North American Journal of Medical Sciences最新文献_第9页

Diabetes Insipidus: An Unusual Presentation of Adenocarcinoma of the Lung in a Patient with no Identifiable Lung Mass 尿崩症:一种不寻常的肺腺癌的表现，患者没有可识别的肺肿块

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168677

S. Gulati, C. Kiefer, N. Karim

Context: Lung cancers are known to metastasize to unusual sites. Despite this knowledge often times the diagnosis of a primary lung cancer gets delayed especially when the patient presents without respiratory symptoms. Case Report: The patient discussed in our review is a 47-year-old female, smoker who had presented to several hospitals with months of headache, nausea and intermittent episodes of vomiting. She was noted to have hypernatremia due to diabetes insipidus and a pituitary lesion on her magnetic resonance images. The pituitary mass on biopsy was found to represent a metastatic focus from a primary lung adenocarcinoma. Conclusion: Clinicians should be aware of malignancies that are well known to metastasize to the posterior pituitary. Conversely, since not every patient presents with symptoms of metastasis, there is a need to recognize the clinical syndromes (e. g., diabetes insipidus-like symptoms or more subtle symptoms like cranial nerve palsies) associated with potential metastasis to the pituitary.

背景:肺癌是已知的转移到不寻常的部位。尽管有这些知识，但原发性肺癌的诊断常常被推迟，特别是当患者没有呼吸道症状时。病例报告:在我们的回顾中讨论的患者是一名47岁的女性，吸烟者，因数月的头痛，恶心和间歇性呕吐而就诊于几家医院。她被发现有尿崩症引起的高钠血症，并在磁共振图像上发现垂体病变。活检发现垂体肿块是原发性肺腺癌的转移灶。结论:临床医生应注意垂体后叶转移的恶性肿瘤。相反，由于并非每个患者都表现出转移症状，因此有必要认识到与垂体潜在转移相关的临床综合征(例如，尿崩症样症状或更细微的症状，如脑神经麻痹)。

引用次数: 2

Septic Arthritis in the Temporomandibular Joint 颞下颌关节脓毒性关节炎

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168678

H. Al-khalisy, I. Nikiforov, Qurat Mansoora, J. Goldman, P. Cheriyath

Septic arthritis of the temporomandibular joint (TMJ) is a rare event that has only been reported a few dozen times worldwide. This case is remarkable for septic arthritis of the TMJ joint in an otherwise healthy male. Case Report: A 24-year-old male presented to the emergency department with periauricular swelling, erythema, fever, myalgia′s and generalized joint pain. He had previously sought medical attention and was placed on ciprofloxacin. However, he developed facial swelling and a rash and had to discontinue the antibiotic. On physical exam the patient had a large swelling and tenderness in his left periauricular area, with erythema and deviation of the right mandible which limited his ability to open the mouth. A computed tomography showed mild asymmetric soft tissue swelling in the left pharyngeal region but did not show joint effusion. Subsequent magnetic resonance imaging did show effusion of the joint space. The effusion was drained, and the synovial fluid was submitted for gram stain, culture, and sensitivity. The cultures grew menthicillin sensitive Staphyloccocus Aureus. The patient was discharged to complete a two week course of intravenous (IV) Ceftriaxone and IV Vancomycin via home infusion. Conclusion: Septic Arthritis of the TMJ is a rare event with very specific clinical symptoms. Due to the low sensitivity of the computed tomography scan, magnetic resonance imaging should be considered when computed tomography scan is negative for TMJ effusion.

