氟康唑预防恶性血液病患者侵袭性真菌感染疗效的Meta分析

Efficacy of fluconazole in prophylaxis of invasive fungal infections for hematology patients

目的:系统评价氟康唑预防恶性血液病并真菌感染的疗效。方法:计算机检索中国知网(CNKI)、万方、Pubmed、Em Base数据库,采取Rev Man 5. 3软件进行Meta分析。结果:共纳入研究14篇,共3 767例,氟康唑组预防真菌感染失败率高于伊曲康唑组(P=0. 001)、伏立康唑组(P=0. 009)、泊沙康唑组(P <0. 001),较空白对照组低(P=0. 006),且差异均有统计学意义。其中氟康唑组同伊曲康唑组和泊沙康唑组进行亚组分析,分别比较了白色念珠菌、曲霉菌感染率,其中泊沙康唑组曲霉菌感染率较氟康唑组低(P <0. 000 1),且差异有显著统计学意义。伊曲康唑组白色念珠菌感染率、曲霉菌感染率及泊沙康唑组白色念珠菌感染率差异均无显著统计学意义。结论:氟康唑能有效预防恶性血液病并真菌感染发生率,但疗效低于伊曲康唑、伏立康唑、泊沙康唑。

Objective： To estimate the efficacy of fluconazole as antifungal prophylaxis of invasive fungal infection（ IFI） for hematology patients and hematopoietic stem cell transplant recipients. Methods： Em Base,Pubmed,CBM data-base,CNKI and Wanfang database were searched. The Meta analysis were performed by Rev Man 5. 3. Results：Totally 14 randomized controlled trials of 3 767 cases were included in the study. Meta-analysis showed that invasive fungal infections rate of the fluconazole group was significantly higher than the itraconazole group（ P = 0. 001）,voriconazole group（ P = 0. 009） and posaconazole group（ P〈0. 001）,significantly lower than the blank control group（ P= 0. 006）. The incidence of invasive mold infection in the posaconazole group was lower than that in the fluconazole group（ P〈0. 000 1）. There were no statistical significant differences in incidence of invasive candida infection between the fluconazole group and the control groups of posaconazole and itraconazole. There were no statistical significant differences in incidence of invasive mold infection between the fluconazole group and the itraconazole group.Conclusion： Fluconazole solution for the prevention of fungal infection can decrease the rate of invasive fungal infection,but was worse than posaconazole voriconazole and itraconazole.