切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2023, Vol. 17 ›› Issue (12) : 1277 -1284. doi: 10.3877/cma.j.issn.1674-0785.2023.12.011

所属专题: 临床药学

临床药学

腹主动脉瘤的药物治疗进展:一项系统综述和网状荟萃分析
李瑞华, 周炜, 刘洋()   
  1. 250012 济南,山东大学齐鲁医院普外科血管外科
    250012 济南,山东大学齐鲁医院超声科
  • 收稿日期:2023-09-27 出版日期:2023-12-15
  • 通信作者: 刘洋
  • 基金资助:
    国家自然科学基金青年基金(82000451)

Pharmacological treatment of abdominal aortic aneurysm: a systematic review and network Meta-analysis

Ruihua Li, Wei Zhou, Yang Liu()   

  1. Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
    Department of Ultrasound, Qilu Hospital of Shandong University, Jinan 250012, China
  • Received:2023-09-27 Published:2023-12-15
  • Corresponding author: Yang Liu
引用本文:

李瑞华, 周炜, 刘洋. 腹主动脉瘤的药物治疗进展:一项系统综述和网状荟萃分析[J/OL]. 中华临床医师杂志(电子版), 2023, 17(12): 1277-1284.

Ruihua Li, Wei Zhou, Yang Liu. Pharmacological treatment of abdominal aortic aneurysm: a systematic review and network Meta-analysis[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(12): 1277-1284.

目的

利用网状荟萃分析寻找可以预防腹主动脉瘤扩张和破裂的药物,并对最新的研究进展进行综述。

方法

检索PubMed、Embase、Web of Science和Cochrane数据库,纳入截至2023年6月30日的针对腹主动脉瘤患者的药物治疗的随机对照试验,主要结局为腹主动脉瘤相关事件,即动脉瘤扩张或破裂。使用累积排序(SUCRA)曲线下的面积对干预药物进行排序,网状荟萃分析(NMA)在贝叶斯框架下进行,旨在探索可用于预防腹主动脉瘤扩张和破裂的药物。

结果

共纳入了10项随机对照研究,包括2 234例腹主动脉瘤患者。接受药物治疗的患者与接受安慰剂治疗的患者在腹主动脉瘤相关事件的发生率上无明显差异,汇总的相对危险度(RR)分别为:氨氯地平0.85 (95%CI: 0.28~2.58),阿奇霉素1.24 (95%CI: 0.51~3.07),多西环素0.98 (95%CI: 0.55~1.72),吡嘧司特2.39 (95%CI: 0.57~18.45),培哚普利1.21 (95%CI: 0.43~3.39),普萘洛尔1.22 (95%CI: 0.69~2.11),罗红霉素0.80(95%CI: 0.22~2.66),替米沙坦1.32 (95%CI: 0.47~3.83)。其中5项研究(共包括1 284例患者)报道了与药物治疗相关的不良事件,与安慰剂对比,多西环素、吡嘧司特和替米沙坦在不良事件的发生风险方面并无明显差异,汇总的RR值分别为1.06(95%CI:0.95~1.18)、1.01(95%CI:0.88~1.17)和1.07(95%CI:0.85~1.37)。

结论

网状荟萃分析结果表明,目前没有可有效治疗腹主动脉瘤的药物,仍需进一步的前瞻性随机对照试验研究。

Objective

To identify potential therapeutic agents for abdominal aortic aneurysm (AAA) patients by conducting a network Meta-analysis (NMA) and systematic review.

Methods

A literature search was conducted in PubMed, Embase, Web of Science, and Cochrane to identify randomized controlled trials (RCTs) on patients with AAA for further analysis. The primary outcome was AAA events, which were defined as AAA dilation or rupture. The surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the drugs. The Bayesian framework was used in an NMA to investigate drugs that could prevent dilatation and rupture of AAA.

