抗菌药物预防克罗恩病术后复发的Meta分析

The preventive effect of antibiotics for postoperative Crohn＇s disease recurrence： a systematic review

目的 评价抗菌药物预防克罗恩病（CD）术后复发的有效性和安全性.方法 计算机检索Pubmed、Cochrane Central Register of Controlled Trials、EMbase、中国生物医学文献数据库、中国知网和万方数据库,查找所有抗菌药物预防克罗恩病术后复发的随机对照实验.按纳入、排除标准由两人独立进行文献筛选、资料提取和质量评价后,采用Rev Man 5.2软件进行Meta分析.结果 共纳入3个研究221例患者.Meta分析结果显示：（1）有效性方面：与安慰剂组比较,抗菌药物组术后3个月内镜复发率低（OR=0.40,95％ CI为0.22～0.73,P＜0.01）;术后12个月、24个月临床复发率亦低（OR =0.21,95％ CI为0.09 ～ 0.48,P＜0.01;OR=0.48,95％ CI为0.23～0.98,P＜0.05）.（2）安全性方面：与安慰剂组比较,抗菌药物组术后12个月内发生不良反应人次以及不良反应事件均较多（OR=5.13,95％ CI为2.45～10.72,P＜0.01;OR =3.51,95％ CI为2.14～5.76,P＜0.01）.结论 与安慰剂相比,抗菌药物可以显著减少CD术后的内镜复发和临床复发,但是使用抗菌药物出现的不良反应较多.

Objective To evaluate the effectiveness and security of antibiotics in prevention of postoperative Crohn＇ s disease recurrence.Methods We searched the PubMed,Cochrane Central Register of Controlled Trials,EMbase,CBM,C NKI and WanFang to collect randomized controlled trials（RCTs）about antibiotic VS placebo for the prevention of postoperative Crohn＇s disease recurrence.After study selection,assessment and data extraction were conducted by two reviewers independently,meta-analyses were performed by using the Rev Man 5.2 software.Results Three studies involving 221 patients were included.The results of meta-analyses showed that：①efficacy：compared with placebo group,the antibiotic group are more effective for prevention of endoscopic recurrence in 3 months after operation,OR =0.40,95％ CI（0.22 ～0.73）,P ＜ 0.01,more effective in prevention clinical recurrence in 12 and 24 months after operation,OR =0.21,95 ％ CI （0.09 ～ 0.48）,P ＜ 0.01 ; OR =0.48,95％ CI （0.23 ～ 0.98）,P ＜0.05.②safety：compared with placebo group,antibiotic group had more patients with side effects or side effect events after antibiotics treatment in 12 months,OR =5.13,95 ％ CI （2.45 ～ 10.72）,P ＜ 0.01 or OR =3.51,95％CI（2.14 ～5.76）,P ＜0.01 respectively.Conclusion Antibiotics are more effective than placebo in prevention of endoscopic and clinical recurrence in postoperative Crohn＇s disease,but have more side effects occurrence after antibiotics treatment.