利奈唑胺和万古霉素对重症监护治疗病房革兰阳性球菌感染患者治疗效果的Meta分析  

Linezolid vs vancomycin for the treatment of Gram-positive cocci infections in intensive care uhit patients:metaanalysis for randomized controlled trials

作　　者：杨九一[1] 顾健[2] 

机构地区：[1]北京大学国际医院,北京102206 [2]北京大学人民医院药剂科,北京100044

出　　处：《临床药物治疗杂志》2015年第3期61-66,共6页Clinical Medication Journal

摘　　要：目的:比较、评价利奈唑胺和万古霉素治疗重症监护治疗病房(intensive care unit,ICU)革兰阳性球菌感染患者的疗效及安全性。方法:采用Meta分析的方法,用计算机检索Pub Med、Cochrane Library、CNKI和万方数据库,评价筛选文献,纳入利奈唑胺和万古霉素的随机对照试验(RCT),并采用Rev Man 5.2进行Meta分析。结果:6个随机对照试验,共纳入革兰阳性球菌感染的ICU患者444名,其中利奈唑胺组218名,万古霉素组226名。Meta分析显示,临床治疗有效率,利奈唑胺优于万古霉素[OR=3.07,95%CI(1.76,5.34),P<0.01],细菌清除率上,利奈唑胺高于万古霉素[OR=3.83,95%CI(1.81,8.12),P=0.000 5];微生物学治愈率和不良反应发生率,利奈唑胺与万古霉素两组间差异均无统计学意义。结论:在治疗ICU重症患者革兰氏阳性球菌感染中,利奈唑胺在临床有效率和细菌清除率方面,明显优于万古霉素,而在微生物学治愈率和不良反应发生率上利奈唑胺则和万古霉素相当,但仍需要更大样本量、更加严格设计的随机对照试验进一步验证。Objective： A meta-analysis of randomized controlled trials on the efficacy and safety in intensive care uhi （ICU） patients with Gram-positive cocci infections treated with linezolid versus with vancomycin. Methods： The data were collected from the PubMed, the Cochrane library, CNKI and Wanfang database. Randomized controlled trials comparing linezolid with vancomycin in ICU patients with Gram-positive cocci infections were eligible for inclusion. Two investigators independently assessed the quality and extracted the data. RevMan 5.2 was used to conduct the meta-analysis. Results： Six randomized controlled studies comparing linezolid with vancomycin were analyzed, focusing on the 444 ICU patients with Gram-positive cocci infections. It was found by meta-analysis that, with respect to clinical treatment success, linezolid was more effective than vancomycin [OR=3.07, 95% CI（1.76, 5.34）, P〈0.01] and to bacterium clearance rates, linezolid was more effective than vancomyein [OR=3.83, 95% CI（1.81, 8.12）, P=0.0005]. But, there was no difference in microbiological cure rates between linezolid and vancomyein [OR=1.47, 95% CI（0.64, 3.34）, P=0.36] .Treatment with linezolid was not associated with more adverse effects in general in comparison with vancomyein [OR=0.48, 95% CI（0.23, 1.01）, P=0.05]. Conclusion： Linezolid is more effective than vancomycin for treatment of ICU patients with Gram-positive cocci infections although rigorously designed large sample size randomized double blind clinical trials are required to further demonstrate and support the conclusion.

关 键 词：利奈唑胺 万古霉素 重症监护治疗病房 META分析 

分 类 号：R978.1[医药卫生—药品]