更昔洛韦治疗传染性单核细胞增多症有效性的Meta分析

Efficacy of Ganciclovir in the Treatment of Infectious Mononucleosis: A Meta -Analysis

目的：应用Meta分析法对国内、外已发表和未发表的有关传染性单核细胞增多症（IM）急性期应用更昔洛韦与传统抗病毒药的随机对照试验（RCT）进行综合定量分析，为应用更昔洛韦提高IM治疗有效率提供参考依据。方法：以更昔洛韦、IM为主题词，通过电子检索Medline（1963—2007．12）、OVID数据库（1993-2007．12）、Springer数据库（1994—2007．12）和中国期刊全文数据库（1994—2007．12）等，同时辅以手工检索包括会议资料和学位论文。尽可能全面收集IM急性期应用更昔洛韦治疗的RCT，对符合要求的文献进行质量评估，应用Review Manager4．2．8统计软件，对文献结果进行合并统计分析，计算治疗组相对于对照组显效率的优势比（OR），评价应用更昔洛韦是否能提高IM的治疗效果。结果：本次评价中共纳入8篇RCT。在IM急性期治疗中。更昔洛韦与病毒唑比较的Meta分析结果显示：OR=0．16，95％CI：0．09～0．26，提示更昔洛韦治疗的有效率高于病毒唑治疗（P〈0．01）。更昔洛韦与干扰素比较的Meta分析结果显示：OR=0．34．95％CI：0．21～0．57，提示更昔洛韦治疗的有效率高于干扰素治疗（P〈0．01）。结论：急性期应用更昔洛韦有能够提高IM治疗有效率的趋势。可靠结论尚需大样本、多中心、设计良好的RCT进一步验证。

Objective： To perform a meta-analysis of all retrieved data from ublished or unpublished randomized controlled trials （RCT） worldwide, which compares the efficacy of early administration of Ganciclovir （GCV） and traditional anti-viral agents in patients with infectious mononucleosis （IM）, and to provide evidences for improved outcomes of IM with GCV therapy. Methods：Target papers were retrieved in Medline （1963 through Dec 2007）, OVID database （1993 through Dec 2007）, Springer （1994 through Dec 2007）, CNKI database （1994 through Dec 2007） using keywords ＂Ganciclovir （GCV）＂ and ＂infectious mononucleosis （IM）＂. For inclusion of GCV-based RCT of acute IM therapy as many as possible, relevant papers were manually obtained from a collection of meeting proceedings and these. All eligible papers were evaluated for their quality strictly according to Jadad Standard, and only those with high quality were included in Meta-analysis. Review Manager 4.2.8 software was used to analyze the data input. We calculated the odds ratio （OR） for GCV＇s advantage over control therapy to see whether GCV was associated with improved outcomes for IM. Results： Totally 8 studies were analyzed. For early management of IM, meta-analysis showed an OR of 0.16 （95% CI： 0.09-0.26） favoring GVC over Virazole （P〈0.01）, and an OR of 0.34 （95% Ch 0.21-0.57） favoring GVC over IFN （P〈0.01）. Conclusion： Early use of GCV in IM tends to be associated with improving efficacy, although large-scale, multi-center, well-designed RCTs are warranted to make this finding conclusive.