持续泵入对比间断滴注两性霉素B治疗侵袭性真菌感染疗效与安全性的Meta分析

Efficacy and safety of continuous pump versus intermittent infusion of amphotericin B in the treatment of invasive fungal infection:a meta-analysis

目的比较持续泵入与间断滴注两性霉素B治疗侵袭性真菌感染的疗效与安全性,为临床治疗提供循证参考。方法计算机检索PubMed、the Cochrane Library、Web of Science、Embase、万方、中国知网、中国生物医学文献数据库、维普网,收集24 h持续泵入(试验组)对比间断滴注(对照组)两性霉素B的随机对照试验(RCT)及队列研究,检索时间均从建库起至2023年1月。筛选文献、提取资料后采用改良的Jadad量表评价RCT的质量,采用纽卡斯尔-渥太华评分量表评价队列研究的质量;采用RevMan 5.4软件进行Meta分析、敏感性分析。结果共纳入7篇文献,包括1篇RCT及6篇队列研究,共计767例患者。Meta分析结果显示,试验组患者的临床有效率[RR=1.44,95%CI(1.13,1.83),P=0.003]显著高于对照组,全因死亡率[RR=0.37,95%CI(0.19,0.72),P=0.003]、输液反应发生率[RR=0.28,95%CI(0.18,0.43),P<0.00001]均显著低于对照组;两组患者的肾功能损害发生率比较,差异无统计学意义[RR=0.71,95%CI(0.45,1.11),P=0.13]。敏感性分析结果显示,本研究所得结果稳健。结论24 h持续泵入两性霉素B治疗侵袭性真菌感染的疗效和安全性均优于间断滴注。

OBJECTIVE To compare efficacy and safety of continuous pump versus intermittent infusion of amphotericin B in the treatment of invasive fungal infection,and to provide evidence-based reference for clinical treatment.METHODS Retrieved from PubMed,the Cochrane Library,Web of Science,Embase,Wanfang,CNKI,CBM and VIP database,randomized controlled trial(RCT)and cohort study about 24 h continuous pump(trial group)versus intermittent infusion(control group)of amphotericin B were collected from the inception to Jan.2023.After literature screening and data extraction,the quality of RCT was evaluated with modified Jadad scale,and the quality of cohort study was evaluated with Newcastle-Ottawa scale.Meta-analysis and sensitivity analysis were performed by using RevMan 5.4 software.RESULTS A total of 7 literature were included,involving 1 RCT and 6 cohort studies with a total of 767 patients.The results of meta-analysis showed that the clinical effective rate[RR=1.44,95%CI(1.13,1.83),P=0.003]of trial group was significantly higher than that of control group,and all-cause mortality rate[RR=0.37,95%CI(0.19,0.72),P=0.003]and the incidence rate of infusion reaction[RR=0.28,95%CI(0.18,0.43),P<0.00001]were significantly lower than control group;there was no statistical significance in the incidence rate of renal impairment between 2 groups[RR=0.71,95%CI(0.45,1.11),P=0.13].The sensitivity analysis results showed that the results obtained in this study were robust.CONCLUSIONS The efficacy and safety of 24 h continuous pump of amphotericin B are better than those of intermittent infusion in the treatment of invasive fungal infection.