更昔洛韦治疗儿童传染性单核细胞增多症的Meta分析

Meta-analysis of ganciclovir in the treatment of infectious mononucleosis in children

目的评价更昔洛韦治疗儿童传染性单核细胞增多症(infecfious mononucleosis,IM)的有效性。方法检索中国知网、万方、维普、PubMed、Cochrane library、Web of Science、Embase等数据库,将更昔洛韦治疗传染性单核细胞增多症的随机对照试验(randomized controlled trial,RCT)和回顾性队列研究(试验组使用更昔洛韦,对照组为常规治疗)纳入研究,检索时间为各数据库建库至2022年4月。采用改良杰达德(Jadad)评定量表对RCT进行质量评分;根据纽卡斯尔–渥太华量表(Newcastle–Ottawa scale,NOS)对回顾性队列研究进行质量评价。对纳入文献的总有效率、总热程、退热时间、咽峡炎恢复时间、淋巴结恢复时间、肝脾恢复时间、异型淋巴细胞<10%时间进行Meta分析。结果共纳入12篇文献,试验组511例,对照组516例。Meta分析显示,更昔洛韦可以缩短IM的总热程(P=0.009)及脾脏肿大时间(P=0.004)。在有效性(P=0.580)、咽峡炎恢复时间(合并分析P=0.020,亚组分析P>0.05)、肝脏肿大恢复时间(P=0.080)、淋巴结肿大时间(P=0.110)等结局指标上无明显差异,在退热时间及异型淋巴细胞下降时间上亚组分析之间结论不一致。结论更昔洛韦不能明显改善传染性单核细胞增多症的疾病严重程度、临床症状、缩短病程,不建议常规推荐使用抗病毒,但可能对某种情况或感染分选下的IM具有治疗的价值。

Objective To evaluate the efficacy of ganciclovir in the treatment of infectious mononucleosis in children.Method Retrieval of CNKI,Wanfang Database,VIP Database,PubMed,Cochrane Library,Web of Science,Embase and other databases.Randomized controlled trial and retrospective cohort study of ganciclovir in the treatment of infectious mononucleosis(The experimental group received ganciclovir and the control group received routine treatment).The retrieval time was from the establishment of each database to April 2022.A modified Jadad scale was used to score the quality of randomized controlled trials.The quality of retrospective cohort studies was evaluated according to Newcastle–Ottawa scale.Meta–analysis was conducted on the total effective rate,total heat duration,fever reduction time,angina recovery time,lymph node recovery time,liver and spleen recovery time,and abnormal lymphocyte<10%time in the included literatures.Results A total of 12 literatures were included,including 511 cases in experimental group and 516 cases in control group.Meta–analysis showed that ganciclovir could shorten the total heat duration of IM(P=0.009)and the time of splenomegaly(P=0.004).There were no significant differences in efficacy(P=0.580),recovery time of angina(P=0.020 in combined analysis,P>0.05 in subgroup analysis),recovery time of hepatomegaly(P=0.080),and time to lymphadenopathy(P=0.110).The results of subgroup analysis were inconsistent in the time of antipyretic and the time of lymphocyte descent.Conclusion Ganciclovir does not significantly improve the severity,clinical symptoms,and duration of infectious mononucleosis,and antiviral therapy is not routinely recommended.But it may have therapeutic value for IM under certain conditions or infection sorting.