Results

A total of 10 RCTs including 2234 patients with AAA were included. Patients under pharmacological therapies exhibited a comparable incidence of AAA events to those treated with placebo, with a pooled relative risk (RR) of 0.85 (95% confidence interval [CI]: 0.28-2.58), 1.24 (95%CI: 0.51-3.07), 0.98 (95%CI: 0.55-1.72), 2.39 (95%CI: 0.57-18.45), 1.21 (95%CI: 0.43-3.39), 1.22 (95%CI: 0.69-2.11), 0.80 (95%CI: 0.22-2.66), and 1.32 (95%CI: 0.47-3.83) for amlodipine, azithromycin, doxycycline, pemirolast, perindopril, propranolol, roxithromycin, and telmisartan, respectively. A total of 5 studies (1284 patients) reported adverse events associated with drug therapy. There was no significant difference in the risk of adverse events with doxycycline, pimirolast, and telmisartan compared with placebo, and the pooled RR values were 1.06 (95%CI: 0.95-1.18), 1.01 (95%CI: 0.88-1.17), and 1.07 (95%CI: 0.85-1.37), respectively.

Conclusion

This NMA demonstrated that no drugs have a definitive therapeutic effect on AAA, and further prospective RCTs are still required.

图1 本研究文献检索、纳入和排除的流程图
图2 本研究文献Cochrane偏倚风险评估工具结果
图3 腹主动脉瘤相关事件的漏斗图 注:A为安慰剂;B为多西环素;C为吡嘧司特;D为罗红霉素;E为普萘洛尔;F为替米沙坦;G为培哚普利;H为氨氯地平;I为阿奇霉素
表1 纳入网络荟萃分析的腹主动脉瘤药物治疗研究的基线特征
研究 地区 干预措施 例(男/女) 年龄(岁)a 腹主动脉瘤直径(mm)a 吸烟/不吸烟(例) 平均舒张压(mmHg)a 腹主动脉瘤事件(例) 所有预期不良事件(例)
Baxter[18] 美国 安慰剂 125(108/17) 70.9±7.3 44.0(40.0~47.0) 43/82 NR 9 111
多西环素 129(111/18) 71.0±7.5 43.0(40.0~46.0) 44/85 NR 13 121
Mosorin[19] 芬兰 安慰剂 15(13/2) 68.1 (64.1~73.0) 35.0(31.0~40.0) NR NR 3 NR
多西环素 17(16/1) 68.6 (64.4~71.3) 31.0(27.5~38.5) NR NR 2 NR
Meijer[20] 荷兰 安慰剂 142(114/28) 70.0±8.0 43.1±5.5 52/90 85.0±10.0 24 21
多西环素 144(120/24) 70.0±7.0 43.0±5.5 48/96 83.0±9.0 21 28
Vammen[21] 丹麦 安慰剂 49(NR) 73.0±3.7 36.9±5.1 29/20 85.5±12.8 7 NR
罗红霉素 43(NR) 72.0±3.7 38.1±5.7 26/17 86.5±13.1 5 NR
Karlsson[22] 加拿大 安慰剂 107(79/28) 71.0(67.0~76.0) 40.0(36.0~44.0) 40/65 NR 13 8
阿奇霉素 106(84/22) 71.0(67.0~74.0) 40.0(37.0~44.0) 40/66 NR 16 13
Sillesen[23] 欧洲 安慰剂 84(77/7) 70.7±5.7 44.0±2.8 34/50 NR 2 68
吡嘧司特 242(210/32) 70.8±6.3 44.2±2.8 96/146 NR 12 196
Lindholt[24] 丹麦 安慰剂 24(NR) 69.6±4.7 34.7±5.3 15/9 93.3±10.4 5 NR
普萘洛尔 30(NR) 68.7±6.4 34.6±5.6 21/9 98.0±10.6 7 NR
Investigators[25] 加拿大 安慰剂 282(233/49) 68.7(61.1~76.3) 39.0(34.0~45.0) NR 82.0(63.0~101.0) 58 NR
普萘洛尔 266(227/39) 69.1(61.0~77.2) 39.0(34.0~45.0) NR 83.0(73.0~93.0) 73 NR
Golledge[26] 澳大利亚 安慰剂 101(91/10) 73.8±7.8 43.1±5.2 27/74 78.0±9.0 8 58
替米沙坦 106(92/14) 73.2±8.1 43.3±5.8 23/83 80.0±10.0 11 65
Bicknell[27] 英国 安慰剂 79(74/5) 70.7±7.5 41.0±7.0 17/62 77.9±7.6 9 NR
培哚普利 73(71/2) 71.6±6.9 41.0±7.0 21/52 76.7±8.0 10 NR
氨氯地平 72(66/6) 71.5±6.7 40.0±7.0 18/54 78.0±7.0 7 NR
图4 8种药物关于腹主动脉瘤相关事件的比较的网络图。 注:不同的圆圈代表着不同的治疗药物,连线代表两个节点之间存在直接比较,连线的粗细表示直接比较的次数的多少,越多越粗
表2 药物治疗与腹主动脉瘤相关事件的网状荟萃分析结果 [RR(95%Cl)]
图5 腹主动脉瘤不同治疗药物的累积排序图与累积排序曲线下面积(SUCRA)X轴表示排名,Y轴表示累积概率,累积排序曲线下面积越大,药物治疗效果越好,8种药物和安慰剂的累积概率一致,其治疗效果无明显差异
图6 腹主动脉瘤不同治疗药物的排名概率图 在横轴上是九个可能的等级,在纵轴上是药物治疗效果达到每个等级的概率,8种药物和安慰剂可达到的治疗效果无明显差异
1
