头孢曲松对比青霉素治疗梅毒患者快速血浆/清反应素试验转阴率的Meta分析

Meta analysis of negative conversion rate of serum RPR in syphilis patients treated with ceftriaxone versus penicillin

目的系统评价头孢曲松对比青霉素治疗梅毒的疗效。方法制定检索策略,对7个在线数据库(PubMed、Web of science、Embase、Cochrane图书馆、CNKI、万方、维普)进行全面检索。建立纳入标准,纳入头孢曲松治疗梅毒的随机对照实验(RCT)研究。使用Newcastle-Ottawa量表(the newcastle-ottawa scale,NOS)评估纳入文献的质量,使用RevMan5.3软件计算治疗后快速血浆/清反应素试验(RPR)转阴率的相对危险度(RR)。结果经筛选纳入16个RCT研究文献,包括1410例梅毒患者(头孢曲松组672例,青霉素组738例)。经Meta分析,头孢曲松与青霉素治疗后梅毒患者血清RPR转阴率无统计学意义(RR=1.04,95%CI为1.0~1.08,I^(2)=56%,P=0.07);按随访时间进行亚组分析,治疗后3个月头孢曲松组患者RPR转阴率高于青霉素组(RR=1.44,95%CI为1.03~2.01,I^(2)=73%,P=0.03);治疗后6个月P值处于临界值(RR=1.18,95%CI为1.00~1.40,I^(2)=66%,P=0.05),需要更大样本量的验证;治疗后12个月两组差异无统计学意义(RR=1.02,95%CI为0.97~1.07,I^(2)=48%,P=0.50)。结论与青霉素相比,头孢曲松能更快促进梅毒患者血清RPR转阴;治疗后12个月,两者对血清RPR转阴率的影响无统计学差异。

Objective To systematically review the treatment results of syphilis with ceftriaxone versus penicillin.Methods A comprehensive search strategy was developed for 7 online databases(PubMed,web of science,EMBASE,Cochrane Library,CNKI,Wanfang and VIP).The inclusion criteria were established,and the RCTs of ceftriaxone in the treatment of syphilis were included.The Newcastle Ottawa scale(NOS)was used to evaluate the quality of the study,and Revman 5.3 software was used to calculate the rate ratio(RR)of RPR negative conversion rate after treatment.Results Sixteen RCTs were included,consisting of1410 syphilis patients(There were 672 cases in ceftriaxone group and 738 cases in penicillin group).Meta analysis showed that there was no significant difference between ceftriaxone and benzathine penicillin/procaine penicillin in seroconversion rate of syphilis RPR[RR=1.04,95%CI(1.0-1.08),I^(2)=56%,P=0.07];According to the follow-up time,the negative rate of RPR in ceftriaxone group was higher than that in penicillin group after 3 months treatment[RR=1.44,95%CI(1.03-2.01),I^(2)=73%,P=0.03];after 6 months treatment[RR=1.18,95%CI(1.00-1.40),I^(2)=66%,P=0.05],P value was at the critical value,which needed to be verified by a larger sample size;after 12 months treatment[RR=1.02,95%CI(0.97-1.07),I^(2)=48],there was no significant difference between the two groups.Conclusion Compared with penicillin,ceftriaxone can accelerate the seroconversion of RPR in syphilis patients;after 12 months of treatment,and there is no significant difference in the seroconversion rate of RPR between ceftriaxone and penicillin.