多黏菌素治疗耐药革兰氏阴性菌感染致肾毒性的Meta分析  

Nephrotoxicity caused by polymyxin in the treatment of drug-resistant Gram-negative bacterial infections: a meta-analysis

作　　者：王晓洁 董志强 董媛[1] 张春霞[1] 武婧[1] 陈晨[1] WANG Xiaojie;DONG Zhiqiang;DONG Yuan;ZHANG Chunxia;WU Jing;CHEN Chen(Dept.of Pharmaceutical Clinical Research,the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science&Technology,Inner Mongolian Baotou 014010,China;Dept.of Pharmacy,Baotou Eighth Hospital,Inner Mongolian Baotou 014040,China)

机构地区：[1]内蒙古科技大学包头医学院第一附属医院药物临床研究室,内蒙古包头014010 [2]包头市第八医院药剂科,内蒙古包头014040

出　　处：《中国药房》2023年第22期2793-2799,共7页China Pharmacy

基　　金：内蒙古自治区卫生健康科技计划项目(No.202201414);北京医学科学研究基金项目(No.YWJKJJHKYJJ-TYU108F);包头医学院科学研究基金项目(No.BYJJ-QWB202228)。

摘　　要：目的评价耐药革兰氏阴性菌感染患者使用多黏菌素后的肾毒性发生情况,为临床用药提供循证参考。方法计算机检索PubMed、Embase、Web of Science、the Cochrane Library、万方数据、中国知网、维普网和中国生物医学数据库,收集多黏菌素(试验组)对比其他抗菌药物(对照组)或者多黏菌素B(试验组)对比多黏菌素E(对照组)的随机对照试验(RCT)或队列研究,筛选文献、提取数据和质量评价后,采用RevMan 5.4.1软件进行Meta分析。结果共纳入37项研究,其中4篇RCT、33篇队列研究,共计5871例患者。Meta分析结果显示,RCT[RR=2.64,95%CI(1.43,4.87),P=0.002]和队列研究[RR=1.59,95%CI(1.27,1.98),P<0.0001]中,试验组患者的肾毒性发生率均显著高于对照组。队列研究亚组分析结果显示,试验组中使用多黏菌素患者的肾毒性发生率显著高于对照组中使用新型β-内酰胺及其酶抑制剂类药物、替加环素的患者;使用改善全球肾脏病预后组织指南标准、肾脏替代治疗标准、血肌酐升高0.5倍标准时,试验组患者的肾毒性发生率亦显著高于对照组(P<0.05)。使用多黏菌素E患者的肾毒性发生率显著高于使用多黏菌素B患者[RR=0.57,95%CI(0.39,0.84),P=0.005]。结论在耐药革兰氏阴性菌感染的治疗中,多黏菌素的肾毒性发生率较高,且多黏菌素E高于多黏菌素B。OBJECTIVE To evaluate the incidence of nephrotoxicity in patients with drug-resistant Gram-negative bacterial infections after the use of polymyxin,and to provide evidence-based reference for clinical rational drug use.METHODS PubMed,Embase,Web of Science,the Cochrane Library,Wanfang database,CNKI,VIP and SinoMed were searched to collect randomized controlled trials(RCTs)or cohort studies about the polymyxin(trial group)versus other antibiotics(control group)or polymyxin B(trial group)versus polymyxin E(control group).After literature screening,data extraction and quality evaluation,RevMan 5.4.1 software was used for meta-analysis.RESULTS A total of 37 studies were included,including 4 RCTs and 33 cohort studies,with a total of 5871 patients.The meta-analysis results showed that in RCT[RR=2.64,95%CI(1.43,4.87),P=0.002]and in cohort studies[RR=1.59,95%CI(1.27,1.98),P<0.0001],the incidence of nephrotoxicity in the trial group was significantly higher than control group.The results of the subgroup analysis of cohort studies showed that the incidence of nephrotoxicity in the trial group(receiving polymyxin)was significantly higher than control group(receiving newβ-lactam andβ-lactamase inhibitors and tigecycline);when Kidney Disease Improving Global Outcomes(KDIGO),renal replacement therapy or 0.5 times increase in serum creatinine were used as the standard of nephrotoxicity,the incidence of nephrotoxicity in the trial group was significantly higher than the control group(P<0.05).The incidence of nephrotoxicity in patients receiving polymyxin E was significantly higher than those using polymyxin B[RR=0.57,95%CI(0.39,0.84),P=0.005].CONCLUSIONS In the treatment of drug-resistant Gram-negative bacteria infections,the incidence of nephrotoxicity caused by polymyxin is relatively high.The incidence of nephrotoxicity caused by polymyxin E is higher than polymyxin B.

关 键 词：多黏菌素 肾毒性 耐药革兰氏阴性菌 感染 

分 类 号：R978.16[医药卫生—药品]