治疗经前期综合症妇女的临床证据显示:①溴隐停(只对乳房症状):RCT所提供的有限证据提示,溴隐停的副作用虽然较常见,但与安慰剂相比对乳房胀痛的缓解更有效.②认知行为治疗:RCT发现,认知行为治疗较对照组能显著缓解经前期症状,但有关疗效大小的证据不足.③达那唑:RCT发现,达那唑较安慰剂能显著缓解经前期症状,但长期持续使用可能导致男性化等严重的副作用.④利尿剂:RCT发现,螺内酯较安慰剂能显著缓解乳房胀痛、水肿等症状.2个RCT发现,甲苯喹唑酮或氯化铵与安慰剂相比,能降低经前期水肿和抑制体重增加.⑤体育锻炼:1个RCT发现,有氧运动较安慰剂更能显著改善经前期症状.另1个RCT发现,高强度的有氧运动比低强度的有氧运动能更有效地缓解症状.⑥促黄体生成素释放激素类似物:RCT发现,促黄体生成素释放激素类似物(过去称GnRH类似物)较安慰剂能显著缓解经前期症状.RCT发现,促黄体生成素释放激素类似物+孕激素+雌激素(反向添加治疗)缓解症状的评分低于单用促黄体生成素释放激素类似物,但其评分优于安慰剂组.1个小样本RCT发现,促黄体生成素释放激素类似物+7-甲异炔诺酮缓解症状评分与单用促黄体生成素释放激素类似物相当.因为持续使用促黄体生成素释放激素类似物超过6个月将带来骨质疏松的危险,所以其长期使用受限.⑦子宫切除术伴或不伴双卵巢切除术:缺乏相关RCT.但观察性研究发现,子宫切除术伴双卵巢切除术具有治愈效果.只行子宫切除术也可缓解症状,但由于缺乏对照,导致证据强度有限.该疗法的危险主要是由手术造成的.双卵巢切除术后的不育也是不可逆的.⑧非选择5-羟色胺重摄取抑制剂--抗抑郁药/抗焦虑药:RCT发现,非选择性5-羟色胺重摄取抑制剂,包括抗抑郁药和抗焦虑药,较安慰剂能显著改善经前期综合症的至少一个症状,但部分妇女因副作用而中断治疗.有关β-阻滞剂和锂剂效果的RCT样本量太小,证据不足.⑨非甾体类抗炎药:一些RCT发现,前列腺素抑制剂较安慰剂能显著改善部分经前期症状,但不能缓解经前期乳房胀痛.⑩雌激素:一些小样本RCT的有限证据提示,雌激素较安慰剂能有效地改善症状,但有效程度尚不明确.(11)口服避孕药:RCT发现,口服避孕药较安慰剂改善经前期症状的证据不足.(12)孕酮:1个系统评价发现,孕酮可以小幅度缓解经前期综合症的所有症状且不增加由于副作用导致的治疗中断,其缓解程度与安慰剂有明显差异,但缓解的程度还达不到理想的临床疗效.目前尚不清楚给药的时间和途径对孕酮的作用是否有影响.(13)孕激素(人工合成):1个小样本RCT比较了孕激素和安慰剂的疗效,但证据不足.(14)Vit B6:1个纳入低质量RCT的系统评价发现,证实Vit B6疗效的证据不足.在这篇系统评价中,一些质量不高的RCT提示Vit B6较安慰剂能有效缓解症状,但另一些方法学质量不高的RCT发现,证实Vit B6效果的证据互有矛盾.(15)选择性5-羟色胺重摄取抑制剂:1篇系统评价和其后的RCT发现,选择性5-羟色胺重摄取抑制剂较安慰剂能显著缓解经前期症状,但也更易出现副反应.(16)7-甲异炔诺酮(替勃龙):1个小样本RCT的有限证据提示,替勃龙较安慰剂(复合维生素)更能缓解经前期症状.(17)其他治疗,如按摩疗法、饮食补充、子宫内膜切除术、月见草油、腹腔镜下行双卵巢切除术、反射论、放松疗法等的疗效证据不足.
①供体授精:我们发现,在供体授精的效果方面,尚缺乏高质量证据.②胞浆内精子注射+体外授精:1篇系统评价发现,尚无足够的证据说明胞浆内精子注射+体外授精与单独使用体外授精何者效果更好.③宫腔内人工授精:两篇系统评价发现,宫腔内人工授精较宫颈内授精或自然性交,能明显增加每个周期的妊娠率.④体外授精与配子输卵管内移植:1个RCT显示,尚无足够证据证明体外授精与配子输卵管内移植何者效果更好.
