两性霉素B、氟康唑和伊曲康唑治疗AIDS合并马尔尼菲青霉病疗效的Meta分析

Efficacy of amphotericin B, fluconazole and itraconazole in treatment of AIDS complicated by penicilliosis marneffei: a meta-analysis

目的采用Meta分析评价两性霉素B、氟康唑与伊曲康唑对AIDS合并马尔尼菲青霉病（penicilliosis marneffei,PSM）的治疗效果。方法检索Cochrane图书馆、美国国立医学图书馆Pub Med数据库、美国Ovid数据库、荷兰医学文摘数据库、万方数据库、中国知网CNKI全文数据库和中国生物医学文献数据库,按照Cochrane协作网推荐的纳入标准筛选文献并进行质量评价,采用Stata 12.0进行Meta分析。结果纳入文献6篇,AIDS合并PSM共893例,其中两性霉素B治疗467例,氟康唑治疗152例,伊曲康唑治疗274例。Meta分析结果显示：两性霉素B治疗好转率高于氟康唑[OR=7.138（95%CI 1.761~28.932）,P〈0.05],病死率低于氟康唑[OR=0.507（95%CI 0.294~0.875）,P〈0.05],差异均具有统计学意义;两性霉素B与伊曲康唑对比,治疗好转率[OR=0.777（95%CI 0.498~1.212）,P〉0.05]和病死率[OR=1.427（95%CI 0.890~2.287）,P〉0.05]差异均无统计学意。结论两性霉素B治疗AIDS合并PSM效果优于氟康唑,与伊曲康唑比较疗效无明显差异。今后应积累更多前瞻性资料进一步证实。

Objective To evaluate the efficacy of amphotericin B, fluconazole and itraconazole in treatment of AIDS complicated by penicilliosis marneffei（PSM） with meta-analysis. Methods Cochrane Library, Pub Med, Ovid database, Embase database, Wanfang database, National Knowledge Infrastructure full-text database and China Bio Medical Literature database were searched. Literatures were selected according to the criteria recommended by Cochrane Method Group and evaluated according to the quality. Meta-analysis was performed with Stata version 12.0. Results Six papers were identified, in which a total of 893 AIDS patients with PSM were recruited, 467 patients receiving amphotericin B, 152 patients fluconazole and 274 patients itraconazole. Meta-analysis showed that patients receiving amphotericin B had a higher recovery rate [OR=7.138（95%CI 1.761-28.932）, P〈0.05] and a lower mortality rate [OR=0.507（95% CI 0.294-0.875）, P〉0.05] than patients receiving fluconazole, and the differences between the two patient groups were significant. The recovery rate [OR=0.777（95%CI 0.498-1.212）, P0.05] and mortality rate [OR=1.427（95%CI 0.890-2.287）, P〉0.05] were not significantly different between patients receiving amphotericin B and those receiving itraconazole. Conclusions Amphotericin B has a better efficacy in treatment of AIDS complicated by PSM than fluconazole, and the treatment efficacy is not significantly different between amphotericin B and itraconazole. More prospective data need to be accumulated for further verification.