我国是结核病高发国，结核病的预防和治疗研究是热点领域。DOT策略由WHO推荐，且在我国一些小样本临床试验中也显示出一定的有效性。因此，目前DOT策略做为结核病治疗的标准方法在我国广泛推行。但在医学实践中，该策略的贯彻需要较大的资源投入，实际操作中也存在着一些矛盾和争议。DOT策略及其方法的实施效果如何，是否需要改良或引入替代方法，这些问题均需要回答。但相关问题的大样本临床治疗评价研究在国内外均未见报道。该系统评价以南非、坦桑尼亚、尼泊尔、泰国、巴基斯坦、斯威士兰、美国、澳大利亚等国家人群的研究资料为依据，通过Meta分析比较直视下服药组与自我管理下服药组的防治效果，其评价的问题是临床和预防工作面临的普遍性问题，其结论对指导发展中国家的卫生保健决策有参考价值。中国属于发展中国家，但不同地区在经济、医疗卫生水平以及人群的生活行为特征上却存在较大差异，亟待开展有针对性的防治策略和方法的研究和评价。因此，该系统评价的结果对我国相关决策工作的改变也将产生一定的影响。 该系统评价的步骤和方法规范，检索了Cochrane Infectious Diseases Group Specialized Register、CENTRAL、MEDLINE、EMBASE、LILACS以及mRCT等综合性数据库截至2007年5月发表的文献；并从有关研究人员和相关组织获取尚未发表或在研试验进行分析。该系统评价纳入了比较医务人员、社区志愿者或家庭成员常规督导患者服药与患者在家自行服药，并由门诊医生定期随访两种管理方式的随机和半随机对照试验。纳入对象是需要接受治疗的活动型肺结核患者或需要预防性药物治疗的患者。根据防治研究设计评价的标准，该系统评价内容涉及随机化方法、随机分配隐藏，盲法及随访等内容，作者最终纳入11项试验，5 609名研究对象。这些试验属于较高质量的研究。但不足的是，评价内容中缺乏观察指标描述和样本量的纳入标准评价。特别是在系统评价时，缺乏对混杂因素的考虑。Meta分析后作者认为， DOT督导化疗对于提高正在接受抗结核药物治疗患者的治愈率及疗程完成率无效或效果甚微，其方法的常规使用没有充分理由。这一结论为我们提供了全新的思考路径。 但是，虽然该分析数据涉及11项试验，5 609名研究对象，但其中存在多亚组成分，如既有治疗人群又有预防用药人群，既有发达国家人群又有发展中国家人群，其中存在许多混杂因素。相关结论需要在大样本人群中进一步分层分析予以验证。因此，进一步扩大样本，开展系统评价非常必要。 该系统评价带给我们的启示是：① 在科学和医疗实践中任何权威性的结论和策略在推广应用时不能盲目接受，需结合实际环境进行客观再评价。② DOT策略是WHO通过专家系统评价后推广的项目，其确定性效应也是值得重视的。③ 从理论上进行分析，DOT策略的实施不仅仅是一种简单的督导方式产生的效果，可能与DOT条件下的医疗服务质量（包括医患关系、药物种类、综合治疗手段）、病人的环境影响（经济水平、文化背景和社会支持）、疾病进程和症状程度等有关。我国人群特征丰富，应当系统开展干预和观察研究，充分认识DOT实用性人群特征，并结合对象特征，探索DOT策略伴随的其他真实的有效促进因素，掌握实质性的干预手段和方法。 收稿日期：2008–07–08 修回日期：2008–07–13本文编辑：杜亮
ObjectiveTo systematically review the clinical features of chronic fatigue syndrome (CFS) cases with pathogens infection. MethodsWe electronically searched databases including VIP, WanFang Data, CNKI, CBM, PubMed, MEDLINE, EMbase, The Cochrane Library, Web of Science, Elsevier and Google Scholar from 1994 to 2014 for CFS-related studies. Two reviewers independently screened literature and extracted data. Then we systematically reviewed and analyzed the information on demographic characteristics, clinical manifestations, types of infected pathogens, and results of some biochemical examinations. ResultsA total of 84 studies (case reports and case series) involving 2 565 CFS cases from 18 countries were included. The major infected pathogens of included CFS cases were mycoplasma, EB virus, intestinal virus, Bernat rickettsia, human-herpes virus, and Gram-negative intestinal bacteria. Fifty-seven studies reported that there might be associations between the pathogenic infection and CFS pathogenesis. Although there were different types of CFS-related pathogens, almost all the studies inferred that pathogens infection linked with immune dysfunction, which might cause CFS symptoms. ConclusionThere may be associations between the pathogenic infection and CFS pathogenesis.
ObjectiveTo systematically review the characteristics of adverse transfusion reaction in Grade Three Class-A hospitals in China, and to provide scientific evidence for related control and prevention work. MethodsSuch databases as the PubMed, EMbase, The Cochrane Library (Issue 11, 2014), CNKI, VIP, WanFang Data and CBM were searched for studies investigating the characteristics of adverse transfusion reaction with ≥6 months observation time in Grade Three Class-A hospitals in China up to November 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using the R 3.1.1 software. ResultsSeventy-two studies involving 1 660 472 cases of blood transfusion were included. The results of pooled analysis showed that the total number of adverse transfusion reaction rate was 0.58% (95%CI 0.48 to 0.69). Sub-group analysis shows that the blood transfusion adverse reaction rates in the eastern, central and western regions were 0.42% (95%CI 0.31 to 0.55), 0.55% (95%CI 0.41 to 0.70), 0.56% (95%CI 0.43 to 0.70), respectively; and there were statistical differences between regions (P<0.05). Different types of adverse transfusion reaction rates were 38.85% (95%CI 34.27 to 43.53) for non hemolytic febrile reaction and 55.67% (95%CI 50.79 to 60.50) for allergic. The adverse reactions incidence of different kinds of blood products transfusion occurred were 0.41% (95%CI 0.32 to 0.50) in red blood cell, 0.57% (95%CI 0.43 to 0.72) in plasma, 1.00% (95%CI 0.73 to 1.30) in platelet. The incidence of adverse reaction of platelet transfusion was significantly higher than that of red blood cell and plasma (P<0.05). ConclusionThere is a big gap between domestic and foreign blood transfusion adverse reaction reports, therefore comprehensive measures should be taken for further prevention and control.
Objective To explore the key influencing factors of HIV risk behavior among male who have sex with male (MSM). Methods 36 MSM subjects in a community were recruited for HIV risk behavior characteristics, social environment and the attitude of exposure of high risk sexual intercourse, using behavior scales and qualitative research methods. The collected data were orderly input and analyzed using Nvivo 8.0 software. Then, after three-level transcription, the data were further summarized and extracted based on the method of the grouding theory. Results The HIV Risk Assessment Questionnaire score of 36 subjects was 8.08±2.46, of whom, 72% scored at a medium level (5 to 10 scores) and 19% scored at a high level (more than 10 scores). The social support rating scale (SSRS) score was 32.38±5.99 in MSM population, lower than in undergraduates and floating population. The results of qualitative analysis showed that, after open coding, 11 key message and 4 categories contributed to HIV risk in MSM populaiton, including: a) low levels of fear for AIDS; b) male role and uncertain sexual orientation; c) low degree social support; and d) poor availability of condom in the setting of sexual intercourse. Conclusion The interventions against AIDS/HIV for MSM need to be further studied. Besides, we should strengthen the community intervention mode based on fear for AIDS, social support, and condom distribution methods