降钙素原指导抗生素治疗策略在慢性阻塞性肺疾病急性加重期中应用的Meta分析

Procalcitonin Guided Antibiotics Therapy in Patients with Acute Exacerbation Chronic Obstructive Pulmonary Disease:A Meta-analysis

目的系统评价降钙素原(PCT)指导抗生素治疗策略在慢性阻塞性肺疾病急性加重期(AECOPD)中的有效性及安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年6期)、CBM、CNKI、VIP和Wan Fang Data数据库,搜集有关PCT指导抗生素治疗策略在AECOPD应用的随机对照试验(RCT),检索时限均从建库至2016年7月。同时,追溯纳入文献的参考文献,以补充获取相关文献。由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.2软件进行Meta分析。结果共纳入10个RCT,包括1 071例患者。Meta分析结果显示:与对照组相比,PCT组抗生素使用率[RR=0.70,95%CI(0.55,0.89),P=0.004]、抗生素使用疗程>10天人数占比[RR=0.38,95%CI(0.26,0.56),P<0.000 01]和二重感染发生率[RR=0.23,95%CI(0.09,0.58),P=0.002]明显更低;但在临床有效率[RR=0.98,95%CI(0.91,1.06),P=0.61]、ICU入住率[RR=0.77,95%CI(0.40,1.47),P=0.43]及住院期间死亡率[RR=0.84,95%CI(0.52,1.73),P=0.43]方面,两组差异无统计学意义。结论对于AECOPD患者,使用PCT指导抗生素治疗策略可明显减少抗生素的使用和二重感染的发生。受纳入研究数量及质量的限制,上述结论尚需开展更多高质量大样本的研究进一步验证。

Objective To systematically evaluate the efficacy and safety of procalcitonin guided algorithms of antibiotic therapy in acute exacerbation chronic obstructive pulmonary disease（AECOPD）. Methods We searched Pub Med, EMbase, The Cochrane Library（Issue 6, 2016）, CBM, CNKI, VIP, and Wan Fang Data from the date of their establishment to July 2016, to collect randomized controlled trials（RCTs） about procalcitonin guided antibiotics therapy in patients with AECOPD. References of the included literature were also searched manually for additional studies. The literature screening, data extraction and bias risk assessment of the included studies were completed by two reviewers independently. Statistical analysis was conducted using Rev Man 5. 2 software. Results A total of ten RCTs involving 1 071 patients were included. The results of meta-analysis indicated that compared with the standard treatment group, the antibiotic prescription rate（RR= 0. 70, 95 %CI 0. 55 to 0. 89, P= 0. 004）, the rate of duration of antibiotic 10 days（RR= 0. 38, 95 %CI 0. 26 to 0. 56, P〈0. 000 01） and the superinfection rate（RR= 0. 23, 95 %CI 0. 09 to 0. 58, P= 0. 002） were significantly lower in the procalcitonin-guided treatment group. There were no statistical differences in clinical effective rate（RR= 0. 98, 95 %CI 0. 91 to 1. 06, P= 0. 61）, hospital mortality（RR= 0. 84, 95 %CI 0. 52 to 1. 73, P= 0. 43）, and the rate of need for intensive care（RR= 0. 77, 95 %CI 0. 40 to 1. 47, P= 0. 43）. Conclusion Procalcitonin guided antibiotics therapy may reduce antibiotic exposure and superinfection rate in patients with AECOPD. In addition, due to the low methodological quality and limited quantity of the included studies, larger sample-size, and high quality RCTs are needed to verify the above conclusion.