复发性生殖器疱疹阿昔洛韦抑制疗法撤药后疗效的系统评价

Efficacy of Oral Acyclovir for Recurring Genital Herpes after Discontinuation of Suppressive Therapy: A Systematic Review

目的对抑制疗法治疗复发性生殖器疱疹患者在撤药后的疗效进行系统评价。方法检索Pubmed,Embase,Cochrane图书馆和中国生物医学文献数据库,纳入抑制疗法与安慰剂和/或间歇疗法作对照治疗频繁复发的生殖器疱疹的随机试验。对纳入文献进行方法学质量评估,采用RevMan5.2对撤药后的风险比及复发频率进行Meta分析。结果纳入的3个随机对照试验均为阿昔洛韦与安慰剂对照,共纳入了1 349例患者,随访对象仅有273例。研究的方法学质量均不高,亚组分析评估风险比未发现两组差异存在显著的统计学意义,撤药后的平均复发频率差异也无统计学意义(P=0.30)。结论与安慰剂相比,阿昔洛韦抑制疗法不能显著减少生殖器疱疹频繁复发者在撤药后的复发频率,对疾病的自然病程可能没有显著影响。

Objective To assess the efficacy of oral antiviral drugs after discontinuation of suppressive therapy for patients with frequently recurring genital herpes. Methods Databases including Pubmed, Embase, Cochrane Library and CBM were searched and randomized controlled trials comparing suppression therapy with placebo were included. Methodological quality was evaluated for each included study and meta-analysis was performed. Results Three randomized controlled trials with low methodological quality were included. One thousand three hundred and forty-nine participants were enrolled and 273 were followed up after therapy. There were no significant differences between acyclovir suppression therapy and placebo on the hazard ratio and recurrence frequency after the medication was discontinued. Conclusion Oral acyclovir could not decrease the frequency of recurrent genital herpes after withdrawal of suppressive treatment and would not influence the long-term natural history of the disease.