万古霉素鞘内阶梯浓度注射治疗颅内葡萄球菌感染的系统评价

Meta-analysis on Intrathecal Gradient Injection of Vancomycin in Treatment of Intracranial Staphylococcal Infection

目的:系统评价万古霉素鞘内阶梯浓度注射治疗颅内葡萄球菌感染的疗效。方法:检索Pubmed、Cochrane Library、EMbase及中国学术文献总库、万方数据库及维普数据库中2014年12月31日前发表的有关万古霉素鞘内阶梯浓度注射给药法治疗颅内葡萄球菌感染的文献,采用严格的文献筛选及质量评价标准,提取有效数据,分别对总有效率、体温、血液白细胞计数、脑脊液生化检查各项指标进行文献荟萃(Meta)分析。结果:共纳入4篇文献、173例患者,Meta分析结果显示,与对照组及本组治疗前比较,万古霉素鞘内阶梯浓度注射治疗颅内葡萄球菌感染,可显著降低患者体温(Z=12.49,MD=2.21,95%CI=1.87~2.56,P<0.000 01)、血液白细胞计数(Z=30.17,MD=38.38,95%CI=35.88~40.87,P<0.000 01)及脑脊液蛋白含量(Z=12.19,MD=0.64,95%CI=0.54~0.75,P<0.000 01),可升高患者脑脊液葡萄糖含量(Z=9.51,MD=-1.03,95%CI=-1.25^-0.82,P<0.000 01)及脑脊液氯化物含量(Z=16.58,MD=-43.11,95%CI=-48.21^-38.02,P=0.80)。结论:万古霉素鞘内阶梯浓度注射可有效治疗颅内葡萄球菌感染。

OBJECTIVE： To systematically review the efficacy of intrathecal gradient injection of vancomycin in treatment of intracranial staphylococcal infection. METHODS： Literature relevant to intrathecal gradient injection of vancomycin in treatment of intracranial staphylococcal infection published before Dec. 31 st in 2014 from databases of Pubmed,Cochrane Library,EMbase,CNKI,Wanfang and VIP were retrieved,strict standard of literature screening and quality evaluating were adopted to obtain the valid data,and then Meta-analysis was conducted on the cure rate,body temperature, leukocyte count and biochemical examination results of cerebrospinal fluid in intracranial staphylococcal infection patients. RESULTS： Totally 4 literatures were involved,including 173 patients. The results of meta-analysis showed that,compared with the control group and before treatment,intrathecal gradient injection of vancomycin in treatment of intracranial staphylococcal infection could significantly decrease the body temperature（ Z =12. 49,MD = 2. 21,95% CI = 1. 87-2. 56,P〉 0. 000 01）,leukocyte count（ Z = 30. 17,MD = 38. 38,95% CI = 35. 88-40. 87,P〉 0. 000 01）,and protein content in cerebrospinal fluid（ Z = 12. 19,MD = 0. 64,95% CI = 0. 54-0. 75,P 〉0. 000 01）,and increase the content of glucose（ Z = 9. 51,MD =- 1. 03,95% CI =- 1. 25-0. 82,P〉 0. 000 01） and chloride（ Z = 16. 58,MD =- 43. 11,95% CI =- 48. 21-38. 02,P = 0. 80） in cerebrospinal fluid for intracranial staphylococcal infection patients, respectively. CONCLUSIONS： Intrathecal gradient injection of vancomycin in treatment of intracranial staphylococcal infection is significant.