摘要
目的 评价早期应用两性霉素B联合氟胞嘧啶或两性霉素B联合氟康唑对艾滋病相关隐球菌脑膜炎生存率的影响.方法 采用国际循证医学协作组织（Cochrane）系统综述方法,计算机检索范围包括Cochrane图书馆、美国国家医学数据库（PubMed）、美国Ovid数据库、荷兰医学文摘数据库（Embase）、万方数据库、中国知网（CNKI）全文数据库、中国生物医学文献数据库等,辅以文献追述和手工检索,对相关的参考文献严格按照文献纳入、剔除标准进行筛选,检索年限从上述数据库建库至2013年10月;采用系统评价管理和分析软件（RevMan 5.2版）进行Meta分析.结果 纳入4项前瞻性对照试验,共有隐球菌脑膜炎患者399例,其中艾滋病相关隐球菌脑膜炎患者386例,非艾滋病相关隐球菌脑膜炎患者13例.两性霉素B联合氟胞嘧啶治疗227例,其中艾滋病相关隐球菌脑膜炎患者217例,非艾滋病相关隐球菌脑膜炎患者10例.两性霉素B联合氟康唑治疗172例,其中艾滋病相关隐球菌脑膜炎患者169例,非艾滋病相关隐球菌脑膜炎患者3例.两性霉素B联合氟胞嘧啶治疗组的2周病死率为6.6％（95％CI：-18.5％～31.6％）,低于两性霉素B联合氟康唑治疗组的19.7％ （95％CI：-23.6％～62.9％）,差异有统计学意义（OR=0.51,95％CI：0.27～0.93,P＜0.05）.两性霉素B联合氟胞嘧啶治疗组的10周病死率为12.9％（95％CI：-22.2％～48.0％）,低于两性霉素B联合氟康唑治疗组的31.4％（95％CI：-23.1％～85.9％）,但差异无统计学意义（OR=0.70,95％CI：0.44～1.13,P=0.15）.结论 早期应用两性霉素B联合氟胞嘧啶治疗可减少艾滋病相关隐球菌脑膜炎患者的病死率.
Objective To evaluate the survival benefit of amphotericin B （AmB） plus flucytosine or fluconazole for treatment of patients with acquired immunodeficiency syndrome （AIDS）-associated cryptococcal meningitis.Methods The following database were searched from the beginning to October 2013,including Cochrane library,PubMed,OVID,Embase,Wanfang Date,CNKI and Chinese Biomedical Database,and the references of eligible studies were manually screened.Reference lists of relevant articles were screened according to selection and extraction criteria.Meta-analysis was performed using RevMan 5.2.Results Four prospective controlled studies with a total of 399 patients with cryptococcal meningitis were identified,including 386 patients with AIDS-associated cryptococcal meningitis and 13 human immunodeficiency virus （HIV）-negative patients.Two hundred and twentyseven patients were treated with AmB and flucytosine combination therapy,including 217 patients with AIDS-associated cryptococcal meningitis and 10 HIV-negative patients.One hundred and seventy-two patients were treated with AmB and fluconazole combination therapy,including 169 patients with AIDS-associated cryptococcal meningitis and 3 HIV-negative patients.The Meta-analysis revealed that the mortality rate in AmB plus flucytosine combination therapy group was 6.6％ （95％ CI：18.5％-31.6 ％） at two weeks point,which was significantly lower than that in AmB plus fluconazole combination group （19.7％,95％CI：-23.6％-62.9％; OR=0.51,95％CI：0.27-0.93,P＜0.05）.But at 10 weeks point,the mortality rate in flucytosine combination group was 12.9％ （95％oo CI：-22.2％-48.0％）,which was lower than that in fluconazole combination group （31.4％,95％ CI：-23.1％-85.9 ％）.However,there was no statistically significant difference between these two groups at 10 weeks point （OR=0.70,95％CI：0.44-1.13,P=0.15）.Conclusion Administration of AmB plus flucytosine at early stage can reduce the mortality rate in patients with AIDS-associated cryptococcal meningitis.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2014年第6期353-356,共4页
Chinese Journal of Infectious Diseases