摘要感染性颞下颌关节关节炎(TMJ)是一种罕见的疾病，在世界范围内仅报道过几十次。这是一个值得注意的化脓性关节炎的TMJ关节在其他健康的男性。病例报告:一名24岁男性，因耳周肿胀、红斑、发热、肌痛和全身关节痛而就诊于急诊科。他以前曾寻求医疗照顾，并被给予环丙沙星治疗。然而，他出现了面部肿胀和皮疹，不得不停止使用抗生素。体格检查时，患者左侧耳廓周围有大的肿胀和压痛，右下颌骨有红斑和偏曲，限制了他张嘴的能力。计算机断层扫描显示轻度不对称软组织肿胀在左咽区，但没有显示关节积液。随后的磁共振成像确实显示关节间隙积液。排出积液，将滑液进行革兰氏染色、培养和敏感性检查。培养出了对甲氧西林敏感的金黄色葡萄球菌。患者出院，完成两周的静脉注射(IV)头孢曲松和静脉万古霉素通过家庭输注。结论:脓毒性TMJ关节炎是一种罕见的疾病，临床症状非常特殊。由于计算机断层扫描的灵敏度较低，当计算机断层扫描为TMJ积液阴性时，应考虑磁共振成像。

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引用次数: 9

Eighth Joint National Committee (JNC-8) Guidelines and the Outpatient Management of Hypertension in the African-American Population 第八届全国联合委员会(JNC-8)指南和非裔美国人高血压门诊管理

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168669

N. Abel, K. Contino, N. Jain, N. Grewal, Elizabeth Grand, I. Hagans, K. Hunter, Satyajeet Roy

Background: Hypertension is a common medical disease, occurring in about one third of young adults and almost two thirds of individuals over the age of 60. With the release of the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment (JNC-8) guidelines, there have been major changes in blood pressure management in the various subgroups. Aim: Optimal blood pressure management and markers of end-organ damage in African-American adult patients were compared between patients who were managed according to the JNC-8 hypertension management guidelines and those who were treated with other regimens. Materials and Methods: African-American patients aged 18 years or older with an established diagnosis of hypertension were included in the study who were followed up in our internal medicine clinic between January 1, 2013 and December 31, 2103; the data on their systolic and diastolic blood pressure readings, heart rate, body mass index (BMI), age, gender, comorbidities, and medications were recorded. Patients were divided into four groups based on the antihypertensive therapy as follows - Group 1: Diuretic only; Group 2: Calcium channel blocker (CCB) only; Group 3: Diuretic and CCB; Group 4: Other antihypertensive agent. Their blood pressure control, comorbidities, and associated target organ damage were analyzed. Results: In all 323 patients, blood pressures were optimally controlled. The majority of the patients (79.6%) were treated with either a diuretic, a CCB, or both. Intergroup comparison analysis showed no statistically significant difference in the mean systolic blood pressure, mean diastolic blood pressure, associated comorbidities, or frequency of target organ damage. Conclusion: Although diuretics or CCBs are recommended as first-line agents in African-American patients, we found no significant difference in the optimal control of blood pressure and frequency of end-organ damage compared to management with other agents.

背景:高血压是一种常见的医学疾病，大约三分之一的年轻人和近三分之二的60岁以上的人都有高血压。随着第八届全国预防、检测、评估和治疗联合委员会(JNC-8)指南的发布，不同亚组的血压管理发生了重大变化。目的:比较根据JNC-8高血压管理指南和其他方案治疗的非裔美国成年患者的最佳血压管理和终末器官损伤标志物。材料与方法:纳入2013年1月1日至2013年12月31日在我院内科门诊随访的18岁及以上确诊为高血压的非裔美国人患者;记录他们的收缩压和舒张压读数、心率、体重指数(BMI)、年龄、性别、合并症和用药情况。根据降压治疗方法将患者分为四组:第一组:仅使用利尿剂;第2组:仅钙通道阻滞剂(CCB);第三组:利尿剂和CCB;第4组:其他降压药。分析他们的血压控制、合并症和相关靶器官损伤。结果:323例患者血压均得到良好控制。大多数患者(79.6%)使用利尿剂、CCB或两者兼用。组间比较分析显示，两组患者在平均收缩压、平均舒张压、相关合并症、靶器官损伤频率等方面均无统计学差异。结论:尽管利尿剂或CCBs被推荐为非裔美国患者的一线药物，但我们发现与其他药物相比，在血压的最佳控制和终末器官损伤频率方面没有显著差异。

