| 龙曼,陈爱华,邓敏峰,赖文文,梁艺海.妊娠相关蛋白A对急性冠脉综合征预后的评价[J].Chinese journal of Epidemiology,2013,34(3):279-284 |
| 妊娠相关蛋白A对急性冠脉综合征预后的评价 |
| Meta-analysis on the prognostic value of pregnancy—associated plasma protein—A in acute coronary syndrome |
| Received:October 15, 2012 |
| DOI： |
| KeyWord: 妊娠相关蛋白A 急性冠脉综合征 预后 Meta分析 |
| English Key Word: Pregnancy-associated plasma protein·A Acute coronary syndrome Prognosis Meta—analysis |
| FundProject:国家科技重大专项(2012ZXl0004213—005);广州市医药卫生科技重点项目(201102A212006) |
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| Abstract: |
| 目的 定量评价妊娠相关蛋白A对急性冠脉综合征患者未来不良心血管事件发生的预测作用.方法 检索PubMed 、EMBASE 、OVID 、Web of Knowledge和Cochrane Library数据库并手工检索相关参考文献.采用随机效应模型,RR值为效应指标合并妊娠相关蛋白A在急性冠脉综合征预后的相关研究,进行亚组分析识别异质性的来源.结果 纳入14篇文献共9413例急性冠脉综合征患者,合并RR值及其95％CI为1.97(1.49 ～ 2.60),提示妊娠相关蛋白A可预测急性冠脉综合征患者的预后.研究设计类型、风险效应指标值的选用及随访时间的长短是异质性的主要来源.结论 妊娠相关蛋白A是评价急性冠脉综合征患者预后的有效指标,即患者早期血浆妊娠相关蛋白A水平升高预示未来不良心血管事件发生的风险增加. |
| English Abstract: |
| Objective To synthesize relevant data and to analyze the benefit-cost ratio on strategies related to preventing the maternal-infantile transmission of hepatitis B virus infection and to explore the optimal strategy.Methods A decision tree model was constructed according to the strategies of hepatitis B immunization and a Markov model was conducted to simulate the complex disease progress after HBV infection.Parameters in the models were drawn from meta-analysis and information was collected from field study and review of literature.Economic evaluation was performed to calculate costs,benefit,and the benefit-cost ratio.Sensitivity analysis was also conducted and a tornado graph was drawn.Results In view of the current six possible strategies in preventing maternal-infantile transmission of hepatitis B virus infection,a multi-stage decision tree model was constructed to screen hepatitis B surface antigen (HBsAg) or screen for HBsAg then hepatitis B e antigen (HBeAg).Dose and the number of injections of HBIG and hepatitis B vaccine were taken into consideration in the model.All the strategies were considered to be cost-saving,while the strategy of screening for HBsAg and then offering hepatitis B vaccine of 10 μg × 3 for all neonates with hepatitis B immunoglobulin (HBIG) of 100 IU × 1 for the neonates born to mothers who tested positive for HBsAg appeared with most cost-saving.In the strategies,the benefit-cost ratio of using 100 IU HBIG was similar to 200 IU HBIG,and one shot of HBIG was superior to two shots.Results from sensitivity analysis suggested that the rates of immunization and the efficacy of the strategy in preventing maternal-infantile transmission were the main sensitive variables in the model.Conclusion The passive-active immune-prophylaxis strategy that using 10μg hepatitis B vaccine combined with 100 IU HBIG seemed to be the optimal strategy in preventing maternal-infantile transmission,while the rates of immunization and the efficacy of the strategy played the key roles in choosing the ideal strategy. |
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