经验性抗真菌治疗血液病恶性肿瘤患者侵袭性真菌感染的Meta分析

Meta-analysis of Empirical Therapy for Haematological Malignancies Patients with Invasive Fungal Infection

目的:系统评价经验性抗真菌治疗血液病恶性肿瘤患者的疗效和安全性。方法:系统性回顾随机、安慰剂或空白对照抗真菌经验性治疗的随机对照试验,采用Cochrane协作网提供的RevMan5.0进行数据分析。主要临床结局为全因死亡率和侵袭性真菌感染,汇总分析95%置信区间的相对危险度(RR)。所有研究均为血液病恶性肿瘤患者。结果:共纳入7个RCT(包括6个经验性治疗与空白组或安慰剂组对照的研究和1个经验性治疗与抢先治疗的对照研究),Meta分析结果显示经验性治疗未明显减少[RR=0.82,95%CI(0.50～1.34)]死亡率,但明显降低侵袭性真菌感染的发生[RR=0.25,95%CI(0.12～0.54)]。经验性治疗组的不良反应没有明显增多。结论:目前的有限证据表明,经验性抗真菌治疗与降低侵袭性真菌感染发生率有关,但对总体死亡率无明显影响。

Objective： To evaluate the efficacy and safety of empirical therapy in haematological malignancies hemopathic cancer patients with invasive fungal infection. Me, hods： Systematic review and meta-analysis of randomized controlled trials comparing empirical therapy with placebo or no intervention. Data were analyzed using RevMan4.2 provided by the Cochrane Center. The primary outcomes were all-cause mortality and invasive fungal infections （IFI）. Relative risks （RR） with 95% confidence intervals （CI） were pooled. All trials included patients with haematological malignancies. Results： Seven RCTs were included. （Six trials assessed the efficacy of empirical treatment compared to no treatment or placebo and one trial compared empirical to preemptive therapy.） Empirical treatment did not decrease mortality significantly[RR=0.82, 95% CI（0.50~1.34）], but significantly decreased IFIs [（RR=0.25, 95% CI （0.12-0.54）]. Adverse effect did not increase in empirical treatment group. Conclusion： The current limited evidence suggested that empirical antifungal treatment was associated with a lower rate of IFIs but no significant difference in overall mortality.