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引用次数: 47

Cytokeratin 8 in Association with sdLDL and ELISA Development 细胞角蛋白8与sdLDL和ELISA发展相关

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168673

M. Ashmaig

Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Cytokeratins (CKs) which may also be expressed in vascular smooth muscle cells (SMCs) are generally considered to be markers for the differentiation of epithelial cells. Small, dense, low-density lipoprotein (sdLDL) particles, also termed LDL-IV, independently predict risk of CVD. Aims: The aims of this study were to develop an analytical method, apart from ultracentrifugation capable of isolating sdLDL in order to study any associated proteins. Materials and Methods: Using modified gradient gel electrophoresis (GGE), de-identified sdLDL-enriched plasma was used to physically elute and isolate sdLDL particles. To validate the finding, additional plasma from 77 normal and 48 higher risk subjects were used to measure sdLDL particles and CK8. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting method were used to identify the characteristics of proteins associated with sdLDL. An enzyme-linked immunosorbent assay (ELISA) method was developed and validated for the measurement of CK8 in plasma. Results: The validation of the CK8 ELISA method showed good analytical performance. The isolated sdLDL particles were verified with nondenaturing GGE with the apolipoprotein B component confirmed by Western immunoblotting. Confirmed by SDS-PAGE and Western immunoblotting, CK8 was associated with sdLDL. Two-tailed statistical analysis showed that CK8 and sdLDL particles were significantly higher in the high-risk CVD group compared to control group (P < 0.01 and P < 0.01, respectively). Conclusion: This study reports a novel association between CK8 and sdLDL in individuals with CVD who have a predominance of sdLDL.

背景:心血管疾病(CVD)仍然是世界范围内发病率和死亡率的主要原因。细胞角蛋白(Cytokeratins, ck)也可在血管平滑肌细胞(vascular smooth muscle cells, SMCs)中表达，通常被认为是上皮细胞分化的标志。小而致密的低密度脂蛋白(sdLDL)颗粒，也称为LDL-IV，独立预测心血管疾病的风险。目的:本研究的目的是开发一种除超离心外能够分离sdLDL的分析方法，以研究任何相关蛋白。材料与方法:采用改良梯度凝胶电泳(GGE)，用去鉴定的sdLDL富集血浆物理洗脱分离sdLDL颗粒。为了验证这一发现，我们使用了77名正常受试者和48名高危受试者的额外血浆来测量sdLDL颗粒和CK8。采用十二烷基硫酸钠-聚丙烯酰胺凝胶电泳(SDS-PAGE)和免疫印迹法鉴定与sdLDL相关的蛋白特征。建立了一种酶联免疫吸附法(ELISA)测定血浆中CK8的方法。结果:CK8酶联免疫吸附试验方法具有良好的分析性能。分离的sdLDL颗粒经非变性GGE验证，载脂蛋白B组分经Western免疫印迹证实。SDS-PAGE和Western免疫印迹证实，CK8与sdLDL相关。双侧统计分析显示，CVD高危组CK8和sdLDL颗粒明显高于对照组(P < 0.01和P < 0.01)。结论:本研究报告了在以sdLDL为主的CVD患者中CK8和sdLDL之间的一种新的关联。

