伏立康唑治疗恶性血液病并真菌感染临床应用Meta分析

Clinical application of Voriconazole treatment in invasive fungal infection for malignant hematology patients: a meta analysis

目的:系统评价伏立康唑治疗恶性血液病并真菌感染临床应用的有效性及安全性。方法:检索PubMed、Co-chrane Library、EMbase、CNKI、CBM数据库,收集截至2014年9月已发表的伏立康唑治疗恶性血液病并真菌感染的随机对照试验,采取RevMan 5.0软件进行Meta分析。结果:共纳入研究10项,1 773例。Meta分析结果提示,伏立康唑治疗成功率均高于两性霉素B、伊曲康唑、米卡芬净、氟康唑,差异有统计学意义(P<0.000 01);4项研究表明伏立康唑较两性霉素B的不良反应发生率低,差异有统计学意义(P<0.000 01);1项研究在伏立康唑、两性霉素B不良反应发生率差异无统计学意义(P=0.57);伏立康唑、米卡芬净组不良反应发生率差异无统计学意义(P=0.69);伏立康唑、氟康唑不良反应发生率差异无统计学意义(P=0.70);2项研究伏立康唑与伊曲康唑不良反应发生率分亚组分析结果分别为P=0.001、P=0.17。结论:伏立康唑在治疗恶性血液病并侵袭性真菌感染中表现出高效相对低毒的特点。随着其临床应用愈加广泛,其价值有待进一步检验。

Objective To estimate the efficacy and safety of Voriconazole as antifungal prophylaxis of invasive fungal infection （IFI） for malignant hematology patients. Methods The randomized controlled trials of Voriconazole treatment in invasive fungal infection for malignant hematology patients （ended in September 2014） were searched from Cochrane library, Medline, Embase, Pubmed, CBM, CNKI, Blood database. The meta analysis were performed by RevManS.0. Results Ten literatures reported in 1 773 cases, in which there was significantly difference in effective rate between Voricanazole and other antifungal agents such as Amphotericin- B, Itraconazole, Micafungin and Fluconazole（P 〈 0.000 01）; Four literatures indicated that there was significantly difference in adverse event rate between Voricanazole and amphotericin-B （P 〈 0.00 001 ）; no significantly difference in adverse event rate between Voriconazole and amphotericin-B（P = 0.57）; no significantly difference in adverse event rate between Voriconazole and Micafungin （P = 0.69）; no significantly difference in adverse event rate between Voriconazole and Fluconazole （P = 0.70） ; Subgroup analysis indicated that adverse event rate between Voriconazole and Itraconazole is P = 0.001, P = 0.17 respectively. Conclusion Voriconazole showed relative high efficient and low toxicity characteristics in treatment of malignant hematology accompanied by invasive fungal infection. But with its widely clinical application, the clinical value of Voriconazole needs to be further tested.