Golledge J, Muller J, Daugherty A, et al. Abdominal aortic aneurysm: pathogenesis and implications for management[J]. Arterioscler Thromb Vasc Biol, 2006,26(12):2605-2613.
2
Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet, 2015,385(9963):117-171.
3
Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery[J]. Eur J Vasc Endovasc Surg, 2011,41Suppl 1:S1-S58.
4
Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm[J]. J Vasc Surg, 2018,67(1):2-77.
5
Sweeting MJ, Patel R, Powell JT, et al. Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: very long-term follow-up in the EVAR-2 randomized controlled trial[J]. Ann Surg, 2017,266(5):713-719.
6
Cao P, De Rango P, Verzini F, et al. Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial[J]. Eur J Vasc Endovasc Surg, 2011,41(1):13-25.
7
Buck DB, van Herwaarden JA, Schermerhorn ML, et al. Endovascular treatment of abdominal aortic aneurysms[J]. Nat Rev Cardiol, 2014,11(2):112-123.
8
Golledge J. Abdominal aortic aneurysm: update on pathogenesis and medical treatments[J]. Nat Rev Cardiol, 2019,16(4):225-242.
9
Salata K, Syed M, Hussain MA, et al. Renin-angiotensin system blockade does not attenuate abdominal aortic aneurysm growth, rupture rate, or perioperative mortality after elective repair[J]. J Vasc Surg, 2018,67(2):629-636.e2.
10
Golledge J, Singh TP. Effect of blood pressure lowering drugs and antibiotics on abdominal aortic aneurysm growth: a systematic review and meta-analysis[J]. Heart, 2021,107(18):1465-1471.
11
Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations[J]. Ann Intern Med, 2015,162(11):777-784.
12
Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J]. BMJ, 2011,343:d5928.
13
Shim SR, Kim SJ, Lee J, et al. Network meta-analysis: application and practice using R software[J]. Epidemiol Health, 2019,41:e2019013.
14
Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial[J]. J Clin Epidemiol, 2011,64(2):163-171.
15
Veroniki AA, Vasiliadis HS, Higgins JP, et al. Evaluation of inconsistency in networks of interventions[J]. Int J Epidemiol, 2013,42(1):332-345.
16
Bowes J, Budu-Aggrey A, Huffmeier U, et al. Dense genotyping of immune-related susceptibility loci reveals new insights into the genetics of psoriatic arthritis[J]. Nat Commun, 2015,6:6046.
17
Burry L, Hutton B, Williamson DR, et al. Pharmacological interventions for the treatment of delirium in critically ill adults[J]. Cochrane Database Syst Rev, 2019,9(9):CD011749.
18
Baxter BT, Matsumura J, Curci JA, et al. Effect of doxycycline on aneurysm growth among patients with small infrarenal abdominal aortic aneurysms: a randomized clinical trial[J]. JAMA, 2020,323(20):2029-2038.
19
Mosorin M, Juvonen J, Biancari F, et al. Use of doxycycline to decrease the growth rate of abdominal aortic aneurysms: a randomized, double-blind, placebo-controlled pilot study[J]. J Vasc Surg, 2001,34(4):606-610.
20
Meijer CA, Stijnen T, Wasser MN, et al. Doxycycline for stabilization of abdominal aortic aneurysms: a randomized trial[J]. Ann Intern Med, 2013,159(12):815-823.
