mainly caused by intrahepatic metastasis (IM), which was related to the tumor itself, while late recurrence was mainly caused by multicentric occurrence (MO) and was related to background liver factors. Factors of the tumor itself, including tumor diameter and number, invasion of tumor large vessels and microvessels, anatomical and non-anatomical resection, tumor margin, residual liver ischemia (RLI), intermittent total entry hepatic blood flow interruption method (IPM), the expression level of circulating microRNA in serum and long-chain non-coding RNA, circulating tumor cells, and circulating tumor DNA were related to early recurrence; background liver factors, including liver cirrhosis, high viral load, and liver inflammatory activity, were associated with late recurrence.ConclusionsBoth the tumor factors associated with early recurrence and the background liver factors associated with late recurrence can affect the recurrence after radical resection of HCC.
Objectives To systematically review the efficacy and safety of de-escalation therapy for severe pneumonia. Methods We searched PubMed, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases and the Chinese Clinical Trial Registry (www.chictr.org.cn) to collect randomized controlled trials (RCTs) of de-escalation therapy for patients with severe pneumonia from inception to June, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 13 RCTs involving 1 860 patients were included. The results of meta-analysis showed that: the de-escalation therapy group was superior to the control group on clinical cure rate (RR=1.28, 95%CI 1.20 to 1.35, P<0.000 01), the total hospitalization time (MD=–6.86, 95%CI –9.12 to –4.59,P<0.000 01), remission time of complications (MD=–6.26, 95%CI –8.43 to –4.10,P<0.000 01) and mortality (RR=0.48, 95%CI 0.28 to 0.82,P=0.001). Reported cases of adverse reactions were rare, in which the degree of reactions ranged from mild to moderate. The safety was fairly satisfactory. Conclusions Current evidence shows that de-escalation therapy for patients with severe pneumonia has improved efficacy compared with conventional treatments, and can significantly shorten the total hospitalization time and reduce mortality. Due to the limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To investigate the method and effect of continuous improvement of adverse drug reaction (ADR) monitoring in a major public hospital’s cooperating branch hospital. Methods PDCA cycle management was used to continuously improve the quality of ADR monitoring. ADR report network platform was established in the fourth quarter of 2014; ADR report specification training for the medical personnel was held in the first quarter of 2015; a examine mechanism was built in the second quarter of 2015. The quality and quantity of ADR monitoring before and after the PDCA cycle management were analyzed. Results ADR report timeliness conform to the requirements increased from 45.5% (from the first to third quarter of 2014) to 98.1% (from the fourth quarter of 2014 to the second quarter of 2015); accurate ADR types checking, normal name writting, and complete process description increased from 68.6%, 65.7%, 8.6% (from January 2014 to Frequency 2015) to 92.9%, 96.4%, 85.7% (from March to June 2015); the quantity of ADR report was obviously improved. Conclusion Learning from public hospital’s experience and considering its own condition in ADR monitoring, cooperating branch hospital utilizes PDCA cycle management which could continuously improve the ADR monitoring.
ObjectivesTo systematically review the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis.MethodsPubMed, EMbase, The Cochrane Library, VIP, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy and safety of iguratimod compared with methotrexate in the treatment of rheumatoid arthritis from inception to June 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 10 RCTs involving 970 patients were included. The results of meta-analysis showed that: there was no statistical difference between iguratimod and methotrexate in ACR20 (RR=1.06, 95%CI 0.91 to 1.23, P=0.49), ACR50 (RR=0.93, 95%CI 0.73 to 1.19, P=0.55), ACR70 (RR=0.92, 95%CI 0.62 to 1.39, P=0.70), morning stiffness time (MD=0.45, 95%CI –0.26 to 1.16, P=0.22), tender joint count (MD=0.07, 95%CI –2.31 to 2.45, P=0.95), swollen joint count (MD=–0.30, 95%CI –1.44 to 0.84, P=0.61), health assessment questionnaire (MD=0.01, 95%CI –0.05 to 0.07, P=0.73) and the rate of adverse effects (RR=0.66, 95%CI 0.41 to 1.07, P=0.09). Meta-analysis of 2 RCTs using double-blind method showed that, iguratimod was superior to methotrexat in the patient (MD=4.11, 95%CI 0.11 to 8.10, P=0.04) and physician (MD=4.81, 95%CI 0.93 to 8.69, P=0.01) global assessment of disease activities.ConclusionsCurrent evidence shows that the efficacy and safety of iguratimod in the treatment of rheumatoid arthritis are similar to methotrexate. And iguratimod is superior in global assessment of disease activities by patients and doctors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To investigate the relationship between adipocyte fatty acid binding protein ( A-FABP) and obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 120 patients were recruited and underwent polysomnography. The groups were allocated according severity of OSAHS and obesity. Plasma A-FABP ( ng/mL) levels were measured by ELISA. The associations between A-FABP and AHI, BMI, LSaO2 , MSaO2 , neck collar, waist /hip ratio, insulin resistance index were analyzed. Results Plasma A-FAPB levels were significantly higher in the OSAHS group than in the non-OSAHS group of same weight, independent of age and gender. In the non-OSAHS group and the severe OSAHS group, plasma A-FABP levels of obesity persons were significantly higher than those without obesity, independent of age and gender. Plasma A-FAPB level was positively correlated with AHI, BMI, insulin resistance index, neck collar, SLT90% , and waist/hip ratio, but negatevely correlated with LSaO2 and MSaO2 in the OSAHS group. In the non-OSAHS group, plasma A-FAPB level was positively correlated with BMI and insulin resistance index. Conclusions Plasma A-FABP level is higher in patients with severe OSAHS. Plasma A-FABP level is positively correlated with BMI and insulin resistance index both in OSAHS and non-OSAHS patients.