美罗培南治疗老年卒中相关性肺炎疗效及安全性的Meta分析

Meta-analysis on efficacy and safety of meropenem in the treatment of elderly patients with stroke-associated pneumonia

目的系统评估美罗培南(MEC)治疗老年卒中相关性肺炎(SAP)的有效性与安全性。方法应用计算机检索Cochrane图书馆、维普(VIP)、PubMed、知网(CNKI)、Embase、万方(WanFang)、中国生物医学文献数据库(CBM),采用主题词、关键词进行相关检索,时间范围为建库至2020年11月30日。搜集美罗培南临床治疗老年SAP相关的随机对照试验(RCT),之后进行筛选,同时完成资料的提取,对文献质量进行评价,采用RevMan 5.3软件进行Meta分析、敏感性以及发表偏倚分析。结果共纳入11项研究,包括SAP患者881例。Meta分析结果显示:与对照组相比,试验组SAP患者白细胞恢复正常时间[OR=-2.41,95%CI(-2.61~-2.20),P<0.00001]、湿啰音消失时间[OR=-2.46,95%CI(-2.75~-2.18),P<0.00001]、退热时间[OR=-1.45,95%CI(-1.59~-1.30),P<0.00001]、咳嗽消失时间[OR=-1.94,95%CI(-2.64~-1.24),P<0.00001]、住院时间[OR=-4.35,95%CI(-5.29~-3.41),P<0.00001]均明显减少;试验组临床疗效高于对照组[RR=1.22,95%CI(1.13~1.32),P<0.00001],不良反应发生率低于对照组[RR=0.38,95%CI(0.26~0.58),P<0.00001]。敏感性与发表偏倚分析结果显示,发表偏倚几率较低,指标结果较稳定。结论美罗培南能够缩短老年SAP患者的白细胞值恢复正常时间、湿啰音消失时间、退热时间、咳嗽消失时间和住院时间,增强临床疗效,安全性较高。

Objective To systematically evaluate the efficacy and safety of meropenem(MEC)in the treatment of elderly patients with stroke-associated pneumonia(SAP).Methods Subject terms and key words were used for search through Cochrane Library,VIP,PubMed,CNKI,Embase,WanFang and Chinese Biomedical Literature Database(CBM)by computer,and relevant retrieval was carried out until Nov 30,2020.Randomized controlled trial(RCT)related to the clinical application of meropenem in the treatment of elderly patients with SAP was collected and then screened,and data were extracted at the same time.Literature quality was evaluated and Meta analysis,sensitivity analysis and publication bias analysis were performed by RevMan 5.3.Results Eleven studies were included,involving a total of 881 SAP patients.Meta analysis results showed that compared with control group,the recovery time of WBC[OR=-2.41,95%CI(-2.61~-2.20),P<0.00001],disappearance time of moist rale[OR=-2.46,95%CI(-2.75~-2.18),P<0.00001],antipyretic time[OR=-1.45,95%CI(-1.59~-1.30),P<0.00001],disappearance time of cough[OR=-1.94,95%CI(-2.64~-1.24),P<0.00001]and hospitalization[OR=-4.35,95%CI(-5.29~-3.41),P<0.00001]of the patients in the experimental group were all significantly decreased.The clinical efficacy of treatment in the experimental group was significantly higher[RR=1.22,95%CI(1.13~1.32),P<0.00001],and the incidence of adverse reactions was significantly lower[RR=0.38,95%CI(0.26~0.58),P<0.00001],compared to the control group.The sensitivity and publication bias analysis showed that the probability of publication bias was low,the index results were stable.Conclusion Meropenem can shorten the recovery time of WBC,disappearance time of moist rale,antipyretic time,disappearance time of cough and hospitalization in elderly SAP patients,with better clinical efficacy and higher safety.