中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2014年
6期
353-356
,共4页
姚志文%鲁翔%沈冲%林东昉
姚誌文%魯翔%瀋遲%林東昉
요지문%로상%침충%림동방
氟胞嘧啶%氟康唑%两性霉素B%脑膜炎,隐球菌性%Meta分析
氟胞嘧啶%氟康唑%兩性黴素B%腦膜炎,隱毬菌性%Meta分析
불포밀정%불강서%량성매소B%뇌막염,은구균성%Meta분석
Flucytosine%Fluconazole%Amphotericin B%Meningitis,cryptococcal%Meta-analysis
目的 评价早期应用两性霉素B联合氟胞嘧啶或两性霉素B联合氟康唑对艾滋病相关隐球菌脑膜炎生存率的影响.方法 采用国际循证医学协作组织(Cochrane)系统综述方法,计算机检索范围包括Cochrane图书馆、美国国家医学数据库(PubMed)、美国Ovid数据库、荷兰医学文摘数据库(Embase)、万方数据库、中国知网(CNKI)全文数据库、中国生物医学文献数据库等,辅以文献追述和手工检索,对相关的参考文献严格按照文献纳入、剔除标准进行筛选,检索年限从上述数据库建库至2013年10月;采用系统评价管理和分析软件(RevMan 5.2版)进行Meta分析.结果 纳入4项前瞻性对照试验,共有隐球菌脑膜炎患者399例,其中艾滋病相关隐球菌脑膜炎患者386例,非艾滋病相关隐球菌脑膜炎患者13例.两性霉素B联合氟胞嘧啶治疗227例,其中艾滋病相关隐球菌脑膜炎患者217例,非艾滋病相关隐球菌脑膜炎患者10例.两性霉素B联合氟康唑治疗172例,其中艾滋病相关隐球菌脑膜炎患者169例,非艾滋病相关隐球菌脑膜炎患者3例.两性霉素B联合氟胞嘧啶治疗组的2周病死率为6.6％(95％CI:-18.5％～31.6％),低于两性霉素B联合氟康唑治疗组的19.7％ (95％CI:-23.6％～62.9％),差异有统计学意义(OR=0.51,95％CI:0.27～0.93,P＜0.05).两性霉素B联合氟胞嘧啶治疗组的10周病死率为12.9％(95％CI:-22.2％～48.0％),低于两性霉素B联合氟康唑治疗组的31.4％(95％CI:-23.1％～85.9％),但差异无统计学意义(OR=0.70,95％CI:0.44～1.13,P=0.15).结论 早期应用两性霉素B联合氟胞嘧啶治疗可减少艾滋病相关隐球菌脑膜炎患者的病死率.
目的 評價早期應用兩性黴素B聯閤氟胞嘧啶或兩性黴素B聯閤氟康唑對艾滋病相關隱毬菌腦膜炎生存率的影響.方法 採用國際循證醫學協作組織(Cochrane)繫統綜述方法,計算機檢索範圍包括Cochrane圖書館、美國國傢醫學數據庫(PubMed)、美國Ovid數據庫、荷蘭醫學文摘數據庫(Embase)、萬方數據庫、中國知網(CNKI)全文數據庫、中國生物醫學文獻數據庫等,輔以文獻追述和手工檢索,對相關的參攷文獻嚴格按照文獻納入、剔除標準進行篩選,檢索年限從上述數據庫建庫至2013年10月;採用繫統評價管理和分析軟件(RevMan 5.2版)進行Meta分析.結果 納入4項前瞻性對照試驗,共有隱毬菌腦膜炎患者399例,其中艾滋病相關隱毬菌腦膜炎患者386例,非艾滋病相關隱毬菌腦膜炎患者13例.兩性黴素B聯閤氟胞嘧啶治療227例,其中艾滋病相關隱毬菌腦膜炎患者217例,非艾滋病相關隱毬菌腦膜炎患者10例.兩性黴素B聯閤氟康唑治療172例,其中艾滋病相關隱毬菌腦膜炎患者169例,非艾滋病相關隱毬菌腦膜炎患者3例.兩性黴素B聯閤氟胞嘧啶治療組的2週病死率為6.6％(95％CI:-18.5％～31.6％),低于兩性黴素B聯閤氟康唑治療組的19.7％ (95％CI:-23.6％～62.9％),差異有統計學意義(OR=0.51,95％CI:0.27～0.93,P＜0.05).兩性黴素B聯閤氟胞嘧啶治療組的10週病死率為12.9％(95％CI:-22.2％～48.0％),低于兩性黴素B聯閤氟康唑治療組的31.4％(95％CI:-23.1％～85.9％),但差異無統計學意義(OR=0.70,95％CI:0.44～1.13,P=0.15).結論 早期應用兩性黴素B聯閤氟胞嘧啶治療可減少艾滋病相關隱毬菌腦膜炎患者的病死率.
