2种碳氢酶烯类抗生素对粒缺肿瘤患者伴感染治疗的Meta分析

The treatment of two kinds of carbapenem antibiotics for neutropenia and infection in tumor patients: A systematic review

目的系统评价美罗培南与亚胺培南在肿瘤患者中性粒细胞缺乏伴发热治疗中的有效性及安全性。方法采用Cochrane系统评价方法,检索1985—2013年5月之间MEDLINE、EMbase、CBM、CNKI、VIP等电子数据库发表的美罗培南与亚胺培南治疗肿瘤患者中性粒细胞缺乏伴发热研究的随机对照试验(RCT)文献。由2名评价员独立评价并交叉核对纳入研究质量,方法学评估采用Jadad评分,用于评估各个研究的质量;对符合纳入标准的研究,使用Revman5.0与Stata10.0软件进行Meta分析,采用Egger's test及Begg's test评价发表偏倚。结果共纳入6个RCT临床研究,总计409例患者,Meta分析结果显示,其临床治愈率、临床有效率、细菌清除率以及不良反应发生率,在美罗培南与亚胺培南之间均没有表现出显著性差异(P>0.05),Egger's test及Begg's test没有显示发表偏倚(P>0.05)。仅在不良反应中,亚胺培南神经系统不良反应发生率较美罗培南高。结论美罗培南与亚胺培南在肿瘤患者中性粒细胞缺乏伴发感染的治疗中其有效性与安全性是一致的。

Objective To evalulate the efficiency and safety of two kinds ofcarbapenem antibiotics meropenem and imipenem in the treatment of tumor with neutropenia and infection.Methods According to the method of cochrane systematic review,the MEDLINE,EMBase,CBM,CNKI,and VIP databases were searched to collect all randomized control trials （RCTs） involving the treatment of neutropenia and infection in tumor patients by meropenem or imipenem between 1985 and 2009.Two reviewers evaluated the quality of included trials independently by using the Jadad-scale criterion.The cochrane collaboration＇s sottware RevMan 5.0 and the Stata10.0 software were used for meta-analyses.The Egger＇s test and Begg＇s test were used to evaluate the publication bias.Results Under the Meta analysis of 6 RCTs,the clinical cure rate,clinical effective rate,bacterial eradication rate,and adverse reaction rate did not exhibit significant statistic difference between the domestic meropenem and imipenem （P〉0.05）.The results of Egger＇s test or Begg＇s test revealed that no significant publication bias was found （P〉0.05）.Only in the nervous system,the incidence of adverse reactions is higher in imipenem than meropenem.Conclusion The meropenem was effective and safe in the therapy of neutropenia and infection in tumor patients with imipenem.