卡泊芬净联合复方磺胺甲恶唑治疗肺孢子虫肺炎的疗效和安全性分析  

Efficacy and safety of caspofungin combined with trimethoprim-sulfamethoxazole in the treatment of Pneumocystis pneumonia

作　　者：贠菊平 栗芳 裴雨晴 刘炜 马迎民 YUN Ju-ping;LI Fang;PEI Yu-qing;LIU Wei;MA Ying-min(Department of Pharmacy,Beijing You’an Hospital,Capital Medical University,Beijing 100069,China;Department of Pharmacy,West Campus,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京佑安医院药学部,北京100069 [2]首都医科大学附属北京朝阳医院西院药事办,北京100043

出　　处：《中国临床药理学杂志》2022年第11期1258-1261,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的分析卡泊芬净联合复方磺胺甲恶唑(SMZ-TMP)治疗肺孢子虫肺炎(PCP)的临床疗效和安全性。方法计算机检索PubMed、Cochrane Library、Web of Science、EmBase、中国期刊全文数据库、万方数据库、中国生物医学文献数据库、中国科技期刊全文数据库等数据库,筛选出卡泊芬净联合SMZ-TMP(试验组)对比SMZ-TMP(对照组)治疗PCP的随机对照试验(RCT),用改良Jadad评分量表对纳入文献进行质量评价,用RevMan 5.3和Stata 15.0软件对总有效率、临床疗效指标及安全性指标变化进行Meta分析。结果最终纳入12篇RCT文献。Meta分析结果显示:试验组的总有效率为90.31%(382例/423例)显著高于对照组的72.56%(312例/430例),差异有统计学意义(P<0.05)。临床有效性指标:CD4+计数变化[均数差(MD)=2.71,95%CI=0.94~4.49],动脉二氧化碳分压变化(MD=-0.29,95%CI=-0.53~-0.04),血清白蛋白变化(MD=3.13,95%CI=2.38~3.87),动脉氧分压变化(MD=0.66,95%CI=0.21~1.12),乳酸脱氢酶变化(MD=-20.25,95%CI=-26.96~-13.54),试验组的上述指标与对照组比较,差异均有统计学意义(均P<0.05)。临床安全性指标:谷丙转氨酶变化(MD=-0.67,95%CI=-1.44~0.09),血尿素氮变化(MD=-0.01,95%CI=-0.05~0.03),肌酸酐变化(MD=-0.17,95%CI=-0.71~0.38),试验组的上述指标与对照组比较,差异均无统计学意义(均P>0.05)。结论卡泊芬净联合SMZ-TMP对比SMZ-TMP可提高PCP的治疗有效率,在安全性方面差异无统计学意义。Objective To evaluate the efficacy and safety of caspofungin combined withtrimethoprim-sulfamethoxazole(SMZ-TMP)in the treatment of Pneumocystis pneumonia(PCP).Methods PubMed,Cochrane Library,Web of Science,EmBase,CNKI,Wanfang database,CBM,VIP and other databases were retrieved by computers to screen out the randomized controlled trials(RCTs)of caspofungin combined with SMZ-TMP(treatment group)and SMZ-TMP(control group)in the treatment of PCP.The quality of the included literature was evaluated with the modified Jadad scale.Meta-analysis of the overall response rate,the changes of clinical efficacy indexes and the safety indexes were conducted by using RevMan 5.3 and Stata 15.0 software.Results A total of 12 RCTs literatures were included.The results of Meta analysis showed that the total effective rate of the treatment group was higher than that of the control group[90.31%(382cases/423 cases)vs.72.56%(312 cases/430 cases)]with the significant difference(P<0.05).The changes of the efficacy indexes CD4+count[mean deviation(MD)=2.71,95%CI=0.94-4.49],arterial carbon dioxide partial pressure(MD=-0.29,95%CI=-0.53--0.04),serum albumin(MD=3.13,95%CI=2.38-3.87),arterial oxygen partial pressure(MD=0.66,95%CI=0.21-1.12),serum lactate dehydrogenase(MD=-20.25,95%CI=-26.96--13.54)were statistically significant(all P<0.05).The changes of the safety indexes glutamic-pyruvic transaminase(MD=-0.67,95%CI=-1.44-0.09),blood urea nitrogen(MD=-0.01,95%CI=-0.05-0.03),creatinine(MD=-0.17,95%CI=-0.71-0.38)were no statistically significant(all P>0.05).Conclusion Compared with SMZ-TMP,caspofungin combined with SMZ-TMP can improve the treatment efficiency of PCP,and there is no significant difference in safety.

关 键 词：卡泊芬净 复方磺胺甲恶唑 肺孢子虫肺炎 疗效 安全性 

分 类 号：R978.1[医药卫生—药品]