This paper introduces the process of design and implementation on the clinical evidence database of acupuncture (ACU-CED), including establishing expert groups on the basis of demands to formulate top-design, project implementation plans and standard, comprehensively searching publications of clinical randomized controlled trials (RCTs) of acupuncture and moxibustion, conducting strictly data extraction and evaluation, and eventually achieve automatic utilization of clinical evidence. ACU-CED will become the first structural data platform with the function of searching-screening-result, analysis-data, and statistics-evidence extraction, which fills in gapes in database of clinical evidence sources, increases efficiency of evidence transformation, and reduces waste of resources. It will also achieve auto-completion of systematic review/meta-analysis as well as visualization of clinical evidence, so as to provide evidence for clinical decision, guidelines and disease spectrum of acupuncture therapy.
Objective To provide evidence of the role of helicobacter pylori eradication in the treatment of functional dyspepsia. Methods We searched VIP, CBMdisc, MEDLINE and The Cochrane Library for systematic reviews, meta-analysis, randomized controlled trials and clinical guidelines involving helicobacter pylori and functional dyspepsia, so as to provide the best evidence for clinical practice. Results We included two systematic reviews, one meta-analysis and eleven randomized controlled trials. The evidence identified showed that helicobacter pylori infection was more prevalent in functional dyspepsia than in asymptomatic patients, but the effect of H pylori infection in the pathogenesis of functional dyspepsia remained controversial. H pylori eradication therapy had a relatively weak effect in H pylori positive functional dyspepsia. An economic model suggested that this modest benefit may still be cost-effective, but more studies are needed to assess this. Conclusion According to the current evidence, it can be concluded that helicobacter pylori eradication for the treatment of functional dyspepsia should be individualized.
Although anaphylaxis induced by vitamin K1 seldom happens, 4 allergic cases were observed in the patients we treated recently who were given intramuscular injection of vitamin K1 before renal biopsy. To provide the best clinical evidence, we searched MEDLINE （-May 2005） and evaluated the studies. The studies were only case reports and retrospective reviews which showed the anaphylaxis were mainly allergic dermatitis with different manifestation and reaction time. The serious reactions such as allergic shock was very rare. We conclude that although vitamin K1 anaphylaxis is rare, strict indications should be followed and the drug surveillance on adverse events should be strengthened.
现有治疗排卵功能障碍性不孕的临床证据如下,①克罗米酚.1个系统评价结果表明,对不规则排卵妇女,克罗米酚与安慰剂相比,明显提高了妊娠率.另外4个克罗米酚和他莫昔芬的研究表明,这两种药物对排卵率和妊娠率的影响无统计学差异.1个随机对照试验(RCT)表明,6个月疗程的克罗米酚加二甲双胍比单用克罗米酚可明显提高妊娠率.②环芬尼:1个RCT表明,环芬尼与安慰剂相比,对妊娠率的影响无统计学差异.③促性腺激素(HMG):1个系统评价表明,HMG治疗与尿促卵泡素(urofollitropin)治疗相比,两者妊娠率无统计学差异.2个RCT表明,重组的促滤泡素和尿促卵泡素治疗相比,两者的持续妊娠率和活产率无统计学差异.以往的研究发现,虽然仅限于那些没有配合使用GnRHa的妇女,但HMG与尿促卵泡素治疗相比,发生卵巢过度刺激综合征的危险性较小.观察性研究证据表明,促性腺激素使用可能使卵巢非侵袭性肿瘤发病及多胎妊娠发生增加.④腹腔镜下卵巢打孔:1个系统评价和其后的1个小样本RCT表明,促性腺激素治疗和卵巢打孔治疗相比,对妊娠率影响的无统计学差异,但卵巢打孔术后多胎妊娠的发生率明显较低.促性腺激素脉冲疗法:有1个系统评价结果,但没有发现促性腺激素脉冲疗法有效.
To explain how to treat common gastric diseases like chronic gastritis, peptic ulcer, functional dyspepsia and gastric oesophageal reflux disease (GORD) based on evidence-based medicine. Through this paper, we try to help readers find and use clinical evidence to solve clinical problems.
Until Issue 2 in 2008, the Cochrane Database of Systematic Reviews had included 23 systematic reviews concerning colorectal tumors by the colorectal cancer group. These reviews involved prevention, diagnosis, treatment, prognosis and follow-up. The preventive ability of non-steroid anti-inflammatory drugs, accuracy of chromoscopy, shortterm outcomes of laparoscopic colorectal resection and outcomes of laparoscopic total mesorectal excision were confirmed. Meanwhile, the effect of dietary fibre in prevention, mechanical preoperative preparation, and prophylactic anastomotic drainage was questioned. Because of the low quality of trials, no firm conclusions were revealed in some reviews, such as traditional Chinese medicine in chemotherapy. Through the study of Cochrane systematic reviews, medical practitioners and researchers can obtain high-quality evidence, and identify future research direction in the field of colorectal cancer.