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引用次数: 1

Dyslipidemia in Dermatological Disorders 皮肤疾病中的血脂异常

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168657

C. Shenoy, M. Shenoy, Gururaja Rao

Dyslipidemias are one of the common metabolic disorders. A link between dermatological disorders like psoriasis and dyslipidemia has been established in the recent past. Many dermatological disorders could have a systemic inflammatory component which explains such association. Chronic inflammatory dermatological disorders could also have other metabolic imbalances that may contribute to dyslipidemia. Presence of such abnormal metabolism may justify routine screening of these disorders for associated dyslipidemia and other metabolic abnormalities and early treatment of such comorbidities to improve quality of life. Some of the drugs used by dermatologists such as retinoids are also likely to be a cause of dyslipidemia. Hence, it is imperative that the dermatologists obtain scientific knowledge on the underlying mechanisms involved in dyslipidemia and understand when to intervene with therapies. A systematic review of the English language literature was done by using Google Scholar and PubMed. In this review, attempts are made to list the dermatological disorders associated with dyslipidemia; to simplify the understanding of underlying mechanisms; and to give a brief idea about the interventions.

血脂异常是常见的代谢性疾病之一。最近，牛皮癣等皮肤病和血脂异常之间的联系已经建立起来。许多皮肤病可能有全身性炎症成分，这解释了这种关联。慢性炎症性皮肤病也可能有其他代谢失衡，可能导致血脂异常。这些代谢异常的存在可能证明常规筛查相关的血脂异常和其他代谢异常以及早期治疗这些合并症以提高生活质量是合理的。皮肤科医生使用的一些药物，如类维生素a，也可能是导致血脂异常的原因。因此，皮肤科医生必须获得有关血脂异常的潜在机制的科学知识，并了解何时进行干预治疗。使用Google Scholar和PubMed对英语文献进行了系统的回顾。在这篇综述中，试图列出与血脂异常相关的皮肤病;简化对潜在机制的理解;简要介绍一下干预措施。

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引用次数: 42

Deficiencies Under Plenty of Sun: Vitamin D Status among Adults in the Kingdom of Saudi Arabia, 2013 日照不足:沙特阿拉伯王国成人维生素D状况，2013

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168675

M. Tuffaha, C. El Bcheraoui, Farah Daoud, Hessah A Al Hussaini, Fahad Alamri, Mohammad Al Saeedi, M. Basulaiman, Z. Memish, Mohammad A. Almazroa, Abdullah A. Al Rabeeah, A. Mokdad

Background: Vitamin D deficiency has been correlated with several diseases and injuries including diabetes, osteoporosis, fractures, and falls. In the Kingdom of Saudi Arabia (KSA), current data on vitamin D status are lacking. Aims: To inform Saudi public health authorities on the current status of blood levels vitamin D deficiency, we analyzed data from the Saudi Health Interview Survey. Materials and Methods: The Saudi Health Interview Survey (SHIS) is a cross-sectional national multistage survey of individuals aged 15 years and above on sociodemographic characteristics, tobacco consumption, diet, physical activity, health care utilization, different health-related behaviors, and self-reported chronic conditions. A total of 10,735 participants completed a health questionnaire and were invited to the local health clinics for biomedical exams. Results: 62.65% of female Saudis and 40.6% of male Saudis aged 15 years and above are deficient in vitamin D. Out of them, less than 1% males and less than 2% females consume vitamin D supplements. Women who have never married and obese individuals are more likely to be deficient in vitamin D, compared to men who were currently married and nonobese individuals. Those consuming vitamin D supplements are less likely to be deficient in vitamin D. Conclusions: Our study showed a high prevalence of vitamin D deficiency among Saudi men and women, and the results call for an increased awareness to ensure adequate levels of vitamin D for better health in Saudi Arabia. Moreover, our findings are certainly relevant for other countries in the Gulf region or countries with similar cultures, clothing, and religions.

