利奈唑胺对比糖肽类抗菌药物治疗MRSA相关性院内获得性肺炎的疗效和安全性的Meta分析

A Meta-analysis of Therapeutic Efficacy and Safety of Linezolid vs. Glycopeptide Antibiotic in the Treatment of MRSA Relative Nosocomial Pneumonia

目的:系统评价利奈唑胺对比糖肽类抗菌药物治疗耐甲氧西林金黄色葡萄球菌(MRSA)相关性院内获得性肺炎的疗效和安全性。方法:计算机检索Medline、EMBase、OVID、中国生物医学文献数据库、中国期刊全文数据库、维普及万方数据库,查找利奈唑胺对比糖肽类抗菌药物治疗MRSA相关性院内获得性肺炎的随机对照试验(RCT)。对符合条件的RCT进行资料提取和质量评价后,采用Rev Man 5.1统计软件进行Meta分析。结果:共纳入8项RCT,合计1 966例患者。Meta分析结果显示,利奈唑胺治疗MRSA相关性院内获得性肺炎的临床治愈率[RR=1.10,95%CI(1.01,1.20),P=0.03]、微生物清除率[RR=1.14,95%CI(1.03,1.27),P=0.01]均高于糖肽类抗菌药物;而两者的病死率[RR=0.86,95%CI(0.68,1.08),P=0.20]和不良反应发生率[RR=1.05,95%CI(0.94,1.16),P=0.41]比较差异无统计学意义。结论:利奈唑胺较糖肽类抗菌药物治疗MRSA相关性院内获得性肺炎可以提高患者的临床治愈率和微生物清除率,但是不能改善患者病死率及不良反应发生率。限于研究的设计及报告质量,该结论仍有进一步评价的必要。

OBJECTIVE： To evaluate therapeutic efficacy and safety of linezolid vs. glycopeptide antibiotic in the treatment of MRSA related nosocomial pneumonia systematically. METHODS： Randomized controlled trials （RCTs） about linezolid vs. glyco peptide antibiotic in the treatment of MRSA relative nosocomial pneumonia were searched from Medline, EMBase, OVID, CBM, CNKI, VIP and WanFang datebase. The quality of included RCTs were evaluated and the data were extracted. Meta-analysis was performed with Rev Man 5.1 software. RESULTS： 8 RCTs were included, involving 1 966 patients. Meta-analysis showed that clinical cure rate [RR= 1.10, 95%CI（1.01,1.20）, P=0.03] and microbial clearance rate [RR= 1.14,95%CI（1.03,1.27）, P=0.01] of linezolid group were significantly higher than those of glycopeptide antibiotic group; but there were no significant differences in mortality [RR=0.86, 95%CI（0.68, 1.08）, P=0.20] and the incidence ofADR [RR=1.05, 95%CI（0.94, 1.16）, P=0.41] . CONCLUSIONS： Compared with glycopeptide antibiotics, linezolid can improve clinical cure rate and microbial clearance rate in patients with MRSA related nosocomial pneumonia; but has no effect on the mortality and the incidence of ADR. Due to small-scale and low quality of included studies, more large-scale and high quality RCTs are required for the validation of the conclusion.