替考拉宁与万古霉素治疗中国人群下呼吸道革兰氏阳性菌感染有效性和安全性比较的Meta分析  

Efficacy and Safety of Teicoplanin versus Vancomycin for Lower Respiratory Tract Infection with Gram-positive Bacteria in Chinese Population:A Meta-analysis

作　　者：陶华[1,2] 程小柯[3] 王娟[2] 董擎宇[4] 周丽娜[5] 

机构地区：[1]郑州市第二人民医院质量效能统计科,郑州450006 [2]郑州市第二人民医院药务科,郑州450006 [3]河南大学淮河医院循证医学中心,河南开封475000 [4]郑州市第二人民医院护理部,郑州450006 [5]郑州市第二人民医院呼吸科,郑州450006

出　　处：《中国循证医学杂志》2016年第7期809-818,共10页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价替考拉宁与万古霉素治疗中国人群下呼吸道革兰氏阳性菌感染的疗效与安全性。方法计算机检索PubMed、EMbase、The Cochrane Library(2016年3期)、CNKI和WanFang Data数据库,搜集替考拉宁与万古霉素治疗中国人群下呼吸道革兰氏阳性菌感染的相关随机对照试验(RCT),检索时限均从建库至2016年3月20日。由2位研究者独立进行文献筛选、资料提取和偏倚风险评价,然后采用RevMan 5.3软件进行Meta分析。结果最终纳入12个RCT,共921例下呼吸道革兰氏阳性菌感染患者。Meta分析结果显示:替考拉宁组与万古霉素组在总有效率[RR=0.99,95%CI(0.93,1.05),P=0.69]、痊愈率[RR=1.05,95%CI(0.92,1.19),P=0.49]、细菌清除率[RR=1.00,95%CI(0.93,1.05),P=0.69]方面差异无统计学意义;但替考拉宁组的不良反应发生率[RR=0.65,95%CI(0.47,0.90),P=0.008]和肾毒性发生率[RR=0.33,95%CI(0.16,0.66),P=0.002]明显低于万古霉素组,治疗时间明显短于万古霉素组[MD=–1.78,95%CI(–3.27,–0.29),P=0.02],且差异有统计学意义。结论当前证据表明替考拉宁治疗中国人群下呼吸道革兰氏阳性菌感染的疗效与万古霉素相似,但安全性更好,治疗时间更短。受纳入研究数量和质量的局限性,上述结论尚需开展更多高质量的研究进一步验证。Objective To systematically evaluate the efficacy and safety of teicoplanin versus vancomycin for lower respiratory tract infection with gram-positive bacteria in Chinese population, Methods The PubMed, EMbase, The Cochrane Library （Issue 3, 2016）, CNKI, and WanFang Data databases were searched from their inception to March 20, 2016, to collect randomized controlled trials about teicoplanin versus vancomycin for lower respiratory tract infection with gram-positive bacteria in Chinese population. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 12 RCTs involving 921 patients were included. The results of meta-analysis suggested that there were no significant associations between the teicoplanin group and the vancomycin group in total effective rate （RR=0.99, 95%CI 0.93 to 1.05, P=0.69）, clinical cure rate （RR= 1.05, 95%CI 0.92 to 1.19, P=0.49）, and bacteria clearance rate （RR= 1.00, 95%CI 0.93 to 1.05, P=0.69）. However, the teicoplanin group had lower incidences of the total adverse event （RR=0.65, 95%CI 0.47 to 0.90, P=0.008） and nephrotoxicity （RR=0.33, 95%CI 0.16 to 0.66, P=0.002）, and shorter course of treatment （MD= -1.78, 95%CI -3.27 to -0.29, P=0.02） than that in the vancomycin group. Conclusion Current evidence indicates that teicoplanin is similar to vancomycin in therapeutic effects on treating lower respiratory tract infection with gram- positive bacteria in Chinese population, but teicoplanin is better in safety and has a shorter course of treatment than vancomycin. Due to limited quantity and quality of the included studies, more high-quality RCTs are needed to confirm the above conclusions .

关 键 词：替考拉宁 万古霉素 下呼吸道感染 系统评价 META分析 随机对照试验 

分 类 号：R56[医药卫生—呼吸系统]