经验性与抢先性抗真菌治疗血液系统恶性肿瘤患者侵袭性真菌感染的荟萃分析

Meta-analysis of empirical versus preemptive antifungal therapies in hematologic malignancy patients

目的比较经验性抗真菌治疗与抢先性抗真菌治疗方法。方法计算机检索PubMed、Embase、Web of Science、中国知网、万方数据知识服务平台、维普等数据库,收集2009年1月-2019年1月发表的血液系统恶性肿瘤患者侵袭性真菌感染的经验性治疗与抢先性治疗方法相比较的随机对照试验。采用RevMan 5.3软件进行荟萃分析。结果共纳入5篇文献。荟萃分析结果显示,与经验性治疗相比,抢先性治疗在减少抗真菌药物的使用、降低抗真菌治疗的疗程方面差异有统计学意义,患者的侵袭性真菌感染相关死亡率、全因死亡率、住院时长、抗真菌治疗费用等方面的差异无统计学意义。结论在血液系统恶性肿瘤患者中,与经验性治疗相比,抢先性抗真菌治疗能减少药物的使用及缩短抗真菌治疗的疗程,并且没有增加患者的侵袭性真菌感染相关死亡率及全因死亡率。

Objective To compare empirical versus preemptive antifungal therapies in hematologic malignancy patients. Methods PubMed, Embase, Web of Science, CNKI, Wanfang Data and VIP databases were searched to find the randomized controlled trials comparing empirical and preemptive antifungal therapies in hematologic malignancy patients, which were published from January 2009 to January 2019. RevMan 5.3 software was used for meta-analysis. Results A total of 5 studies were included in this analysis. Meta-analysis results showed that preemptive therapy made statistically significant difference in reduced use of antifungal agents, reduction in the duration of antifungal therapy compared with empirical therapy. However, the two treatment approaches did not show significant difference in invasive fungal disease related mortality, all-cause mortality, length of hospital stay, and cost of antifungal treatment. Conclusions In patients with hematological malignancies, preemptive antifungal therapy can reduce the use of antifungal agents and the duration of antifungal therapy, and does not increase invasive fungal disease related mortality and all-cause mortality compared with empirical antifungal therapy.