抗生素预防儿童原发性膀胱输尿管反流尿路感染的Meta分析  

Antibiotic prophylaxis for febrile urinary tract infections in children with primary vesicoureteral reflux: a meta-analysis

作　　者：魏仪[1,2] 吴盛德[1,2] 王养才 林涛[1,3] 何大维[1,4] 李旭良[1,3] 刘俊宏[2,4] 刘星[1,4] 华燚[1,3] 陆鹏[1,4] 张德迎[1,3] 温晟[3] 魏光辉[1,2,3,4] 

机构地区：[1]重庆医科大学附属儿童医院泌尿外科,重庆400014 [2]重庆医科大学儿童发育疾病研究教育部重点实验室,重庆400014 [3]重庆医科大学儿科学重庆市重点实验室,重庆400014 [4]重庆医科大学重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆400014

出　　处：《第三军医大学学报》2016年第13期1552-1558,共7页Journal of Third Military Medical University

基　　金：国家临床重点专科建设项目{国卫办医函[2013]544};国家自然科学基金(81571425)

摘　　要：目的通过Meta分析,对预防性使用抗生素（continuous antibiotic prophylaxis,CAP）在预防儿童原发性输尿管反流尿路感染（urinary tract infection,UTI）的临床应用疗效性以及安全性进行分析。方法检索Cochrane图书馆临床对照试验数据库、PubMed、EMBASE、Ovid、Springer、中国期刊全文数据库（CNKI）、中文科技期刊数据库（VIP）、万方数据库、中国生物医学文献光盘数据库（截止到2015年5月）。评价文献质量用Cochrane协作网推荐的Jadad记分法,并用Rev Man5.1软件进行分析。筛选出所有已发表的关于比较预防性抗生素与空白（或安慰剂）对照预防原发性输尿管反流尿路感染的随机、对照试验,观察的主要指标：复发性尿路感染发生率;次要指标：新肾脏瘢痕发生率。结果 8项随机对照试验（抗生素组828例,对照组811例）纳入Meta分析,所有纳入文献均被评为A级质量。分析显示：①预防性使用抗生素组的尿路感染发生率明显降低（RR=0.69,95%CI：0.56～0.86,P〈0.05）。②对于Ⅰ～Ⅱ级反流的患儿,预防性使用抗生素可降低复发性尿路感染率（RR=0.57,95%CI：0.37～0.87,P〈0.05）,对于Ⅲ～Ⅳ级反流的患儿,预防性使用抗生素可降低复发性尿路感染率（RR=0.76,95%CI：0.59～0.96,P〈0.05）。③5篇对于不同干预因素下UVR患者肾脏瘢痕的情况进行了详细说明,原发性输尿管反流的患儿预防性使用抗生素对肾脏瘢痕出现的影响无意义（RR=1,95%CI：0.61～1.64,P〉0.05）。结论不论是对低等级还是高等级的反流,持续抗生素使用能有效预防原发性膀胱输尿管反流的尿路感染发生,对于肾脏瘢痕的发生没有显著意义。Objective To assess the effectiveness and safety of continuous antibiotic prophylaxis （CAP） in the prevention of urinary tract infection （UTI） for the children with vesicoureteral reflux （VUR） by meta analysis. Methods Computer retrieval was carried out in Cochrane library, PubMed, EMBASE, Ovid, Springer, China National Knowledge Infrastructure （CNKI）, VIP database, WanFang Data, and China Biology Medicine disc （CBM） from establishment until May 2015 for randomized controlled trials （RCT） about UTI prevention by comparing CAP and no agent/placebo. The quality of the literature was assessed with Jadad scale according to Cochrane Handbook for systematic reviews of interventions. Meta-analysis was performed to the extracted data by statistical software Rev Man 5.1. The main indicator of observation was the incidence of recurrent urinary tract infections, and the secondary indicator was the new incidence of renal scars. Results There were 8 RCTs incorporated in this study, including 828 cases of antibiotic treatment group and 811 cases of control group. The meta-analyses showed ① The risk of febrile UTI was reduced in the CAP group of （RR = 0.69, 95 % CI： 0. 56 - 0.86, P 〈 0.05 ） ; ② CAP reduced the occurrence of febrile UTI in the children with VUR of grade Ⅰ - Ⅱ （RR =0.57, 95% CI： 0. 37 -0.87, P 〈0.05） and those of grade Ⅲ - Ⅳ （RR =0. 76, 95% CI： 0. 59 -0.96, P 〈0.05） ; ③ Based on the 5 RCTs studying the occurrence of new renal scars in children with VUR, antibiotic treatment had no effect of the risk of new renal scars when compared with those receiving no agent/placebo （RR = 1, 95% CI： 0. 61 - 1.64, P 〉0.05）. Conclusion Regardless of the grade of VUR, CAP exerts significant effect on the prevention of UTI, but has no effect on the occurrence of new renal scars in the children.

关 键 词：泌尿道感染 原发性膀胱输尿管反流 抗生素预防感染 肾盂肾炎 儿童 

分 类 号：R726.93[医药卫生—儿科] R726.941[医药卫生—临床医学]