背景:维生素D缺乏与多种疾病和损伤有关，包括糖尿病、骨质疏松症、骨折和跌倒。在沙特阿拉伯王国(KSA)，目前缺乏维生素D状况的数据。目的:为了向沙特公共卫生当局通报血液中维生素D缺乏症的现状，我们分析了沙特健康访谈调查的数据。材料和方法:沙特健康访谈调查(SHIS)是一项针对15岁及以上个人的横断面全国性多阶段调查，内容涉及社会人口统计学特征、烟草消费、饮食、体育活动、医疗保健利用、不同健康相关行为和自我报告的慢性病。共有10 735名参与者填写了健康调查表，并被邀请到当地诊所进行生物医学检查。结果:沙特15岁及以上人群中，62.65%的女性和40.6%的男性缺乏维生素D。其中，摄入维生素D补充剂的男性不足1%，女性不足2%。与已婚男性和非肥胖者相比，从未结婚的女性和肥胖者更容易缺乏维生素D。结论:我们的研究表明，沙特男性和女性中维生素D缺乏症的患病率很高，研究结果呼吁提高意识，确保沙特阿拉伯人摄入足够的维生素D，以改善健康状况。此外，我们的研究结果对海湾地区的其他国家或具有相似文化、服装和宗教的国家肯定是相关的。

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引用次数: 57

The Psychological Attitude of Patients toward Health Practitioners in Lebanon. 黎巴嫩病人对保健医生的心理态度。

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168663

Fouad Ayoub, Youssef Fares, Jawad Fares

Background: Patients often complain about their doctor's attitude toward them. They describe the interaction that they have with some doctors as quick, cold, discourteous, or hardhearted. Although this does not apply to all Lebanese doctors, it does apply to some.

Aims: The purpose of this study was to (1) examine the general perception of satisfaction, trust, and openness that Lebanese patients hold toward the work, office, personal, and social characteristics of their doctors - physician or dentist; and (2) identify the aspects on which a Lebanese health practitioner should focus to improve his/her practice.

Materials and methods: A convenient sample of 450 individuals from an area housing nine hospitals and hundreds of private clinics in Greater Beirut were surveyed regarding the qualities of their health practitioners. They were asked to complete a nine-page, 85-item, anonymous, and voluntary questionnaire that dealt with the medical and dental practice in Lebanon. Participants were older than 18 years and mentally competent. None was physicians, dentists, or nurses. The questionnaire was open-ended and initially pretested and piloted among a random sample.

Results: Four hundred-fifteen (92%) individuals responded. Participants were from different ages, genders, geographical areas, educational backgrounds, and professions. The doctor traits most preferred by the Lebanese public were found to be: Empathy (90%), professionalism (87%), miscellaneous traits (86%), and academics (81%).

Conclusion: The results support the conventional wisdom that the idealized perception of a doctor as a care-giving, compassionate, knowledgeable, well-appearing, and healthy role model still holds true within the Lebanese community.

背景：病人经常抱怨医生对他们的态度。他们形容与某些医生的交流是急躁、冷漠、不礼貌或铁石心肠。目的：本研究的目的是：（1）研究黎巴嫩患者对其医生（内科医生或牙医）的工作、办公室、个人和社会特征的满意度、信任度和开放度的总体看法；（2）确定黎巴嫩医疗从业者应重点改进的方面：对来自大贝鲁特地区九家医院和数百家私人诊所的 450 人进行了关于其医疗从业人员素质的抽样调查。他们被要求填写一份长达 9 页、85 个项目的匿名自愿问卷，内容涉及黎巴嫩的医疗和牙科实践。参与者年龄在 18 岁以上，精神正常。没有人是医生、牙医或护士。问卷为开放式，最初在随机抽样中进行了预试和试用：共有 415 人（92%）作答。参与者来自不同的年龄、性别、地域、教育背景和职业。黎巴嫩公众最喜欢的医生特质是结论：结论：研究结果支持了一种传统观点，即在黎巴嫩社会中，对医生的理想化看法仍然是：提供关怀、富有同情心、知识渊博、仪表堂堂和健康的榜样。

