中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2010年
12期
900-906
,共7页
革兰阳性球菌%万古霉素%利奈唑胺%Meta分析
革蘭暘性毬菌%萬古黴素%利奈唑胺%Meta分析
혁란양성구균%만고매소%리내서알%Meta분석
Gram-positive cocci%Vancomycin%Linezolid%Meta-analysis
目的 采用荟萃分析方法对现已发表的利奈唑胺和万古霉素治疗革兰阳性球菌肺炎的文献进行综合分析,评价利奈唑胺的疗效及其安全性是否优于万古霉素.方法 检索Medline数据库、Embase数据库、Ovid数据库、Cochrane图书馆及中文生物医学期刊数据库中的相关文献.检索年限均从建库到2009年2月,并查阅所有纳入文献的参考文献.外文检索词包括linezolid、glycopeptides、vancomycin、pneumonia、gram-positive cocci、saureus、MRSA、enterococcus及streptococci.限定语言为中文或英文,限定对象为"人".中文检索词为相应的主题词.纳入用英文或中文发表的比较利奈唑胺和万古霉素治疗革兰阳性球菌肺炎疗效的随机对照试验,由2名评价员独立筛查文献、评价质量和提取资料.采用Jadad量表及随机分配方案隐藏方法评估纳入研究的方法学质量;采用x2检验鉴定研究间的异质性,使用随机效应或固定效应模型合并研究;采用敏感性分析方法探讨研究结果的影响因素.结果共纳入7个随机对照研究,包括1425例革兰阳性球菌肺炎患者.荟萃分析结果显示,利奈唑胺治疗结束后在临床可评估患者的临床治愈率优于万古霉素(OR=2.16,95%CI为1.13～4.16,P<0.05);随访结束后,临床可评估患者(OR=1.11,95%CI为0.81～1.53,P>0.05)及意向性治疗患者(OR=1.01,95%CI为0.78～1.31,P>0.05)利奈唑胺的临床治愈率、微生物学总治愈率(OR=1.31,95%CI为0.85～2.04,P>0.05)、金黄色葡萄球菌清除率(OR=1.45,95%CI为0.84～2.51,P>0.05)、耐甲氧西林金黄色葡萄球菌清除率(OR=1.36,95%CI为0.51～3.61,P>0.05)、链球菌清除率(OR=4.27,95%CI为0.01～1365.87,P>0.05)及肠球菌清除率(OR=0.75,95%CI为0.03～17.51,P>0.05)与万古霉素相同.利条唑胺治疗组与万古霉素治疗组的病死率(OR=0.80,95%CI为0.59～1.07,P>0.05)及不良反应总体发生率(OR=1.06,95%CI为0.68～1.64,P>0.05)比较差异无统计学意义.结论 对革兰阳性球菌肺炎患者,利奈唑胺虽在治疗刚结束时的临床疗效优于万古霉素,但1～4周随访结束后,两组临床疗效无明显差异.
目的 採用薈萃分析方法對現已髮錶的利奈唑胺和萬古黴素治療革蘭暘性毬菌肺炎的文獻進行綜閤分析,評價利奈唑胺的療效及其安全性是否優于萬古黴素.方法 檢索Medline數據庫、Embase數據庫、Ovid數據庫、Cochrane圖書館及中文生物醫學期刊數據庫中的相關文獻.檢索年限均從建庫到2009年2月,併查閱所有納入文獻的參攷文獻.外文檢索詞包括linezolid、glycopeptides、vancomycin、pneumonia、gram-positive cocci、saureus、MRSA、enterococcus及streptococci.限定語言為中文或英文,限定對象為"人".中文檢索詞為相應的主題詞.納入用英文或中文髮錶的比較利奈唑胺和萬古黴素治療革蘭暘性毬菌肺炎療效的隨機對照試驗,由2名評價員獨立篩查文獻、評價質量和提取資料.採用Jadad量錶及隨機分配方案隱藏方法評估納入研究的方法學質量;採用x2檢驗鑒定研究間的異質性,使用隨機效應或固定效應模型閤併研究;採用敏感性分析方法探討研究結果的影響因素.結果共納入7箇隨機對照研究,包括1425例革蘭暘性毬菌肺炎患者.薈萃分析結果顯示,利奈唑胺治療結束後在臨床可評估患者的臨床治愈率優于萬古黴素(OR=2.16,95%CI為1.13～4.16,P<0.05);隨訪結束後,臨床可評估患者(OR=1.11,95%CI為0.81～1.53,P>0.05)及意嚮性治療患者(OR=1.01,95%CI為0.78～1.31,P>0.05)利奈唑胺的臨床治愈率、微生物學總治愈率(OR=1.31,95%CI為0.85～2.04,P>0.05)、金黃色葡萄毬菌清除率(OR=1.45,95%CI為0.84～2.51,P>0.05)、耐甲氧西林金黃色葡萄毬菌清除率(OR=1.36,95%CI為0.51～3.61,P>0.05)、鏈毬菌清除率(OR=4.27,95%CI為0.01～1365.87,P>0.05)及腸毬菌清除率(OR=0.75,95%CI為0.03～17.51,P>0.05)與萬古黴素相同.利條唑胺治療組與萬古黴素治療組的病死率(OR=0.80,95%CI為0.59～1.07,P>0.05)及不良反應總體髮生率(OR=1.06,95%CI為0.68～1.64,P>0.05)比較差異無統計學意義.結論 對革蘭暘性毬菌肺炎患者,利奈唑胺雖在治療剛結束時的臨床療效優于萬古黴素,但1～4週隨訪結束後,兩組臨床療效無明顯差異.
