ABSTRACT
Objective To assess the effect of ursodeoxycholic acid on postoperative outcomes in biliary atresia (BA) patient undergoing Kasai procedure.Methods Correlative english articles published until Jun.2013 were searched by computer in Medline (PubMed),EMBASE,Cochrane library,Wanfang Database,China Knowledge Resource Integrated Database and China Biology Medicine Database,the output articles were screened according to inclusion and exclusion criteria.The selected articles were evaluated with the of Review Manager 5.2 software.Results Nine articles were obtained,but only 4 articles were included,including 284 patients with BA were conformed to the inclusion and exclusion criteria.The sensitivity analysis indicated that the total effective rate in ursodeoxycholic acid group was superior to that in the control group,and the difference between the 2 groups was notable significant (OR =7.24,95 ％ CI:2.42-21.68,Z =3.55,P =0.0004).There was no significant difference between ursodeoxycholic acid group and control group in the effect of ursodeoxycholic acid on outcome of patients who had BA(OR =5.50,95％ CI:0.96-31.64 ; Z =1.91,P =0.06).Conclusions Ursodeoxycholic acid has certain effect on alleviating jaundice after Kasai procedure,but it has no advantage on improving the long outcomes as comparison with control group.
ABSTRACT
<p><b>OBJECTIVE</b>To access the prevalence and risk factors for hypertension after heart transplantation (HT), and the impact of post-transplant hypertension on medium-term survival among HT patients.</p><p><b>METHODS</b>Data from 265 consecutive patients underwent HT between June 2004 and May 2012 in Fuwai hospital and survived for at least 6 months were retrospectively analyzed. Hypertension was defined as systolic pressure ≥ 140 mm Hg (1 mm Hg = 0.133 kPa) and/or diastolic pressure ≥ 90 mm Hg or current treatment with antihypertensive drugs. Patients were divided into post-HT hypertension group and non-hypertension group. Logistic regression analysis was used to determine preoperative and postoperative risk factors for hypertension after HT. Kaplan-Meier method and log rank test were used for survival analysis.</p><p><b>RESULTS</b>Hypertension was present in 17.4% (46/265) patients before HT and in 57.4% (152/265) patients post HT. The median follow-up time was 37 months (20 - 57 months). Logistic regression analysis showed that male gender (OR: 2.27, 95%CI: 1.16 - 4.42, P < 0.05), history of pre-HT hypertension (OR: 2.22, 95%CI: 1.05 - 4.71, P < 0.05), and cyclosporine A based immunosuppressive therapy (OR: 2.54, 95%CI: 1.51 - 4.29, P < 0.01) were independent risk factors for the development of post-HT hypertension. At the end of 1, 3, 5 years, the survival rate of heart transplant patients by Kaplan-Meier method estimation were 100%, 97.2%, 86.7% in post-HT hypertension group; 98.1%, 93.8%, 93.8% in non-hypertension group. Log rank test displayed that there was no significant difference between the two survival curves (P > 0.05).</p><p><b>CONCLUSIONS</b>Hypertension is a frequent comorbidity after HT. Male gender, pre-HT hypertension together with cyclosporine A based immunosuppressive therapy are independent predictors for the development of post-HT hypertension. By adjusting the controllable risk factors and active control of blood pressure, the medium-term survival is similar between patients with or without postoperative hypertension in this cohort.</p>