目的:系统评价地西他滨单药治疗骨髓增生异常综合征(MDS)的疗效和安全性,为临床提供循证参考。方法:计算机检索Embase、Cochrane图书馆、PubMed、Medline、Clinical Key、Google学术、中国知网、中国生物医学文献数据库及万方数据等中...目的:系统评价地西他滨单药治疗骨髓增生异常综合征(MDS)的疗效和安全性,为临床提供循证参考。方法:计算机检索Embase、Cochrane图书馆、PubMed、Medline、Clinical Key、Google学术、中国知网、中国生物医学文献数据库及万方数据等中英文数据库,检索时限均为建库起至2020年6月26日,收集地西他滨(地西他滨组)对比传统联合化疗方案(对照组)治疗MDS患者的随机对照试验(RCT)。筛选文献,提取资料并采用Cochrane系统评价员手册5.2.2推荐的偏倚风险评估工具评价纳入文献质量后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入11项RCT,共计590例患者。Meta分析结果显示,地西他滨组患者的完全缓解率[OR=1.82,95%CI(1.23,2.70),P=0.003]和总有效率[OR=1.54,95%CI(1.05,2.27),P=0.03]均显著高于对照组,不良反应发生率[OR=0.26,95%CI(0.16,0.40),P<0.00001]、感染发生率[OR=0.48,95%CI(0.27,0.85),P=0.01]和骨髓抑制发生率[OR=0.37,95%CI(0.17,0.81),P=0.01]均显著低于对照组。按疗程进行的亚组分析结果显示,在疗程为3、4个月的方案中,两组患者的完全缓解率和总有效率比较差异均无统计学意义(P>0.05);在疗程为1、2个月的方案中,地西他滨组患者的完全缓解率和总有效率均显著高于对照组(P<0.05)。结论:地西他滨单药治疗MDS患者的疗效和安全性均较好,且当治疗时长≤2个月时,地西他滨治疗MDS患者的完全缓解率及总有效率更优。展开更多
The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnos...The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.展开更多
文摘目的:系统评价地西他滨单药治疗骨髓增生异常综合征(MDS)的疗效和安全性,为临床提供循证参考。方法:计算机检索Embase、Cochrane图书馆、PubMed、Medline、Clinical Key、Google学术、中国知网、中国生物医学文献数据库及万方数据等中英文数据库,检索时限均为建库起至2020年6月26日,收集地西他滨(地西他滨组)对比传统联合化疗方案(对照组)治疗MDS患者的随机对照试验(RCT)。筛选文献,提取资料并采用Cochrane系统评价员手册5.2.2推荐的偏倚风险评估工具评价纳入文献质量后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入11项RCT,共计590例患者。Meta分析结果显示,地西他滨组患者的完全缓解率[OR=1.82,95%CI(1.23,2.70),P=0.003]和总有效率[OR=1.54,95%CI(1.05,2.27),P=0.03]均显著高于对照组,不良反应发生率[OR=0.26,95%CI(0.16,0.40),P<0.00001]、感染发生率[OR=0.48,95%CI(0.27,0.85),P=0.01]和骨髓抑制发生率[OR=0.37,95%CI(0.17,0.81),P=0.01]均显著低于对照组。按疗程进行的亚组分析结果显示,在疗程为3、4个月的方案中,两组患者的完全缓解率和总有效率比较差异均无统计学意义(P>0.05);在疗程为1、2个月的方案中,地西他滨组患者的完全缓解率和总有效率均显著高于对照组(P<0.05)。结论:地西他滨单药治疗MDS患者的疗效和安全性均较好,且当治疗时长≤2个月时,地西他滨治疗MDS患者的完全缓解率及总有效率更优。
基金supported(in part)by the National Key Research and Development Program of China(2020YFC0845500)the Special Project for Emergency of Hubei Province(2020FCA008)the First Level Funding of the Second Medical Leading Talent Project in Hubei Province。
文摘The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.
