鞘内注射两性霉素B治疗隐球菌脑膜炎的META分析

中国真菌学杂志　 2012, Vol. 7 　Issue (3): 136-141.

鞘内注射两性霉素B治疗隐球菌脑膜炎的META分析

张昕, 涂波, 范荣, 聂为民, 赵敏

解放军第302医院感染性疾病诊疗研究中心,北京 100039

收稿日期:2012-03-02 出版日期:2012-06-28 发布日期:2012-06-28
通讯作者: 赵敏,E-mail:drzhaomin@sina.com E-mail:drzhaomin@sina.com
作者简介:张昕,男 (汉族),硕士,主治医师.E-mail:dr_zhangxin@yahoo.com.cn

Intrathecal injection of amphotericin B in the pharmacological therapy of cryptococcal meningitis, a meta-analysis

ZHANG Xin, TU Bo, FAN Rong, NIE Wei-min, ZHAO Min

Treatment and Research Center for Infectious Diseases,the 302nd Hospital of Chinese PLA,Beijing 100039,China

Received:2012-03-02 Online:2012-06-28 Published:2012-06-28

摘要/Abstract

摘要： 目的评价鞘内注射两性霉素B用于隐球菌脑膜炎患者治疗的有效性和安全性。方法采用循证医学系统评价方法,检索Cochran图书馆注册临床对照试验数据库2012年第1期,PubMed、Ovid、Springer、外文生物医学期刊全文数据库,中国生物医学文献数据库、中文生物医学期刊文献数据库、中国知网、万方数据库、维普中文期刊数据库、中华医学会数字期刊数据库。文献检索时间从建库至2012年2月,纳入探讨鞘内注射两性霉素B治疗隐球菌脑膜炎的临床对照试验,并逐个进行质量评价和资料提取,运用RevMan 5.1.6软件进行统计分析。结果共检出89篇文献,最终纳入6篇,涉及临床对照试验6项,纳入患者175例。Meta分析提示:鞘内注射给药组较对照组有效率高[OR=4.59,95%CI (2.19,9.64),P＜0.000 1]。可使脑膜刺激征持续时间平均缩短8.56 d (95%CI -11.74~-5.38,P＜0.000 01),但相应不良反应较多。结论鞘内注射两性霉素B治疗隐球菌脑膜炎可以提高疗效,但较多的不良反应限制了其广泛应用,能否作为首选治疗手段有待于更大样本的高质量临床对照研究证实。

关键词: 两性霉素B, 系统分析, 隐球菌脑膜炎, 鞘内注射

Abstract: Objective To assess the effectiveness and safety of intrathecal injection of amphotericin B in the therapy of cryptococcal meningitis.Methods The databases such as the Cochrane Central Register of Controlled Trials (Issue 1, 2012), Pubmed, Ovid, Springer, FMJS, CBMdisc,CMCC,CNKI,WanFang DATA,VIP Information and the CMA DATA were electronically searched (from establishment to February,2012).And the reference of the included articles were also manually searched. Controlled trials in which amphotericin B were intrathecal injected to treat patients with cryptococcal meningitis were collected. Then the retrieved studies were screened according to predefined inclusion and exclusion criteria, the quality of the included studies were evaluated, and meta-analyses were performed by RevMan 5.1.6 software.Results Eighty-nine articles were found,6 controlled trials involving 175 patients were finally included. The results of meta-analysis showed that compared with control,intrathecal inject amphotericin B could significantly improve the effective rate[OR=4.59,95%CI(2.19,9.64),P＜0.000 1],and shorten the duration of meningeal irritation sign at 8.56 d (95% CI -11.74~-5.38,P＜0.000 01),but brought about more adverse events.Conclusion Currently available evidence show that intrathecal injection of amphotericin B can improve therapeutic effect of cryptococcal meningitis,but its clinical application is limited by more adverse events. However, due to lack of quality in the included studies, more studies of better quality should be performed.

Key words: amphotericin B, systematic review, cryptococcal meningitis, intrathecal injection

中图分类号:

R 519.4

张昕, 涂波, 范荣, 聂为民, 赵敏. 鞘内注射两性霉素B治疗隐球菌脑膜炎的META分析[J]. 中国真菌学杂志, 2012, 7(3): 136-141.

ZHANG Xin, TU Bo, FAN Rong, NIE Wei-min, ZHAO Min. Intrathecal injection of amphotericin B in the pharmacological therapy of cryptococcal meningitis, a meta-analysis[J]. Chinese Journal of Mycology, 2012, 7(3): 136-141.

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