单用氟喹诺酮类药物对比β-内酰胺类联用大环内酯类药物治疗社区获得性肺炎的有效性和安全性的系统评价

Systematic Review of Therapeutic Efficacy and Safety of Fluoroquinolone Alone and β-lactam Combined with Macrolide for Community-acquired Pneumonia

目的:系统评价单用氟喹诺酮类药物对比β-内酰胺类联用大环内酯类药物治疗社区获得性肺炎(CAP)的有效性和安全性。方法:计算机检索中国期刊全文数据库、中文科技期刊全文数据库、万方数字化期刊全文数据库、中国生物医学文献数据库、PubMed等数据库,纳入单用氟喹诺酮类药物(试验组)与β-内酰胺类联用大环内酯类(对照组)比较治疗CAP的随机对照试验(RCT),按纳入及排除标准评价文献质量和提取有效数据,采用Rev Man 5.0统计学软件进行Meta分析。结果:共纳入15项RCT,合计1 704例患者。Meta分析结果显示,试验组与对照组患者的临床有效率[OR=1.26,95%CI(0.89,1.78),P=0.19]、细菌清除率[OR=1.52,95%CI(0.86,2.70),P=0.15]、不良反应发生率[OR=1.01,95%CI(0.71,1.45),P=0.94]、用药疗程[MD=-1.07,95%CI(-2.22,0.08),P=0.07]、咳嗽与咳痰消失时间[MD=-0.10,95%CI(-1.19,0.99),P=0.85]和肺部啰音消失时间[MD=-0.21,95%CI(-0.90,0.48),P=0.55]比较差异均无统计学意义;试验组患者的退热时间[MD=-1.10,95%CI(-1.71,-0.48),P<0.01]优于对照组患者,两组比较差异有统计学意义。结论:单用氟喹诺酮类药物治疗CAP的有效性和安全性与β-内酰胺类联用大环内酯类药物相当,但退热时间更短。

OBJECTIVE： To evaluate therapeutic efficacy and safety of fluoroquinolone alone and β-lactam combined with mac- rolide for community-acquired pneumonia （CAP）. METHODS： Retrieved from CNKI, VIP Database, Wanfang Database, CBM, PubMed, RCT about fluoroquinolone alone （trial group） and β-lactam combined with macrolide （control group） for CAP were in- eluded, the quality of the literature was evaluated and valid data was extracted according to inclusion and exclusion criteria, and Rev Man 5.0 software was adopted for Meta-analysis. RESULTS： A total of 15 RCT were included, involving 1 704 patients. Me- ta-analysis showed clinical efficacy [OR=1.26, 95%CI（0.89, 1.78）, P=0.19], bacterial clearance rate [OR=1.52, 95%CI（0.86, 2.70）, P=0.15], the incidence of ADR [OR=1.01, 95%CI（0.71,1.45）, P=0.94], treatment course [MD=-1.07, 95%CI（-2.22, 0.08）, P=0.07], cough and sputum disappearance time [MD =- 0.10 , 95% CI （-1.19, 0.99）, P=0.85] and pulmonary rales dis- appearance time [MD=-0.21, 95% CI （-0.90,0.48）, P=0.55] of 2 groups had no statistical difference. The cooling time of trial group [MD=1.10, 95% CI （- 1.71, -0.48）, P〈0.01] was better than control group; there was statistical significance. CONCLUSIONS： Fluoroquinolone alone has same therapeutic efficacy and safety to β-lactam combined with macrolide for CAP, but shows better cooling effect.