목적 평개조기응용량성매소B연합불포밀정혹량성매소B연합불강서대애자병상관은구균뇌막염생존솔적영향.방법 채용국제순증의학협작조직(Cochrane)계통종술방법,계산궤검색범위포괄Cochrane도서관、미국국가의학수거고(PubMed)、미국Ovid수거고、하란의학문적수거고(Embase)、만방수거고、중국지망(CNKI)전문수거고、중국생물의학문헌수거고등,보이문헌추술화수공검색,대상관적삼고문헌엄격안조문헌납입、척제표준진행사선,검색년한종상술수거고건고지2013년10월;채용계통평개관리화분석연건(RevMan 5.2판)진행Meta분석.결과 납입4항전첨성대조시험,공유은구균뇌막염환자399례,기중애자병상관은구균뇌막염환자386례,비애자병상관은구균뇌막염환자13례.량성매소B연합불포밀정치료227례,기중애자병상관은구균뇌막염환자217례,비애자병상관은구균뇌막염환자10례.량성매소B연합불강서치료172례,기중애자병상관은구균뇌막염환자169례,비애자병상관은구균뇌막염환자3례.량성매소B연합불포밀정치료조적2주병사솔위6.6％(95％CI:-18.5％～31.6％),저우량성매소B연합불강서치료조적19.7％ (95％CI:-23.6％～62.9％),차이유통계학의의(OR=0.51,95％CI:0.27～0.93,P＜0.05).량성매소B연합불포밀정치료조적10주병사솔위12.9％(95％CI:-22.2％～48.0％),저우량성매소B연합불강서치료조적31.4％(95％CI:-23.1％～85.9％),단차이무통계학의의(OR=0.70,95％CI:0.44～1.13,P=0.15).결론 조기응용량성매소B연합불포밀정치료가감소애자병상관은구균뇌막염환자적병사솔.
Objective To evaluate the survival benefit of amphotericin B (AmB) plus flucytosine or fluconazole for treatment of patients with acquired immunodeficiency syndrome (AIDS)-associated cryptococcal meningitis.Methods The following database were searched from the beginning to October 2013,including Cochrane library,PubMed,OVID,Embase,Wanfang Date,CNKI and Chinese Biomedical Database,and the references of eligible studies were manually screened.Reference lists of relevant articles were screened according to selection and extraction criteria.Meta-analysis was performed using RevMan 5.2.Results Four prospective controlled studies with a total of 399 patients with cryptococcal meningitis were identified,including 386 patients with AIDS-associated cryptococcal meningitis and 13 human immunodeficiency virus (HIV)-negative patients.Two hundred and twentyseven patients were treated with AmB and flucytosine combination therapy,including 217 patients with AIDS-associated cryptococcal meningitis and 10 HIV-negative patients.One hundred and seventy-two patients were treated with AmB and fluconazole combination therapy,including 169 patients with AIDS-associated cryptococcal meningitis and 3 HIV-negative patients.The Meta-analysis revealed that the mortality rate in AmB plus flucytosine combination therapy group was 6.6％ (95％ CI:18.5％-31.6 ％) at two weeks point,which was significantly lower than that in AmB plus fluconazole combination group (19.7％,95％CI:-23.6％-62.9％; OR=0.51,95％CI:0.27-0.93,P＜0.05).But at 10 weeks point,the mortality rate in flucytosine combination group was 12.9％ (95％oo CI:-22.2％-48.0％),which was lower than that in fluconazole combination group (31.4％,95％ CI:-23.1％-85.9 ％).However,there was no statistically significant difference between these two groups at 10 weeks point (OR=0.70,95％CI:0.44-1.13,P=0.15).Conclusion Administration of AmB plus flucytosine at early stage can reduce the mortality rate in patients with AIDS-associated cryptococcal meningitis.
