美罗培南与亚胺培南/西司他汀治疗重症感染疗效与安全性的Meta分析  

A Meta-analysis of the effi cacy and safety of meropenem with imipenem plus cilastatin in the treatment of severe infections

作　　者：刘茂昌[1] 葛苗苗[2] 陈渝军[1] 李石军[2] 汪洋[1] 

机构地区：[1]武汉市儿童医院药学部,武汉430016 [2]华中科技大学同济医学院协和医院,武汉430022

出　　处：《中国抗生素杂志》2014年第10期785-790,共6页Chinese Journal of Antibiotics

摘　　要：目的评价碳青霉烯类抗生素美罗培南与亚胺培南/西司他汀在重症感染治疗中的疗效和安全性。方法利用计算机检索EMBASE、MEDLINE、Cochrane library和CNKI等数据库,纳入比较美罗培南与亚胺培南/西司他汀在相同给药剂量、给药方案下治疗重症感染疗效和安全性的随机对照试验(RCTs),采用Rev Man 5.2.6软件对入选试验进行Meta分析。结果共纳入16个随机对照试验,包括3055例重症感染患者。Meta分析结果显示,美罗培南相比亚胺培南/西司他汀在治疗重症感染中的临床有效率高[RR=1.03,95%CI(1.00,1.06)]。在临床治愈率[RR=1.04,95%CI(1.00,1.10)]与细菌清除率[RR=1.02,95%CI(0.97,1.07)]方面,美罗培南与亚胺培南/西司他汀相当。美罗培南组与药物相关不良反应发生率为11.6%,相比于亚胺培南/西司他汀组的13.6%[RR=0.85,95%CI(0.70,1.02)],但中枢神经系统不良反应在亚胺培南/西司他汀组发生率较高(P<0.01)。结论现有证据表明,美罗培南在重症感染治疗中的临床有效率略优于亚胺培南/西司他汀,中枢神经系统不良反应发生率显著低于亚胺培南/西司他汀。Objective To compare the effectiveness and safety of meropenem with imipenem plus cilastatin in the treatment of severe infections. Methods The date were collected from the EMBASE, MEDLINE, Cochrane library and CNKI. Randomized controlled trials comparing meropenem with imipenem plus cilastatin administered at the same dosage regimen in patients with severe infections were eligible for inclusion. Meta-analysis was carried out using RevMan 5.2.6 software. Results Sixteen randomized controlled studies comparing meropenem with imipenem plus cilastatin were analyzed, focusing on the 3,055 patients with severe infections. It was found by Meta-analysis that, meropenem exhibited a high clinical efficacy rate compared with imipenem plus cilastatin in the treatment of severe infections[RR=l.03, 95%CI（1.00, 1.06）]. The clinical cure rate and bacterial eradication rate did not show any significant difference between the two drugs. Drug-related adverse events occurred in 11.6% and 13.6% of meropenem and imipenem plus cilastatin patients respectively[RR=0.85, 95%CI（0.70,1.02）]. However, the incidence of adverse reaction in central nervous system possessed a higher rate in imipenem plus cilastatin group（P〈0.01）. Conclusion The available evidence suggests that the clinical efficacy rate of meropenem in the treatment of severe infections is slightly better than imipenem plus cilastatin. Moreover, meropenem shows significantly lower incidence of adverse reaction in central nervous system than imipenem plus cilastatin.

关 键 词：美罗培南 亚胺培南/西司他汀 重症感染 META分析 

分 类 号：R978.1[医药卫生—药品]