목적 채용회췌분석방법대현이발표적리내서알화만고매소치료혁란양성구균폐염적문헌진행종합분석,평개리내서알적료효급기안전성시부우우만고매소.방법 검색Medline수거고、Embase수거고、Ovid수거고、Cochrane도서관급중문생물의학기간수거고중적상관문헌.검색년한균종건고도2009년2월,병사열소유납입문헌적삼고문헌.외문검색사포괄linezolid、glycopeptides、vancomycin、pneumonia、gram-positive cocci、saureus、MRSA、enterococcus급streptococci.한정어언위중문혹영문,한정대상위"인".중문검색사위상응적주제사.납입용영문혹중문발표적비교리내서알화만고매소치료혁란양성구균폐염료효적수궤대조시험,유2명평개원독립사사문헌、평개질량화제취자료.채용Jadad량표급수궤분배방안은장방법평고납입연구적방법학질량;채용x2검험감정연구간적이질성,사용수궤효응혹고정효응모형합병연구;채용민감성분석방법탐토연구결과적영향인소.결과공납입7개수궤대조연구,포괄1425례혁란양성구균폐염환자.회췌분석결과현시,리내서알치료결속후재림상가평고환자적림상치유솔우우만고매소(OR=2.16,95%CI위1.13～4.16,P<0.05);수방결속후,림상가평고환자(OR=1.11,95%CI위0.81～1.53,P>0.05)급의향성치료환자(OR=1.01,95%CI위0.78～1.31,P>0.05)리내서알적림상치유솔、미생물학총치유솔(OR=1.31,95%CI위0.85～2.04,P>0.05)、금황색포도구균청제솔(OR=1.45,95%CI위0.84～2.51,P>0.05)、내갑양서림금황색포도구균청제솔(OR=1.36,95%CI위0.51～3.61,P>0.05)、련구균청제솔(OR=4.27,95%CI위0.01～1365.87,P>0.05)급장구균청제솔(OR=0.75,95%CI위0.03～17.51,P>0.05)여만고매소상동.리조서알치료조여만고매소치료조적병사솔(OR=0.80,95%CI위0.59～1.07,P>0.05)급불량반응총체발생솔(OR=1.06,95%CI위0.68～1.64,P>0.05)비교차이무통계학의의.결론 대혁란양성구균폐염환자,리내서알수재치료강결속시적림상료효우우만고매소,단1～4주수방결속후,량조림상료효무명현차이.
Objective To study the randomised controlled trials on the efficacy and safety in patients with pneumonia caused by Gram-positive cocci treated with linezolid versus with vancomycin.Methods The data were collected from the MEDLINE database,EMBASE,OVID,the Cochrane library,and Chinese Biomedical Database,and the references of eligible studies were manually screened.Randomized controlled trials published in the English and Chinese literatures comparing linezolid with vancomycin in patients with pneumonia caused by Gram-positive cocci were eligible for inclusion.Results Seven randomized controlled studies comparing linezolid with vancomycin were analyzed,focusing on 1425 patients with pneumonia caused by Gram-positive cocci.It was found by meta-analysis that,with respect to clinical treatment success,linezolid was more effective than vancomycin in clinically evaluation patients at the end-of-treatment visit (OR=2.16,95% CI 1.13-4.16,P<.05),however,there was no difference in clinical treatment success for clinically evaluation patients (OR=1.11,95% CI0.81-1.53,P>.05)and intention-to-treat patients (OR=1.01,95% CI0.78-1.31,P>.05)at the test-of-cure visit.With respect to microbiological treatment success,linezolid was as effective as vancomycin in microbiologically evaluation patients at the test-of-cure visit (OR=1.31,95% CI 0.85-2.04,P>.05).Additionally,empirical treatment with linezolid was not associated with increased eradication rates for saureus strains (OR=1.45,95% CI0.84-2.51,P>.05)and methicillin resistant Staphylococcus aureus strains (OR=1.36,95% CI 0.51-3.61,P>.05)in comparison with vancomycin in microbiologically evaluation patients at the test-of-cure visit,and,there was no difference in eradication rates for streptococcal species (OR =4.27,95% CI 0.01-1365.87,P>.05)and enterococcal species (OR=0.75,95% CI 0.03-17.51,P>.05).Mortality was similar between the groups (OR=0.80,95% CI 0.59-1.07,P>0.05).Treatment with linezolid was not associated with more adverse effects in general in comparison with vancomycin (OR=1.06,95% CI 0.68-1.64,P>.05).Conclusions Linezolid is at least as effective as vancomycin for treatment of patients with pneumonia caused by gram-positive cocci although rigorously designed large sample sized,randomized double blind clinical trials are required to further demonstrate and support the conclusion.
