泊沙康唑预防侵袭性真菌感染的Meta分析

摘要/Abstract

摘要：

目的评价泊沙康唑预防侵袭性真菌感染的疗效及安全性。方法采用系统评价方法,通过检索数据库PUBMED、Medline、Embase、Cochrane Library、中国生物医学文献数据库、中国知网、中国维普以及会议论文集等截止至2014年12月所有关于泊沙康唑预防侵袭性真菌感染的随机对照临床试验,同时追查相关参考文献。并逐个进行质量评价和资料提取,运用Review Manager 5.2及Stata 12.0软件进行Meta分析。结果共纳入4项研究,共1487例患者。Meta分析结果提示,泊沙康唑与对照组药物相比,能有效降低侵袭性真菌感染(invasive fungal infection,IFI)发生率,尤其在预防侵袭性曲霉菌感染方面,其疗效优于氟康唑(P<0.0001);预防IFI相关死亡的疗效优于对照组。而不良反应发生率、因不良反应中止治疗发生率、全因死亡率两组间并无统计学差异(P>0.05)。亚组分析显示,泊沙康唑与氟康唑相比,两组间不良反应发生率及侵袭性念珠菌感染发生率均无统计学差异(P>0.05)。结论泊沙康唑可作为两性霉素B脂复合物、氟康唑、伊曲康唑等预防侵袭性真菌感染的良好替代药物,能更有效地预防真菌感染,减少IFI相关死亡率,而且不增加不良反应发生的风险。

关键词: 泊沙康唑, 侵袭性真菌感染, 随机对照试验, 系统评价, Meta分析

Abstract:

Objective To assess the efficacy and safety of posaconazole for prophylaxis of invasive fungal infections.Methods Databases such as PUBMED,Medline,Embase,Cochrane Library,SinoMed,CNKI,VIP Information and conference proceedings were searched for relevant randomized controlled trials (RCTs) about posaconazole for prophylaxis of invasive fungal infections.The cut-off time is December 2014.And reference of the included articles were also manually searched.Quality of included studies were assessed and data of which were extracted.Both Review Manager 5.2 and Stata 12.0 software were used.Results Four RCTs which included 1 476 patients met the search criteria were assessed.Meta analysis results:the IFI rate[RR=0.41,95%CI (0.27,0.63),P<0.000 01],especially in prophylaxis for invasive aspergillosis (posaconazole group significantly reduced:the IFI rate,especially in prophylaxis for invasive aspergillosis (posaconazole vs fluconazole,P<0.000 1);and mortality from IFI.However,no significant differences were observed in adverse reactions,therapy discontinued because of adverse reactions,all-cause mortality rate between posaconazole and controlled groups (P>0.05).For subgroup analysis,there was no significant difference in both the rates of adverse reactions and invasive candidiasis infection between posaconazole and fluconazole (P>0.05).Conclusion Posaconazole can be used as a good alternative of amphotericin B lipid complex,fluconazole or itraconazole for prophylaxis of invasive fungal infections.Posaconazole significantly improves the effect of prophylaxis and decreases IFI associated mortality but with no risk of increase in adverse events.

Key words: posaconazole, IFI, RCT, systematic review, Meta-analysis

中图分类号:

R978.5
R519

黄劲龙, 肖世极, 田丽红, 张媛媛, 周华蓉, 沈建箴. 泊沙康唑预防侵袭性真菌感染的Meta分析[J]. 中国真菌学杂志, 2015, 10(6): 357-364.

HUANG Jin-Long, XIAO Shi-Ji, TIAN Li-Hong, ZHANG Yuan-Yuan, ZHOU Hua-Rong, SHEN Jian-Zhen. Posaconazole for prophylaxis of invasive fungal infections:a meta-analysis[J]. Chinese Journal of Mycology, 2015, 10(6): 357-364.

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