抗病毒药物治疗病毒性呼吸道感染的循证评价(一)  

Evidence based evaluation of anti-virus medicines for virosis communicable respiratory disease

作　　者：蔡羽嘉[1] 孙鑫[2] 李幼平[1,3] 徐娟[4] 唐光敏[4] 马涛[4] 李夏[4] 卢军[4] 

机构地区：[1]四川大学华西医院中国循证医学中心 [2]四川大学华西医院卫生部移植工程与移植免疫重点实验室 [3]通讯作者 [4]四川大学华西医院临床医学,成都610041

出　　处：《中国循证医学杂志》2003年第2期121-127,共7页Chinese Journal of Evidence-based Medicine

基　　金：美国纽约中华医学会基金资助~~

摘　　要：目的　对抗病毒药物治疗病毒性呼吸道传染疾病的临床有效性、安全性和卫生经济学进行循证评价。方法　检索CL(2 0 0 3Issue 1)、Medline(196 6 - 2 0 0 35 )、CCOHTA、SBU、NICE、NCCHTA。收集所有关于抗病毒药物治疗病毒性呼吸道传染疾病的CSR和HTA ,评价研究质量 ,综合分析现有证据。若数据间无明显异质性 ,则进行数据合并。结果　纳入 4个CSRs(38RCT ,n =2 2 835 ) ,5个HTA(2 8RCT ,n =1392 81)。但由于纳入的文献存在明显异质性 ,无法进行数据合并 ,仅作描述性分析。结论　 1 神经氨酸苷酶抑制剂 (扎拉米韦和奥塞米韦vs安慰剂 )能有效缩短有基础疾病患者的症状持续时间 ,对无基础疾病患者疗效有限。对所有人群均有良好的流感预防作用 ,且耐受性良好。但其防治成本太高 ,不宜作为流感治疗的首选药。 2 金刚烷类较安慰剂能有效缩短发热时间 ,对甲型流感有良好预防作用。金刚烷胺和金刚乙烷的预防有效性相当 ,但金刚乙烷副作用比金刚烷胺少。 3 关于利巴韦林预防和治疗小儿上呼吸道感染的RCT病例数太少 ,目前无法作出判断。Objectives Re-evaluation the clinical evidence of. anti-virus medicines for virosis communicable respiratory disease on the effectiveness, safety and health economy.Methods To search CL (2003 Issue 1), Medline (1966-2003 5), CCOHTA, SBU, NICE and NCCHTA and collect all CSRs and HTA with computer .The quality of evaluation partly based on QUOROM will be done before results analysed. If heterogeneity does not exist in CSRs and HTA,. a Meta-analysis will be re-conducted. Results 4 CSRs (38 RCT, n=22835) and 5 HTA (28 RCT, n=139281) were included. Due to the significant heterogeneity between these studies, further Meta-analysis could not be conducted, and descri ptive conclusions were conducted only. Conclusions Neuraminidase inhibitors (zanamivir and oseltamivir) are more effective than placebo in reducing the duration of symptoms of patients with basic disease,and have limited effectiveness in health adults. But, both are well tolerated and reduce the rate of contracting influenza in all individuals. For prevention, neuraminidase inhibitors cost more and are not suitable as first-line drug.2. Diamantane is more effective than placebo in reducing the duration of having fever, and effectively prevents the influenza A. Amantadine and rimantadine have comparable effectiveness in the prevention, although rimantadine induces fewer adverse effects than amantadine. 3. The number of the children patients of upper respiratory tract infection prevented and treated by ribavirin is too small to draw any conculsion now.

关 键 词：抗病毒药物 治疗 病毒性呼吸道感染 有效性 安全性 卫生经济学 循证医学 系统评价 

分 类 号：R56[医药卫生—呼吸系统]