高剂量替加环素治疗肺部感染有效性与安全性的Meta分析

Efficacy and Safety of High Dose Tigecycline in the Treatment of Pulmonary Infection:A Meta-analysis

目的评价高剂量替加环素治疗肺部感染的有效性和安全性。方法计算机检索CNKI、CBM、VIP、WangFang Data、Pubmed、Embase、Web of Science和the Cochrane Library,检索时间为建库至2021年9月10日。收集高剂量替加环素对比常规剂量替加环素或其他抗菌药物治疗肺部感染的随机对照试验,采用Revman5.3软件及STATA软件进行Meta分析。结果纳入15篇文献共纳入1328例患者。Meta分析结果显示:高剂量替加环素治疗肺部感染可显著提高临床治疗有效率〔OR=3.89,95%CI(2.74,5.54),P<0.00001〕、细菌清除率〔OR=3.06,95%CI(2.21,4.23),P<0.00001〕,降低患者的死亡率〔OR=0.25,95%CI(0.14,0.45),P<0.00001〕,且未增加不良反应发生率〔OR=1.03,95%CI(0.73,1.46),P<0.86〕;可改善APACHEⅡ评分、其他炎症指标、呼吸力学指标以及住院时间,但部分指标异质性较大,经敏感性分析显示,PCT及ICU治疗时间的Meta分析结果尚不稳定。结论高剂量替加环素治疗肺部感染可提高临床治疗有效率、细菌清除率,降低患者的死亡率,有利于改善APACHE评分,且未显著增加药物不良反应。但有待更多设计严谨的、大样本的、多中心随机双盲RCT加以验证。

OBJECTIVE To evaluate the efficacy and safety of high dose tigecycline in the treatment of pneumonia in a Meta-analytic approach.METHODS Databases such as WanFang,VIP,CNKI,China Biology Medicine database,Pubmed,EMbase,Web of Science and the Cochrane Library to collect the data related to high dose tigecycline in the treatment of pneumonia compared with standard dose tigecycline and other commonly used antibiotics from their inception to Sep.10,2021.A Meta-analysis was conducted using RevMan 5.3 and STATA 12.0 sofeware.RESULTS A total of 15 studies involving 1328 patients were included.644 patients were in the high dose tigecycline group and 684 patients in the control group.The result of meta-analysis indicated that,compared with the standard dose tigecycline,high dose of tigecycline in the treatment of pulmonary infection could significantly improve the clinical effective rate〔OR=3.89,95%CI(2.74,5.54),P<0.00001〕,microbiological eradication rate〔OR=3.06,95%CI(2.21,4.23),P<0.00001〕,decreased the mortality of patients〔OR=0.25,95%CI(0.14,0.45),P<0.00001〕,and did not increase the incidence of adverse reactions〔OR=1.03,95%CI(0.73,1.46),P<0.86〕.APACHEⅡscore,inflammatory indexes(WBC,CRP,IL-6,IL-8,INF-α),respiratory mechanics indexes and length of hospital stay were improved,but some indexes were highly heterogeneous.Sensitivity analysis showed that Meta-analysis results of PCT and length of ICU treatment were not stable.CONCLUSION High dose tigecycline in the treatment of pulmonary infection can improve clinical effective rate,microbiological eradication rate,reduce the mortality of patients,improve APACHE score,and do not significantly increase the adverse drug reactions.However,it needs to be verified by more well-designed,large-sample,multicenter randomized double-blind RCTs.