伏立康唑预防和治疗儿童真菌感染的有效性及安全性的meta分析

Efficacy and Safety of Voriconazole in the Prevention and Treatment of Invasive Fungal Infections in Children:A Systematic Review and Meta-Analysis

目的系统评价伏立康唑(VRC)在预防和治疗儿童侵袭性真菌感染(IFI)的有效性及安全性,为临床预防性及治疗性应用VRC提供证据。方法系统检索PubMed、Embase、Cochrane图书馆、万方数据库、中国知网,纳入有关儿童应用VRC预防和治疗儿童IFI的所有相关临床研究。检索时间为建库起至2023年5月。采用Stata 14.0软件对给药的有效性及安全性进行meta分析。结果共纳入15项相关研究,其中10项为治疗性给药,5项为预防性给药。meta分析结果显示:VRC治疗IFI的有效率高于对照组(OR=2.05,95%CI:1.10~3.82,P=0.003),其不良反应发生率低于两性霉素B,高于卡泊芬净,但差异无统计学意义(P>0.05)。VRC预防给药未与患儿IFI发病率的降低相关(OR=0.57,95%CI:0.19~1.71,P=0.083),且未增加患儿的不良反应发生率(OR=0.70,95%CI:0.16~3.09,P=0.015)。结论与其他抗真菌剂相比,VRC治疗儿童IFI是有效且相对安全的;预防性应用VRC并未显著降低儿童IFI的发病率。

Objective To systematically evaluate the efficacy and safety of voriconazole(VRC)in the prevention and treatment of invasive fungal infections(IFI)in children and to provide evidence for the clinical prophylactic and therapeutic use of VRC.Methods PubMed,Embase,Cochrane Library,Wanfang database,and China Knowledge Network were systematically searched to include all relevant clinical studies on the application of VRC for the prevention and treatment of IFI in children.The search period was from the establishment of the database to May 2023.Stata 14.0 software was used to perform meta-analysis on the efficacy and safety of drug administration.Results A total of 15 relevant studies were included,10 of which were therapeutically administered and 5 were prophylactically administered.The results showed that VRC was more effective than the control group in the treatment of IFI(OR=2.05,95%CI:1.10-3.82,P=0.003),and its incidence of adverse effects was lower than that of amphotericin B and higher than that of caspofungin,but the difference was not statistically significant(P>0.05).Prophylactic administration of VRC was not associated with a reduction in the incidence of IFI in children(OR=0.57,95%CI:0.19-1.71,P=0.083)and did not increase the incidence of adverse effects in children(OR=0.70,95%CI:0.16-3.09,P=0.015).Conclusion VRC is effective and relatively safe for the treatment of IFI in children compared with other antifungal agents.Prophylactic application of VRC is not significantly associated with the lower incidence of IFI in children.