利奈唑胺和万古霉素对耐甲氧西林金葡菌感染治疗效果的meta分析

Linezolid versus vancomycin for methicillin resistant Staphylococcus aureus infections:A meta analysis

目的采用meta分析法对现已发表的利奈唑胺和万古霉素治疗MRSA的文献进行综合分析,判断利奈唑胺是否可以替代万古霉素治疗MRSA。方法全面收集有关利奈唑胺与万古霉素治疗MRSA的研究资料,共入选7篇完全随机对照研究文献,3420例受试病例随机分为利奈唑胺组和万古霉素组,可供分析病例888例,利用RewMan软件对临床治愈率和微生物清除率进行固定效应模型和随机效应模型的meta分析,漏斗图分析发表性偏倚。结果异质性检验采用χ2检验,临床治愈率比较,χ2=9.35,P=0.1,大于0.05;微生物清除率比较,χ2=18.39,P=0.005,P<0.05。合并效应量的估计:临床治愈率OR合并=2.48(1.68～3.64,Z=4.60,P<0.00001);细菌清除率OR合并=2.68(1.29～5.57Z=2.63,P=0.008)。结论在治疗MRSA所致的感染中,不论是临床治愈率还是细菌清除率,利奈唑胺均优于万古霉素。

Objective A meta-analysis of clinical study on cure rates and bacterial clearance rates in patients with methicillin resistant Staphylococcus aureus infections treated with linezolid vs. with those of vancomycin. Methods The data were collected from the MEDLINE database, the Cochrane library, foreign medical journal full-text service（FMJS）, and EBSCO database. Seven randomized studies comparing linezolid with vancomycin were analyzed, focusing on the 888 adults with methicillin resistant Staphylococcus aureus infections, and performing both fixed-effects and random-effects models of meta analysis with RewMan sofewear. Results Among evaluable patients with MRSA, there were a signifcant difference between the two treatment groups with respect to clinical cure rates （79.4% of patients in the linezolid group and 66. 8% in the vancomycin group, the odd ratio （OR） was 2.48, 95% CI was 1. 68 - 3.64）or bacterial clearance rates （77.9% in the linezolid group and 59.4% in the vancomycin group, OR was 2.68, 95% CI was 1.29 - 5.57）. Conclusion Effect of linezolid is better than that of vancomycin in the treatment of methicillin resistant Staphylococcus aureus infections.