米诺环素联合头孢哌酮治疗鲍曼不动杆菌耐药性肺炎的疗效Meta分析

Meta-analysis of the efficacy of minocycline combined with cefoperazone in the treatment of Acinetobacter baumannii resistant pneumonia

目的:系统性评价米诺环素联合头孢哌酮治疗鲍曼不动杆菌耐药性肺炎的疗效。方法:以计算机检索PubMed、中国生物医学文献服务系统、中国知网、万方数据库等中英文数据库,收集自建库到2019年6月,与米诺环素联合头孢哌酮治疗鲍曼不动杆菌耐药性肺炎的疗效相关的研究,由两名研究人员严格按照纳入/排除标准独立完成文献筛选、相关资料提取以及质量评价等,数据采用RevMan5.3统计学软件进行Meta分析。结果:最终纳入7篇的研究,包括369例患者。Meta分析结果显示:观察组的总有效率与对照组相比,差异有统计学意义(OR=2.45,95%CI:1.06~5.68,P=0.04)。观察组的治疗后WBC水平与对照组相比,差异无统计学意义(MD=-1.47,95%CI:-3.98~1.04,P=0.25)。观察组的治疗后CRP水平与对照组相比,差异无统计学意义(SMD=-0.60,95%CI:-1.35~0.15,P=0.12)。观察组的治疗后PCT水平与对照组相比,差异有统计学意义(SMD=-1.27,95%CI:-2.27^-0.28,P=0.01)。观察组治疗后的细菌清除率与对照组相比,差异无统计学意义(OR=1.00,95%CI:0.40~2.54,P=1.00)。结论:米诺环素联合头孢哌酮/舒巴坦可提高鲍曼不动杆菌耐药性肺炎治疗总有效率高、降低降钙素原水平,可作为治疗鲍曼不动杆菌耐药性肺炎方案,仍需更多高质量研究进一步验证。

Objective:To systematically evaluate the efficacy of minocycline combined with cefoperazone in the treatment of Acinetobacter baumannii resistant pneumonia.Methods:PubMed,China Biomedical Literature Service System,China HowNet and Wanfang database were searched by computer.The self-built database was collected and the related studies on the efficacy of minocycline combined with cefoperazone in the treatment of Acinetobacter baumannii resistant pneumonia were collected by two researchers in strict accordance with inclusion/exclusion.In addition to independently completing literature screening,relevant data extraction and quality evaluation,the data were analyzed by RevMan 5.3 statistical software.Results:Seven studies were included,including 369 patients.Meta analysis showed that the total effective rate of the observation group was significantly higher than that of the control group[OR=2.45,95%CI(1.06,5.68),P=0.04].There was no significant difference in WBC level between the observation group and the control group[MD=-1.47,95%CI(-3.98,1.04),P=0.25].There was no significant difference in CRP level between the observation group and the control group[SMD=-0.60,95%CI(-1.35,0.15),P=0.12].The PCT level in the observation group was significantly higher than that in the control group[SMD=-1.27,95%CI(-2.27,-0.28),P=0.01].There was no significant difference in bacterial clearance rate between the observation group and the control group[OR=1.00,95%CI(0.40,2.54),P=1.00].Conclusions:Minocycline combined with Cefoperazone/sulbactam can improve the total effective rate and reduce the level of procalcitonin in the treatment of Acinetobacter baumannii resistant pneumonia.It can be used as a treatment scheme for Acinetobacter baumannii resistant pneumonia,which needs more high-quality studies to further verify.