RÉSUMÉ
Objective:To evaluate the effect of statins combined with PCSK9 inhibitors on coronary artery atherosclerotic plaque, as well as to verify the lipid-lowering effect of the combined therapy.Methods:A computerized search of PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI databases was conducted to retrieve published literature from inception to December 20, 2022. The English search terms utilized included "PCSK9 inhibitors," "Alirocumab," "Evolocumab," "plaque," "IVUS," and "OCT." The corresponding Chinese search terms were "PCSK9 inhibitors," "plateau," "intravascular ultrasound," and "optical coherence tomography." The literature that examined the effect of statins alone or in combination with PCSK9 inhibitors on coronary atherosclerotic plaques using intravascular ultrasound or optical coherence tomography was identified. The collected data were subsequently processed using Review Manager (Revman) version 5.4.Results:In the final analysis, nine studies involving 1912 patients were included. The analysis results revealed that compared with statins alone, statins combined with PCSK9 inhibitors significantly reduced the percentage of atherosclerotic volume ( MD: -2.08 mm 3, 95% CI: -2.94 to -1.23 mm 3, P < 0.001), accelerated the regression of atherosclerotic volume ( MD: -1.13 mm 3, 95% CI: -1.49 to -0.77 mm 3, P < 0.001), slightly, but not significantly, reduced the overall atherosclerotic volume ( MD: -6.42 mm 3, 95% CI: -14.34-1.51 mm 3, P = 0.110). Nevertheless, the combined therapy contributed to a significant reduction in atherosclerotic volume ( MD: -5.16 mm 3, 95% CI: -7.09 to -3.23 mm 3, P < 0.001) and significantly increased the fiber cap thickness of thin cap plaques ( MD: 8.46 μm, 95% CI: 5.13-11.79 μm, P < 0.001). Additionally, this combined therapy significantly lowered blood lipid levels. Conclusion:The combination of statins and PCSK9 inhibitors can significantly improve the characteristics and phenotype of atherosclerotic plaques and significantly reduce blood lipid levels. For patients with high cardiovascular risk, it is recommended to initiate treatment with statins combined with PCSK9 inhibitors as soon as possible and maintain it for a long time to ensure more benefits.
RÉSUMÉ
Objective To evaluate the curative effect of different operative methods for duodenal diverticulum. Methods Articles of operations for duodenal diverticulum that were published between January 2000 to August 2006 were retrieved from China Journal Full-text Database, and the symptom remission rate and complication rate were underwent Meta-analysis. All data were analyzed by chi-square test. Results There was significant difference in symptom remission rate between Billroth Ⅱ subtotal gastrectomy, Roux-en-Y gastrojejunostomy and diverticulectomy, diverticulum inverting suture, sphincteroplasty of Oddi (χ~2= 21.269, 4.285, 12.914, 19.266, 3.938, P < 0.05). The difference in complication rate between Billroth Ⅱ subtotal gastrectomy, Roux-en-Y gastrojejunostomy and diverticulectomy, diverticulum inverting suture reached statistical significance (χ~2 =4.164, 9.166, 7.926,4.659, 4.858, P < 0.05). Conclusion For duodenal diverticulitis and the related complications which can not be effectively managed by internal medical treatment and with obvious symptom, Billroth Ⅱ subtotal gastrectomy and Roux-en-Y gastrojejunostumy are safe and effective.