口服药物治疗女性单纯性下尿路感染有效性和安全性的网状Meta分析  

Efficacy and safety of oral drugs for uncomplicated lower urinary tract infection in females: a network meta-analysis

作　　者：郭伟 郭翔 朱澜澜 吕佳 胡平成[1] GUO Wei;GUO Xiang;ZHU Lanlan;LV Jia;HU Pingcheng(Department of Epidemiology and Health Statistics,School of Xiangya Public Health,Central South University,Changsha,410078,P.R.China;Shenzhen Prevention and Treatment Center for Occupational Diseases,Shenzhen,518020,P.R.China)

机构地区：[1]中南大学湘雅公共卫生学院流行病与卫生统计学系,长沙410078 [2]深圳市职业病防治院,广东深圳518020

出　　处：《中国循证医学杂志》2019年第9期1051-1062,共12页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价治疗女性急性单纯性下尿路感染常用口服药物的有效性和安全性。方法计算机检索PubMed、The Cochrane Library、EMbase、CBM、WanFang Data、CNKI和VIP数据库,搜集有关口服药物治疗女性急性单纯性下尿路感染有效性和安全性的随机对照试验(RCT),检索时限均从建库到2018年11月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R3.5.1软件“gemtc”程序包进行网状Meta分析。结果共纳入38个RCT。网状Meta分析结果显示:在短期缓解临床症状方面,喹诺酮[RR=1.24,95%CI(1.11,1.37)]、呋喃妥因[RR=1.21,95%CI(1.06,1.37)]、甲氧苄氨嘧啶-磺胺甲恶唑[RR=1.20,95%CI(1.06,1.35)]、磷霉素[RR=1.17,95%CI(1.04,1.31)]和青霉素[RR=1.18,95%CI(1.05,1.33)]均优于非甾体类抗炎药。清除泌尿道致病菌能力方面,喹诺酮优于磷霉素[RR=1.07,95%CI(1.03,1.12)]、青霉素[RR=1.18,95%CI(1.13,1.23)]和头孢菌素[RR=1.13,95%CI(1.08,1.19)];呋喃妥因优于青霉素[RR=1.15,95%CI(1.08,1.21)]和头孢菌素[RR=1.10,95%CI(1.04,1.17)];甲氧苄氨嘧啶-磺胺甲恶唑也优于青霉素[RR=1.15,95%CI(1.09,1.21)]和头孢菌素[RR=1.11,95%CI(1.04,1.16)];磷霉素优于青霉素[RR=1.10,95%CI(1.04,1.16)]。在安全性方面,喹诺酮不良反应发生率低于呋喃妥因[RR=0.83,95%CI(0.70,0.98)]、甲氧苄氨嘧啶-磺胺甲恶唑[RR=0.88,95%CI(0.78,0.99)]和磷霉素[RR=0.74,95%CI(0.59,0.93)];磷霉素高于青霉素[RR=1.33,95%CI(1.01,1.74)]和非甾体类抗炎药[RR=1.46,95%CI(1.11,1.92)]。以上差异均具有统计学意义(P<0.05)。结论现有证据表明,喹诺酮可能是治疗女性单纯性下尿路感染的理想药物。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。Objectives To systematically review the efficacy and safety of oral drugs for treating women with uncomplicated lower urinary tract infection.Methods PubMed,The Cochrane Library,EMbase,CBM,WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of oral drugs for treating females with uncomplicated lower urinary tract infection from inception to November,2018.Two reviewers independently screened literature,extracted data and assessed risk of bias of included studies,then,network meta-analysis was performed by using “gemtc” packages in R 3.5.1 software.Results A total of 38 RCTs were included.The results of network meta-analysis showed that:quinolones (RR=1.24,95%CI 1.11 to 1.37),furantoin (RR=1.21,95%CI 1.06 to 1.37), trimethoprim-sulfamethoxazole (TMP-SMZ)(RR=1.20,95%CI 1.06 to 1.35),fosfomycin (RR=1.17,95%CI 1.04 to 1.31) and penicillin (RR=1.18,95%CI 1.05 to 1.33) were superior to non-steroidal anti-inflammatory drugs (NSAIDS) in clinical cure.Quinolones were better than fosfomycin (RR=1.07,95%CI 1.03 to 1.12),penicillin (RR=1.18,95%CI 1.13 to 1.23) and cephalosporin (RR=1.13,95%CI 1.08 to 1.19);furantoin was better than penicillin (RR=1.15,95%CI 1.08 to 1.21) and cephalosporin (RR=1.10,95%CI 1.04 to 1.17);TMP-SMZ was better than penicillin (RR=1.15,95%CI 1.09 to 1.21) and cephalosporin (RR=1.11,95%CI 1.04 to 1.16);fosfomycin was better than penicillin (RR=1.10,95%CI 1.04 to 1.16) in bacteriological cure.The adverse effect rates of quinolones were lower than furantoin (RR=0.83,95%CI 0.70 to 0.98), TMP-SMZ (RR=0.88,95%CI 0.78 to 0.99) and fosfomycin (RR=0.74,95%CI 0.59 to 0.93),and which of fosfomycin was higher than penicillin (RR=1.33,95%CI 1.01 to 1.74) and NSAIDS (RR=1.46,95%CI 1.11 to 1.92).All differences were statistically significant.Conclusions Current evidence shows that uncomplicated lower urinary tract infection should be recommended to therapy containing quinolones.Due to limited quality and quantity of included studies,more highquality st

关 键 词：泌尿道感染 口服药物 随机对照试验 网状Meta分析 有效性 安全性 

分 类 号：R691.3[医药卫生—泌尿科学]