泊沙康唑预防侵袭性真菌感染疗效及安全性的Meta分析  

Meta-analysis of efficacy and safety of posaconazole in the prevention of invasive fungal infections

作　　者：计建军[1] 张慧[1] 查丽 费爱丽[1] 王小琴[1] 蔡继明[2] 徐少毅[2] 王长江[1] JI Jian-jun;ZHANG Hui;ZHA Li;FEI Ai-li;WANG Xiao-qin;CAI Ji-ming;XU Shao-yi;WANG Chang-jiang(Department of Pharmacy,Second Hospital Affiliated to Jiaxing University,Jia-xing 314000,China;ICU,Second Hospital Affiliated to Jiaxing University,Jia-xing 314000,China)

机构地区：[1]嘉兴学院附属第二医院药学部,浙江嘉兴314000 [2]嘉兴学院附属第二医院重症医学科,浙江嘉兴314000

出　　处：《实用药物与临床》2021年第3期229-236,共8页Practical Pharmacy and Clinical Remedies

基　　金：嘉兴市公益性研究计划项目(2019AD32117)。

摘　　要：目的系统评价泊沙康唑预防侵袭性真菌感染的疗效及安全性。方法检索PubMed、Web of Science、Embase、Cochrane Library、Clinicaltrials.gov、中国知网期刊全文数据库、维普中文科技期刊数据库、万方数据库及中国生物医学文献数据库,截止时间2019年9月20日,收集所有关于泊沙康唑与其他抗真菌药预防侵袭性真菌感染疗效及安全性的对比研究,采用RevMan 5.2软件进行Meta分析。结果共纳入符合标准的文献13篇。Meta分析结果显示,泊沙康唑预防疗效优于氟康唑(RR=0.41,95%CI:0.27~0.62,P<0.0001)和伊曲康唑(RR=0.21,95%CI:0.09~0.54,P=0.001),但与伏立康唑(RR=0.34,95%CI:0.05~2.11,P=0.24)、两性霉素B脂质复合物(RR=0.30,95%CI:0.01~7.02,P=0.46)及米卡芬净(RR=0.44,95%CI:0.19~1.02,P=0.06)预防疗效相当。泊沙康唑全因死亡率(RR=0.80,95%CI:0.66~0.97,P=0.02)和证实或很可能是侵袭性真菌感染引起的死亡率(RR=0.35,95%CI:0.18~0.67,P=0.002]均低于其他抗真菌药,且未增加不良反应的发生率,甚至比伏立康唑(RR=0.36,95%CI:0.20~0.67,P=0.001)的不良反应发生率更低。结论泊沙康唑预防侵袭性真菌感染具有良好的疗效和安全性,能降低患者的全因死亡率和侵袭性真菌感染相关死亡率。Objective To systematically evaluate the efficacy and safety of posaconazole in the prevention of invasive fungal infections.Methods PubMed,Web of Science,Embase,Cochrane Library,Clinicaltrials.gov,CNKI,VIP,WANFANG and CBM DATA were search up to September 20,2019.All comparative studies on the efficacy and safety of posaconazole and other antifungal agents in the prevention of invasive fungal infections were collected.RevMan 5.2 software was adopted for the data analysis.Results A total of 13 articles meeting the criteria were included.Meta-analysis showed that posaconazole was more effective than fluconazole(RR=0.41,95%CI:0.27~0.62,P<0.0001)and itraconazole(RR=0.21,95%CI:0.09~0.54,P=0.001),but was equally effective compared with voriconazole(RR=0.34,95%CI:0.05~2.11,P=0.24),amphotericin B lipid complex(RR=0.30,95%CI:0.01~7.02,P=0.46)or micafungin(RR=0.44,95%CI:0.19~1.02,P=0.06).The all-cause mortality of pasaconazole(RR=0.80,95%CI:0.66~0.97,P=0.02)and proven or probable invasive fungal infections-related mortality(RR=0.35,95%CI:0.18~0.67,P=0.002)were lower than those of other antifungal agents,and did not increase the incidence of adverse reactions.Posaconazole had a lower incidence of adverse reactions than voriconazole(RR=0.36,95%CI:0.20~0.67,P=0.001).Conclusion Posaconazole has good efficacy and safety in preventing invasive fungal infection,and can reduce all-cause mortality and invasive fungal infection-related mortality.

关 键 词：泊沙康唑 侵袭性真菌感染 疗效 安全性 META分析 

分 类 号：R519[医药卫生—内科学]