两性霉素B膀胱冲洗治疗真菌尿的荟萃分析  

A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

作　　者：白向荣[1] 程红勤[1] 张雁[1] 金颖[1] BAI Xiangrong;CHENG Hongqin;ZHANG Yan;JIN Yin(Department of Pharmacy,Xuanwu Hospital,Capital Medical University,Beijing 10053,China)

机构地区：[1]首都医科大学宣武医院药剂科,北京100053

出　　处：《药学实践杂志》2018年第4期379-384,共6页Journal of Pharmaceutical Practice

摘　　要：目的系统评价两性霉素B膀胱冲洗真菌尿路感染的有效性和安全性。方法检索Pubmed、Embase、WEB OF SCIENCE、Cochrane图书馆、万方数据库、维普数据库、中国生物医学文献服务系统数据库。纳入两性霉素B膀胱冲洗治疗真菌尿路感染作用的横断面或对照研究。结果共纳入12个随机对照研究,853例患者,荟萃(Meta)分析结果表明,两性霉素B膀胱冲洗后24h和>5d,真菌清除率分别为0.81[0.75,0.87]和0.71[0.63,0.79],具有统计学意义。冲洗后24h真菌清除率结果:持续冲洗的真菌清除率为0.83[0.75,0.91],间断冲洗的真菌清除率为0.78[0.68,0.88]。冲洗后>5d真菌清除率结果:持续冲洗的真菌清除率为0.74[0.65,0.84],而间断冲洗的真菌清除率为0.60[0.44,0.76]。差异均具有统计学意义。两性霉素B膀胱冲洗与氟康唑相比,在冲洗后24h真菌清除率和冲洗后>5d真菌清除率分别为1.27[1.07,1.50]和0.92[0.78,1.10]。安全性方面有血尿的报道。结论两性霉素B膀胱冲洗具有真菌清除作用,持续冲洗方式优于间断冲洗。具有与全身使用氟康唑相同的真菌清除效果,可以作为尿路感染的治疗方案。但由于受纳入文献的数质量的限制,仍然需要大规模、设计严谨的随机、对照、双盲的临床试验去进一步验证其效果。Objective Systematic evaluation of effectiveness and safety of amphotericin B bladder irrigation in urinary tract fungal infection.Methods Cross-sectional or controlled studies of amphotericin B bladder irrigation in the treatment of urinary tract fungal infection were collected by the search of Pubmed,Embase,WEB OF SCIENCE,Cochrane Library,Wanfang Database,ViP Database and SinoMed.Results 12 studies with 853 patients were included.Amphotericin B bladder irrigation had fungal clearance rate RR=0.81 [0.75,0.87]after 24 hours and 0.71 [0.63,0.79]after 5 days.Clearance of candiduria in 24 hours with amphotericin B continuous irrigation was 0.83[0.75,0.91],while the intermittent bladder irrigation was 0.78 [0.68,0.88].Clearance of candiduria 5 days for those two groups was 0.74[0.65,0.84]and 0.60[0.44,0.76].In the comparative studies with amphotericin B bladder irrigation vs fluconazole,clearance of candiduria in 24 hours and 5 days was 1.27[1.07,1.50]and 0.92[0.78,1.10].There was a report of hematuria with amphotericin B bladder irrigation.Conclusion Amphotericin B bladder irrigation showed similar efficacy in candiduria clearance as the systemic treatment with fluconazole.The continuous bladder irrigation with amphotericin B is more effective than intermittent irrigation.Due to the limited literatures available,the large scale double blinded clinical trials are needed to verify the efficacy.

关 键 词：膀胱冲洗 两性霉素B 真菌尿 荟萃分析 系统评价 

分 类 号：R978.5[医药卫生—药品]