21
Vammen S, Lindholt JS, Ostergaard L, et al. Randomized double-blind controlled trial of roxithromycin for prevention of abdominal aortic aneurysm expansion[J]. Br J Surg, 2001,88(8):1066-1072.
22
Karlsson L, Gnarpe J, Bergqvist D, et al. The effect of azithromycin and Chlamydophilia pneumonia infection on expansion of small abdominal aortic aneurysms--a prospective randomized double-blind trial[J]. J Vasc Surg, 2009,50(1):23-29.
23
Sillesen H, Eldrup N, Hultgren R, et al. Randomized clinical trial of mast cell inhibition in patients with a medium-sized abdominal aortic aneurysm[J]. Br J Surg, 2015,102(8):894-901.
24
Lindholt JS, Henneberg EW, Juul S, et al. Impaired results of a randomised double blinded clinical trial of propranolol versus placebo on the expansion rate of small abdominal aortic aneurysms[J]. Int Angiol, 1999,18(1):52-57.
25
Propanolol Aneurysm Trial Investigators. Propranolol for small abdominal aortic aneurysms: results of a randomized trial[J]. J Vasc Surg, 2002,35(1):72-79.
26
Golledge J, Pinchbeck J, Tomee SM, et al. Efficacy of telmisartan to slow growth of small abdominal aortic aneurysms: a randomized clinical trial[J]. JAMA Cardiol, 2020,5(12):1374-1381.
27
Bicknell CD, Kiru G, Falaschetti E, et al. An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: a randomized placebo-controlled trial (AARDVARK)[J]. Eur Heart J, 2016,37(42):3213-3221.
28
Lindholt JS, Shi GP. Chronic inflammation, immune response, and infection in abdominal aortic aneurysms[J]. Eur J Vasc Endovasc Surg, 2006,31(5):453-463.
29
Sterpetti AV. Doxycycline and growth of abdominal aortic aneurysms[J]. JAMA, 2020,324(15):1568-1569.
30
Lee CC, Lee MG, Hsieh R, et al. Oral fluoroquinolone and the risk of aortic dissection[J]. J Am Coll Cardiol, 2018,72(12):1369-1378.
31
Pasternak B, Inghammar M, Svanström H. Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study[J]. BMJ, 2018,360:k678.
32
Daneman N, Lu H, Redelmeier DA. Fluoroquinolones and collagen associated severe adverse events: a longitudinal cohort study[J]. BMJ Open, 2015,5(11):e010077.
33
Lee CC, Lee MT, Chen YS, et al. Risk of aortic dissection and aortic aneurysm in patients taking oral fluoroquinolone[J]. JAMA Intern Med, 2015,175(11):1839-1847.
34
Newton ER, Akerman AW, Strassle PD, et al. Association of fluoroquinolone use with short-term risk of development of aortic aneurysm[J]. JAMA Surg, 2021,156(3):264-272.
35
Lawaetz Kristensen K, Hallas J, Sanddal Lindholt J. Fluoroquinolones as a trigger for rupture of abdominal aortic aneurysm: A case-crossover analysis[J]. Basic Clin Pharmacol Toxicol, 2021,129(1):44-51.
36
Dong YH, Chang CH, Wang JL, et al. Association of infections and use of fluoroquinolones with the risk of aortic aneurysm or aortic dissection[J]. JAMA Intern Med, 2020, 180(12):1587-1595.
37
Leach SD, Toole AL, Stern H, et al. Effect of beta-adrenergic blockade on the growth rate of abdominal aortic aneurysms[J]. Arch Surg, 1988,123(5):606-609.
38
