单一咪康唑与联合乳酸杆菌活菌制剂治疗单纯性外阴阴道念珠菌病效果的系统评价

Miconazole versus Miconazole plus Living Preparation of Lactobacillus for Vulvovaginal Candidiasis:A Systematic Review

目的比较单一咪康唑和联合乳酸杆菌活菌制剂治疗单纯性外阴阴道念珠菌病(VVC)的疗效。方法电子检索Cochrane图书馆(2008年第4期)、MEDLINE(1966～2009年1月)、PubMed(1966～2009年1月)、中国生物医学文献数据库(CBMdisc1966～2009年1月)、CNK(I1966～2009年1月)、VIP数据库(1966～2009年1月),纳入单一硝酸咪康唑与硝酸咪康唑联合乳酸杆菌活菌制剂比较,治疗单纯性VVC的随机对照试验(RCT)。按Cochrane Handbook 4.2.2手册对合格的RCT进行质量评价,利用RevMan5软件进行统计分析。结果最终纳入8个RCT,包括5156例患者。按联合用药起用咪康唑时间不同分为两个亚组,亚组结果均显示单纯咪康唑和联合乳酸杆菌活菌制剂用药治疗单纯性VVC的疗效更优[RR=0.96,95%CI(0.92,1.00),Z=2.12,P=0.03;RR=0.92,95%CI(0.85,0.99),Z=2.17,P=0.03]。联合乳酸杆菌活菌制剂用药组的VVC复发率优于单用咪康唑组[RR=3.72,95%CI(1.94,7.13),Z=3.97,P<0.0001;RR=12.85,95%CI(8.27,19.96),Z=11.37,P<0.00001]。结论现有研究结果显示,与单用硝酸咪康唑相比,联合乳酸杆菌制剂用药效果更优,且复发率联合用药组更低。

Objective To analyze the effects and recurrence rate of single miconazole and the miconazole plus living preparation of lactobacillus for the treatment of the uncomplicated vulvovaginal candidiasis. Methods We searched the Cochrane Central Register of Controlled Trials （CENTRAL） （The Cochrane Library Issue 4, 2008） MEDLINE （1966 to January 2009）; PubMed （1966 to January 2009）; EMbase （1966 to January 2009）; CNKI （1966 to January 2009）, and the Chinese Biomedicine Database （CBM） （1966 to January 2009） to identify randomized controlled trials of single miconazole versus the miconazole plus living preparation of lactobacillus.The quality of the included trials was assessed, RevMan 5 software was used to conduct meta-analysis. Results Eight trials involving 5 156 patients were included in the effect analysis. Meta-analysis showed miconazole plus with living preparation of lactobacillus was better compared with just miconazole （RR=0.96, 95%CI 0.92 to 1.00, Z=2.12, P=0.03; RR=0.92, 95%CI 0.85 to 0.99, Z=2.17, P=0.03）.Seven trials involving 4 852 patients were included in recurrence rate analysis. Meta-analysis showed miconazole plus living preparation oflactobacillus had lower recurrence rate compared with single miconazole （RR=3.72, 95%CI 1.94 to 7.13, Z=3.97, P〈0.000 1; RR=12.85, 95%CI 8.27 to 19.96, Z=1 1.37, P〈0.000 01）. Conclusion Currently available evidence shows that the effect in the combined group is better, and the recurrence rate is lower.