干扰素联合利巴韦林对重症冠状病毒感染患者死亡风险的影响:基于既往MERS-CoV研究的系统评价  

The effect of interferon combined with ribavirin on the risk of death in patients with severe coronavirus Infection:A systematic review based on previous MERS-CoV studies

作　　者：洪东升[1] 王融溶[1] 叶子奇[1] 饶跃峰[1] 徐凯进[1] 卢晓阳[1] HONG Dong-sheng;WANG Rong-rong;YE Zi-qi;RAO Yue-feng;XU Kai-jin;LU Xiao-yang(Department of Pharmacy,The First Affiliated Hospital,College of Medicine,Zhejiang University,Zhejiang Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院药学部,浙江杭州310003

出　　处：《中国医院药学杂志》2020年第9期960-963,967,共5页Chinese Journal of Hospital Pharmacy

基　　金：国家自然科学基金项目(编号:81971981);浙江省自然科学基金(编号:LQ20G030025);浙江省重点研发计划(编号:2019C04006);浙江省医药卫生科技计划(编号:2012-KY1-001-005)。

摘　　要：目的:通过系统评价干扰素联合利巴韦林治疗重症冠状病毒患者的死亡风险,为该用药方案在重症COVID-19患者中的应用提供借鉴。方法:计算机检索PubMed、The Cochrane Library、EMbase、WanFang Data、VIP、CNKI和CBM数据库,搜集有关干扰素联合利巴韦林治疗MERS患者的临床试验,检索时限均为建库至2020年2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R软件进行Meta分析。结果:共纳入5个临床研究,包括616例患者,约占世界卫生组织(WHO)报告确诊病例的40%;其中试验组干扰素根据使用品种,每周1~3次皮下注射。Meta分析结果显示:干扰素联合利巴韦林组的死亡率为57.96%(I2=85,P<0.01),与对照组相比患者死亡风险并无明显差异[RR=1.029,95%CI(0.748~1.416)],文献质量评分的均值为7.3分。结论:当前证据显示,干扰素联合利巴韦林全身给药在治疗周期内对重症冠状病毒感染患者的死亡风险并无显著改善,基于药物毒性的考虑,建议在真实世界环境下进一步明确干扰素联合利巴韦林对患者长期预后的影响。OBJECTIVE To systematically evaluate the risk of death in patients with severe coronavirus treated with interferon combined with ribavirin,and to provide reference for the application of this medication regimen in patients with severe COVID-19.METHODS PubMed,The Cochrane Library,EMbase,WanFang Data,VIP,CNKI and CBM databases were searched by computer to collect clinical trials on interferon combined with ribavirin in the treatment of MERS patients from the inception to February 2020.After two investigators independently screened the literatures,extracted the data and evaluated the risk of bias of the included studies,R software was used for meta-analysis.RESULTS A total of 5 clinical studies were included,including 616 patients,in which interferon in the experimental group was injected subcutaneously 1-3 times a week according to the type of use.Meta-analysis showed that the mortality rate of interferon plus ribavirin group was 57.96%(I2=85,P<0.01),which was not significantly lower than that of the control group[RR=1.029,95%CI(0.748-1.416)],and the mean value of the literature quality score was 7.3 points.CONCLUSION Current evidence suggests that systemic interferon plus ribavirin does not significantly improve the risk of death in patients with severe coronavirus infection during treatment cycles,and based on the consideration of drug toxicity,it is recommended to further clarify the effect of interferon plus ribavirin on the long-term prognosis of patients in a real-world setting.

关 键 词：新型冠状病毒肺炎 冠状病毒 重症感染 利巴韦林 干扰素 

分 类 号：R969[医药卫生—药理学]