Gadowski GR, Pilcher DB, Ricci MA. Abdominal aortic aneurysm expansion rate: effect of size and beta-adrenergic blockade[J]. J Vasc Surg, 1994,19(4):727-731.
39
Malekzadeh S, Fraga-Silva RA, Trachet B, et al. Role of the renin-angiotensin system on abdominal aortic aneurysms[J]. Eur J Clin Invest, 2013,43(12):1328-1338.
40
Hackam DG, Thiruchelvam D, Redelmeier DA. Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study[J]. Lancet, 2006,368(9536):659-665.
41
Wemmelund H, Høgh A, Hundborg HH, et al. Preadmission use of renin-angiotensin blockers and rupture of abdominal aortic aneurysm: a nationwide, population-based study[J]. Pharmacoepidemiol Drug Saf, 2016,25(2):141-150.
42
Elbadawi A, Omer M, Ogunbayo G, et al. Antiplatelet medications protect against aortic dissection and rupture in patients with abdominal aortic aneurysms[J]. J Am Coll Cardiol, 2020,75(13):1609-1610.
43
Lindholt JS, Sorensen HT, Michel JB, et al. Low-dose aspirin may prevent growth and later surgical repair of medium-sized abdominal aortic aneurysms[J]. Vasc Endovascular Surg, 2008,42(4):329-334.
44
Wanhainen A, Mani K, Kullberg J, et al. The effect of ticagrelor on growth of small abdominal aortic aneurysms-a randomized controlled trial[J]. Cardiovasc Res, 2020,116(2):450-456.
45
Aoki A, Suezawa T, Sangawa K, et al. Effect of type II endoleaks and antiplatelet therapy on abdominal aortic aneurysm shrinkage after endovascular repair[J]. J Vasc Surg, 2011,54(4):947-951.
46
Raffort J, Lareyre F, Clément M, et al. Diabetes and aortic aneurysm: current state of the art[J]. Cardiovasc Res, 2018,114(13):1702-1713.
47
Sweeting MJ, Thompson SG, Brown LC, et al. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms[J]. Br J Surg, 2012,99(5):655-665.
48
Dattani N, Sayers RD, Bown MJ. Diabetes mellitus and abdominal aortic aneurysms: a review of the mechanisms underlying the negative relationship[J]. Diab Vasc Dis Res, 2018,15(5):367-374.
49
Golledge J, Karan M, Moran CS, et al. Reduced expansion rate of abdominal aortic aneurysms in patients with diabetes may be related to aberrant monocyte-matrix interactions[J]. Eur Heart J, 2008,29(5):665-672.
50
Morris D, Sherliker P, Clack R, et al. The association of blood glucose and diabetes with peripheral arterial disease involving different vascular territories: results from 628 246 people who attended vascular screening[J]. Eur Heart J, 2017, 38(suppl_1): ehx504.
51
Vasamsetti SB, Karnewar S, Kanugula AK, et al. Metformin inhibits monocyte-to-macrophage differentiation via AMPK-mediated inhibition of STAT3 activation: potential role in atherosclerosis[J]. Diabetes, 2015,64(6):2028-2041.
52
Wanhainen A, Unosson J, Mani K, et al. The metformin for abdominal aortic aneurysm growth inhibition (MAAAGI) trial[J]. Eur J Vasc Endovasc Surg, 2021,61(4):710-711.
53
Golledge J, Moxon J, Pinchbeck J, et al. Association between metformin prescription and growth rates of abdominal aortic aneurysms[J]. Br J Surg, 2017,104(11):1486-1493.
54