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引用次数: 0

Prostate Cancer for the Internist 前列腺癌的内科医生

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168660

S. Jaiswal, Rehan Sarmad, S. Arora, Radhikha Dasaraju, Komal Sarmad

In the United States, approximately 240,000 men are diagnosed annually with prostate cancer. Although effective treatment options are available for clinically localized cancer, the potential burdensome co-morbidities and attendant healthcare costs from over diagnosis and over treatment have escalated the discussion and controversy regarding appropriate screening, diagnosis, and optimal management of prostate cancer. Although the lifetime risk of developing prostate cancer is approximately 1 in 6 (~16%), the risk of dying from the disease is only ~2%. The discrepancy between the cancer incidence and lethality has led to widespread scrutiny of prostate cancer patient management, particularly for low-grade, low-stage (indolent) disease. The vast majority of men diagnosed with clinically localized prostate cancer are treated with interventional therapies despite studies demonstrating that even without treatment, prostate cancer-specific mortality is low. A MedLine/PubMed search was performed using PICO format (Patient, Intervention, Comparison and Outcome) identifying all relevant articles. No restrictions were used for publication dates. The terms "Prostate Cancer", "Screening", "Mortality", "Morbidity" yielded 307 results. "Diagnosis", "Prognosis" and "Survival" yielded 1504 results. Further filters were applied to narrow down the results using keywords "Prostate cancer screening guidelines 2014", "Beyond PSA", "NCCN Guidelines prostate", "MRI guided Prostate biopsy" yielding 72, 274, 54 and 568 results respectively. Of these, approximately 137 articles were found relevant and were reviewed. References from the reviewed articles were included in the final article.

在美国，每年大约有24万男性被诊断患有前列腺癌。虽然临床上局部癌症有有效的治疗选择，但过度诊断和过度治疗可能带来的沉重的合并症和随之而来的医疗费用，已经使关于前列腺癌适当筛查、诊断和最佳管理的讨论和争议升级。尽管一生中患前列腺癌的风险约为1 / 6(~16%)，但死于该疾病的风险仅为~2%。癌症发病率和致死率之间的差异导致了对前列腺癌患者管理的广泛审查，特别是对低级别，低阶段(惰性)疾病。尽管研究表明，即使不进行治疗，前列腺癌特异性死亡率也很低，但绝大多数临床诊断为局限性前列腺癌的男性都接受了介入治疗。使用PICO格式(患者、干预、比较和结果)进行MedLine/PubMed检索，确定所有相关文章。未对出版日期加以限制。在“前列腺癌”、“筛查”、“死亡率”、“发病率”这几个词中，有307个结果。“诊断”、“预后”和“生存”共产生1504条结果。使用关键词“前列腺癌筛查指南2014”、“Beyond PSA”、“NCCN前列腺指南”、“MRI引导前列腺活检”进行进一步筛选，结果分别为72、274、54和568。其中，约有137篇文章被认为是相关的，并进行了审查。审稿文章中的参考文献包含在最终文章中。

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引用次数: 16

Prostate Cancer Claims for a Personalized Medicine 前列腺癌要求个性化治疗

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168661

M. Lazzeri

Hippocrates (Kos, Greece c. 460-c. 370 BC), generally referred to as the “Father of Western Medicine” remembers us “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” Understanding the personal qualities of the patient, his lifestyle, and his previous medical history is a necessary base to approach prostate cancer (PCa). In times of worldwide changes, globalization, and migration, there is one value that needs maximum protection, since it represents a steady value and it is capable of representing a safe path through the difficulties of the present medicine toward the light of the future. That value is, undeniably, the human being. We have to pursue such commitment by our humanism and our medical culture. They are not a sheer amount of mere human attitude, or technical knowledge, or the tradition of a particular social group but they represent a theoretical and practical attitude consisting of multiple skills concerning the understanding of a disease in its personal and social implications and the ability to develop a balanced and sensible treatment.

