目的 系统评价棘白菌素类抗真菌药在儿童侵袭性念珠菌感染中的有效性与安全性。方法 检索有关数据库,纳入相关随机对照试验(randomized controlled trial, RCT)。检索时间截至2018年9月。按纳入与排除标准筛选文献、提取资料并评价纳入研究的方法学质量后,采用Rev Man 5.3软件进行Meta分析。结果 5项RCT纳入分析,包括1 190例患儿,试验组598例,对照组592例。试验组患者使用的药物包括卡泊芬净和米卡芬净,对照组患者使用氟康唑、两性霉素B脂质体和两性霉素B脱氧胆酸盐。Meta分析结果显示,试验组和对照组药物在儿童侵袭性念珠菌感染治疗的整体有效性存在统计学差异。亚组分析显示,卡泊芬净和米卡芬净在整体有效性上与对照组相比均存在统计学差异;在经验治疗亚组中,试验组与对照组的整体有效性存在显著性差异。安全性结局方面,试验组和对照组在儿童侵袭性念珠菌感染治疗后因ADR停药发生率存在统计学差异。亚组分析显示,卡泊芬净在整体不良事件发生率上与对照组存在有效性差异。结论 根据目前相关研究,棘白菌素类在儿童侵袭性念珠菌感染中应用的有效性和安全性优于氟康唑和/或两性霉素B。
Abstract
OBJECTIVE To review systematically the efficacy and safety of echinocandins to invasive candidiasis in pediatric patients. METHODS Databases including multiple databases were searched electronically for randomized controlled trials (RCTs) of echinocandins to invasive candidiasis in pediatric patients up to September 2018. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using Rev Man 5.3 software. RESULTS A total of 5 RCTs involving 1 190 patients were included. There were 598 patients in the echinocandins group and 592 patients in the control group. Micafungin and caspofungin were retrieved. Fluconazole, and amphotericin B liposome and amphotericin B deoxycholate were used to treat the patient in control group. The results of Meta-analysis showed that there was significant difference between experimental group and control group on the overall effectiveness . Subgroup analysis showed that there were significant difference between caspofungin and control group , also between micafungin and control group . There was significant difference between echinocandins and control group on the subgroup analysis of empiric therapy . There were significant difference between experimental group and control group on the discontinuation due to adverse events . Subgroup analysis showed that there was significant difference between caspofungin and control group . CONCLUSION According to recent analysis, the efficacy and safety of echinocandins in children with invasive candidiasis infections is superior to fluconazole and/or amphotericin B.
关键词
棘白菌素 /
侵袭性念珠菌感染 /
儿童 /
Meta分析 /
随机对照试验
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Key words
echinocandin /
invasive candidiasis /
children /
Meta-analysis /
randomized controlled trial
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中图分类号：
R969.3
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参考文献
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