O'Donnell TF, Deery SE, Shean KE, et al. Statin therapy is associated with higher long-term but not perioperative survival after abdominal aortic aneurysm repair[J]. J Vasc Surg, 2018, 68(2):392-399.
55
Alshaikh HN, Bohsali F, Gani F, et al. Statin intensity and postoperative mortality following open repair of intact abdominal aortic aneurysm[J]. BJS Open, 2018,2(6):411-418.
56
Karrowni W, Dughman S, Hajj GP, et al. Statin therapy reduces growth of abdominal aortic aneurysms[J]. J Investig Med, 2011,59(8):1239-1243.
57
Mathisen SR, Abdelnoor M. Beneficial effect of statins on total mortality in abdominal aortic aneurysm (AAA) repair[J]. Vasc Med, 2017,22(5):406-410.
58
Kertai MD, Boersma E, Westerhout CM, et al. Association between long-term statin use and mortality after successful abdominal aortic aneurysm surgery[J]. Am J Med, 2004,116(2):96-103.
59
Pinchbeck JL, Moxon JV, Rowbotham SE, et al. Randomized placebo-controlled trial assessing the effect of 24-week fenofibrate therapy on circulating markers of abdominal aortic aneurysm: outcomes from the FAME -2 Trial[J]. J Am Heart Assoc, 2018, 7(19): e009866.
60
Moxon JV, Rowbotham SE, Pinchbeck JL, et al. A randomised controlled trial assessing the effects of peri-operative fenofibrate administration on abdominal aortic aneurysm pathology: outcomes from the FAME trial[J]. Eur J Vasc Endovasc Surg, 2020,60(3):452-460.
[1] 蒋敏, 刘馨竹, 李大伟, 冯柏塨, 申传安. 点阵CO2激光联合其他非手术方式治疗痤疮瘢痕有效性的网状荟萃分析[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 429-439.
[2] 张静, 刘畅, 华成舸. 妊娠期患者口腔诊疗进展[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(05): 340-344.
[3] 严华悦, 刘子祥, 周少波. 磷酸烯醇式丙酮酸羧激酶-1在恶性肿瘤中的研究进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 452-456.
[4] 陆信武, 李维敏, 秦金保, 吴小雨, 刘晓兵. 激光原位开窗重建腹主动脉瘤内脏分支[J/OL]. 中华普通外科学文献(电子版), 2024, 18(01): 17-17.
[5] 张腾花, 尚培中, 王晓梅, 李晓武, 王金, 苗建军, 刘冰. 外伤性脾破裂三阶梯分层治疗策略[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 510-512.
[6] 李海风, 战俊, 滕世岗, 尹鹏, 刘忠诚. 改良套扎法在腹腔镜完全腹膜外疝修补术中关闭腹膜破裂的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 192-196.
[7] 肖伍豪, 刘抗寒. 晚期慢性肾脏病患者骨质疏松症的治疗研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(02): 92-96.
[8] 汤畅通, 王永楠, 王诗筌. 颅脑外伤后阵发性交感神经兴奋患者的药物治疗效果分析[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(04): 233-237.
[9] 潘冬生, 梁国标. 颅脑创伤治疗的最新进展与未来趋势[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(04): 193-197.
[10] 吴天宇, 刘子璇, 杨浦鑫, 贾思明, 丁凯, 程晓东, 李泳龙, 陈伟, 吕红芝, 张奇. 腰椎间盘突出症保守治疗进展[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 379-384.
[11] 周章明, 余水, 梁张. 老年破裂前循环动脉瘤患者的急诊显微手术治疗研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(02): 106-111.
[12] 陈秋怡, 林熙, 刘珍银. 淋巴管畸形分子机制的研究进展[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 374-379.
[13] 崔斯童, 马骏, 刘亮, 夏加庚, 刘振. 双微导管与支架辅助技术治疗颅内未破裂宽颈分叶状动脉瘤的疗效对比分析[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 200-205.
[14] 张成惠, 闫中瑞, 盛志强, 袁嫣然. 脑肌酸缺乏症诊断与治疗研究进展[J/OL]. 中华诊断学电子杂志, 2024, 12(04): 270-275.
[15] 胡瑞芳, 樊丽娟. 食管鳞状上皮内瘤变诊断的生物标志物研究进展及其非内镜治疗现状[J/OL]. 中华诊断学电子杂志, 2024, 12(04): 281-286.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?