利奈唑胺与万古霉素对MRSA随机对照试验的治疗效果及安全性的Meta分析

Effects and Safety of Linezolid vs.Vancomycin for the Treatment of Patients with MRSA:Meta Analysis of Randomized Controlled Trials

目的比较利奈唑胺与万古霉素对耐甲氧西林金黄色葡菌感染的治疗效果及安全性。方法计算机检索Cochrane图书馆、MEDLINE、EMbase、PUBMED、中国科技期刊全文数据库、维普电子期刊全文数据库、万方数据库等文献数据库以及手工检索相关会议的论文集,采用RevMan 5.0进行Meta分析。结果纳入研究12项,共3 405例患者。Meta分析结果示,利奈唑胺治疗组的临床生存率明显长于万古霉素对照组[OR=1.71,95%CI(1.23,2.37),P=0.002],亚组分析表明,MRSA肺炎感染治疗组也比对照组明显长[OR=1.94,95%CI(1.34,2.81),P=0.0004];临床治愈率高于万古霉素组,两者有统计学差异[OR=1.57,95%CI(1.08,2.28),P<0.05];细菌清除率高于万古霉素对照组,两者有统计学差异[OR=2.03,95%CI(1.12,3.66),P<0.05],其中亚组分析示利奈唑胺治疗皮肤及软组织感染或手术部位感染者优于万古霉素(P<0.05);而不良反应发生率,两者没有显著性差异[OR=1.10,95%CI(0.92,1.31),P(0.05]。结论利奈唑胺治疗效果优于万古霉素,安全性方面相似,肾毒性较小,在治疗危重病人或肾功能不全者可能获益更多。

OBJECTIVE To compare the effects and safety of linezolid and vancomycin for the treatment of patients with MRSA.METHODS Cochrane library,MEDLINE,Embase,PUBMED,CNKI,VIP database,Wanfang database and paper manual of related conferences were searched.Then Meta analysis were performed by RevMan 5.0.RESULTS Twelve studies were included（n=3 405）.The analysis indicated that there were significant differences between linezolid and vancomycin in survival rate[OR=1.71,95%CI（1.23,2.37）,P=0.002],especially for MRSA pneumonia[OR=1.94,95%CI（1.34,2.81）,P=0.000 4],clinical cure rate[OR=1.57,95%CI（1.08,2.28）,P0.05] and microbiological cure rate[OR=2.03,95%CI（1.12,3.66）,P0.05],especially for the SSTI or SSI.There was no significant difference between the 2 groups in the adverse event rate[OR=1.10,95%CI（0.92,1.31）,P﹥0.05].CONCLUSION With superior effects,similar safety,better tolerability and less toxicity,linezolid may be preferred for the patients with critical illness and renal dysfunction.