希波克拉底(科斯，希腊，约460-公元前)通常被称为“西医之父”的他对我们说:“知道一个人得了什么样的病，比知道一个人得了什么样的病更重要。”了解患者的个人素质、生活方式和既往病史是了解前列腺癌的必要基础。在世界范围的变化、全球化和移民的时代，有一种价值需要最大限度的保护，因为它代表了一种稳定的价值，它能够代表一条穿越当前医学困难走向未来光明的安全之路。不可否认，这个价值就是人。我们必须通过我们的人文主义和医学文化来追求这样的承诺。它们不是纯粹的人类态度，或技术知识，或特定社会群体的传统，而是代表了一种理论和实践态度，由多种技能组成，涉及对疾病的个人和社会影响的理解，以及制定平衡和合理治疗的能力。

引用次数: 3

Periprocedural Nebivolol for the Prevention of Contrast-Induced Acute Kidney Injury: A Systematic Review and Meta-analysis 围手术期奈比洛预防造影剂诱导的急性肾损伤:系统回顾和荟萃分析

North American Journal of Medical Sciences

Pub Date : 2015-10-01 DOI: 10.4103/1947-2714.168670

Natanong Thamcharoen, C. Thongprayoon, P. J. Edmonds, W. Cheungpasitporn

Background: Nebivolol provides a protective effect on contrast-induced acute kidney injury (CIAKI) in animal models. However, the reports on the efficacy of nebivolol for the prevention of CIAKI in human remain unclear. Aims: The objective of this meta-analysis was to assess the effect of nebivolol for the prevention of CIAKI. Materials and Methods: Comprehensive literature searches were performed using MEDLINE, EMBASE, and Cochrane Database from inception through February 2015. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of CIAKI in patients who received nebivolol versus those who did not were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Four studies (2 randomized controlled trials and 2 cohort studies) with 543 patients were included in our analysis to assess the risk of CIAKI and the use of nebivolol. Patients in the nebivolol group had an overall lower incidence of CIAKI (14.4%) compared to the control group (18.4%). The pooled RR of CIAKI in patients receiving nebivolol was 0.66 (95% CI: 0.38-1.15, I2 = 0). When meta-analysis was limited only to randomized control trials (RCTs), the pooled RR of CIAKI in patients receiving nebivolol was 0.79 (95% CI: 0.35-1.79, I2 = 0%). Conclusions: Despite no statistical significance, there was a trend toward reduced CIAKI risk in patients receiving nebivolol. The findings of our meta-analysis suggest the need of a large RCT with very careful attention to the balance of benefits and harms.

背景:奈比洛尔在动物模型中对造影剂诱导的急性肾损伤(CIAKI)具有保护作用。然而，关于奈比洛尔预防人类CIAKI疗效的报道仍不清楚。目的:本荟萃分析的目的是评估奈比洛尔预防CIAKI的效果。材料和方法:从成立到2015年2月，使用MEDLINE、EMBASE和Cochrane数据库进行综合文献检索。研究报告了相对风险、奇比或危险比，比较了接受纳比洛尔治疗的患者与未接受纳比洛尔治疗的患者发生CIAKI的风险。合并风险比(RR)和95%置信区间(CI)采用随机效应、通用逆方差法计算。结果:我们的分析纳入了4项研究(2项随机对照试验和2项队列研究)，共543例患者，以评估CIAKI的风险和奈比洛尔的使用。与对照组(18.4%)相比，奈比洛尔组患者的总体CIAKI发生率(14.4%)较低。纳比洛尔患者CIAKI的合并RR为0.66 (95% CI: 0.38-1.15, I2 = 0)，当荟萃分析仅限于随机对照试验(rct)时，纳比洛尔患者CIAKI的合并RR为0.79 (95% CI: 0.35-1.79, I2 = 0%)。结论:尽管没有统计学意义，但接受奈比洛尔治疗的患者有降低CIAKI风险的趋势。我们的荟萃分析结果表明，需要进行大规模的随机对照试验，仔细权衡利弊。

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引用次数: 7