齐多夫定单用预防HIV母婴传播的有效性与安全性的系统评价  

Effectiveness and Safety of Zidovudine for Preventing the Risk of Mother-to-Child Transmission of HIV:A Systematic Review

作　　者：王莉[1] 孟月[1] 毛秀[1] 彭丽华 姚巡[3] 刘关键[1] 敬媛媛[1] 文进[1] 原志芳[1] 李幼平[1] 

机构地区：[1]四川大学华西医院循证医学与临床流行病学中心,成都610041 [2]四川大学华西临床医学院,成都610041 [3]四川大学华西临床医学院教务部,成都610041

出　　处：《中国循证医学杂志》2007年第5期367-384,共18页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金面上项目(青年科学基金项目)资助(项目编号:70503021)

摘　　要：目的系统评价单独应用齐多夫定(zidovudine,ZDV)阻断HIV母婴传播的有效性和安全性。方法采用Cochrane系统评价方法,计算机检索Cochrane图书馆(2007第1期)、PubMed、EMbase、CINAHL、AIDSearch、AIDSLINE、AIDSTRIALS、AIDSDRUGS、AIDSinfo、CRD(center of review and dissemination)、CBMdisc,VIP和CNKI等数据库,以及全球或地区性AIDS相关的会议论文集、政府或非政府组织的相关文件等,检索日期截至2007年4月30日,全面收集全球抗艾滋病病毒药物预防HIV母婴传播的随机对照试验。由两名评价员独立筛查文献、评价质量和提取资料,然后交叉核对,若遇分歧则征求第三方意见讨论解决。使用RevMan软件进行Meta分析。结果共纳入8个RCT,包括24篇全文和13篇摘要,其方法学质量的Jadad评分≥3分。Meta分析显示:①ZDV与安慰剂比较共纳入4个RCTs(2385例),无论长短疗程、母乳或非母乳喂养人群,ZDV预防HIV母婴传播的效果均优于安慰剂组,降低HIV母婴传播风险43%～50%,且两组死产率、婴儿死亡率、母亲死亡率、早产、低体重儿、出生缺陷、母婴不良反应发生率和母亲产前、产时和产后并发症发生率差异均无统计学意义(P>0.05)。②1个大样本RCT(1437例)比较了ZDV不同疗程的效果,结果显示ZDV“长–长疗程”(从孕28周开始到产后6周)比“短–短疗程”(从孕35周开始到分娩后3天)降低HIV母婴传播风险61%[RR=0.39,95%CI(0.19,0.82)]。长–长疗程与长–短疗程(从孕28周开始到产后3天)及短-长疗程(从孕35周开始到产后6周)比较,其预防HIV母婴传播的效果差异均无统计学意义(P>0.05)。各组死产、新生儿死亡、1年内婴儿死亡、母亲死亡、早产、低体重儿、出生缺陷、母婴不良反应发生率相似(P>0.05)。③1个大样本RCT(1200例)显示:人工喂养+短程ZDV预防HIV母婴传播的效果优于母乳喂养+长程ZDV,可降低婴儿HIV感染风险的35%～39%,但提高了婴儿7个月时�Objective To assess the effectiveness and safety of zidovudine （ZDV） for preventing mother-to-child transmission （MTCT） of HIV. Methods A systematic review of randomized controlled trials （RCTs） was conducted using the methodology of The Cochrane Collaboration. PUBMED, EMBASE, CINAHL, AIDSearch, AIDSLINE, AIDSTRIALS, The Cochrane Library （Issue 1, 2007）,AIDSDRUGS, AIDSinfo, CRD （Center of Review and Dissemination） databases and three Chinese Databases （CBM, CNKI, VIP） were searched from establishment to 20 April,2007. We also searched the documents of government and non-governmental organizations （NGOs）, as well as the abstracts from relevant conferences, including the International AIDS Conferences, the annual Conference on Retroviruses and Opportunisticlnfections, etc. RCTs assessing the effects of ZDV for preventing MTCT were included. Trial selection, quality assessment and data extraction were done by two reviewers independently, with confirmation by cross-checking the information. Different opinions were resolved by discussion with a third party. Meta-analyses were conducted using The Cochrane Collaboration＇s RevMan 4.2.9 software. Results Eight original studies, involving 24 published articles and 13 conference abstracts were included. All included studies were of high quality with Jadad score of 3 or more. Our meta-analyses showed that： ①Based on four trials （2 385 participants）, any ZDV regimen （both long course and short course, either in breast-feeding population or not） significantly reduced the risk of mother-to-child transmission of HIV compared with placebo by 43%-50%. The incidences of stillbirth, infant mortality, maternal mortality, premature delivery, low birth weight, birth defects, adverse reactions （either in mothers or in children）, any antenatal, intrapartum or postpartum complication were comparable between ZDV and placebo （P〉0.05）. ② One trial （1 437 participants） compared different courses of ZDV. The ＂long-long＂ course （fr

关 键 词：艾滋病病毒 母婴传播 齐多夫定 奈韦拉平 系统评价 

分 类 号：R714.2[医药卫生—妇产科学]