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α干扰素辅助疗法治疗高危黑色素瘤患者的系统评价与Meta分析
Interferon Alpha Adjuvant Therapy in Patients With High-Risk Melanoma: A Systematic Review and Meta-analysis
Mocellin S, Pasquali S, Rossi CR  2010/9/13 18:02:14 
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J Natl Cancer Inst, 2010,
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Abstract
Background:
Based on previous meta-analyses of randomized controlled trials (RCTs), the use of interferon alpha (IFN-α) in the adjuvant setting improves disease-free survival (DFS) in patients with high-risk cutaneous melanoma. However, RCTs have yielded conflicting data on the effect of IFN-α on overall survival (OS).

Methods:
We conducted a systematic review and meta-analysis to examine the effect of IFN-α on DFS and OS in patients with high-risk cutaneous melanoma. The systematic review was performed by searching MEDLINE, EMBASE, Cancerlit, Cochrane, ISI Web of Science, and ASCO databases. The meta-analysis was performed using time-to-event data from which hazard ratios (HRs) and 95% confidence intervals (CIs) of DFS and OS were estimated. Subgroup and meta-regression analyses to investigate the effect of dose and treatment duration were also performed. Statistical tests were two-sided.

Results:
The meta-analysis included 14 RCTs, published between 1990 and 2008, and involved 8122 patients, of which 4362 patients were allocated to the IFN-α arm. IFN-α alone was compared with observation in 12 of the 14 trials, and 17 comparisons (IFN-α vs comparator) were generated in total. IFN-α treatment was associated with a statistically significant improvement in DFS in 10 of the 17 comparisons (HR for disease recurrence=0.82, 95% CI=0.77 to 0.87; P< 001) and improved OS in four of the 14 comparisons (HR for death=0.89, 95% CI=0.83 to 0.96; P= 002). No between-study heterogeneity in either DFS or OS was observed. No optimal IFN-α dose and/or treatment duration or a subset of patients more responsive to adjuvant therapy was identified using subgroup analysis and meta-regression.

Conclusion:
In patients with high-risk cutaneous melanoma, IFN-α adjuvant treatment showed statistically significant improvement in both DFS and OS.
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甲状腺功能亢进合并黄疸

 王燕燕 王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
 

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