替加环素超剂量使用与临床结局相关性的评价

Review of association between high-dose tigecycline and clinical outcome

目的评价替加环素超剂量使用的有效性与安全性。方法检索Pub Med、Em Base、Cochrane Library、中国知网、中国生物医学文献数据库、万方数据库和Clinical Tirals.gov数据库,检索时间均从建库至2017年5月。用Rev Man5.3软件对患者的全因死亡率、微生物学清除率、临床有效率和临床治愈率进行Meta分析。结果共纳入5篇队列研究,患者348例。Meta分析显示,与常规剂量替加环素(50 mg,q12 h)单药或联合其他抗菌药物治疗相比,超剂量替加环素(>50 mg,q12 h)单药或联合其他抗菌药物治疗可以显著降低患者的全因死亡率(RR=0.65,95%CI=0.50~0.84,P<0.01),提高微生物学清除率(RR=1.71,95%CI=1.22~2.41,P<0.01),临床有效率(RR=1.46,95%CI=1.13~1.87,P<0.01)和临床治愈率(RR=1.71,95%CI=1.71~2.48,P<0.01)。结论超剂量替加环素(>50 mg,q12 h)单药或联合其他抗菌药物治疗与常规剂量替加环素(50 mg,q12 h)单药或联合其他抗菌药物治疗相比具有一定的优势。

Objective To evaluate the efficacy and safety of the usage of high-dose tigecycline. Methods Databases including Pub Med,EmBase,The Cochrane Library,CNKI,Wanfang data and Clinical Tirals. gov were searched to select randomized controlled trials（ RCTs） and observational studies that met the inclusion criteria from inception to May2017. Two reviewers independently screened literature,extracted data,and evaluated the risk of bias of included studies. Risk ratio and 95%confidence interval were used to present results. Meta-analysis was performed using Rev Man 5. 3 software to analyze patients＇ all-cause mortality,micro-biological clearance rate,clinical effective rate and clinical cure rate. Result A total of 5 observational studies were included,which involved 348 patients. The results of meta-analysis indicated that compared with the regular-dose group（ 50 mg,q12 h）,the high-dose group（〉 50 mg,q12 h） could significantly decrease all-cause mortality（ RR = 0. 65,95% CI = 0. 50-0. 84,P〈 0. 01）,increase micro-biological clearance rate（ RR = 1. 71,95% CI = 1. 22-2. 41,P 〈0. 01）,clinical effective rate（ RR = 1. 46,95% CI = 1. 13-1. 87,P 〈0. 01）and clinical cure rate（ RR = 1. 71,95% CI = 1. 71-2. 48,P 〈0. 01）.Conclusion Compared with regular-dose tigecycline（ 50 mg,q12 h）,the usage of high-dose tigecycline（〉 50 mg,q12 h） showed superiority.