目的:通过网状Meta分析,评价四种两性霉素B静脉剂型在治疗真菌感染方面的疗效和安全性。方法:检索中英文电子数据库(PubMed、Scopus、Web of Science、the Cochrane Library、Embase、中国知网、万方数据库、维普数据库和中国生物医学...目的:通过网状Meta分析,评价四种两性霉素B静脉剂型在治疗真菌感染方面的疗效和安全性。方法:检索中英文电子数据库(PubMed、Scopus、Web of Science、the Cochrane Library、Embase、中国知网、万方数据库、维普数据库和中国生物医学文献数据库),纳入比较两性霉素B与三唑类或棘白菌素类药物治疗真菌感染的随机对照试验(RCT)进行网状Meta分析。检索时间为建库至2023年8月5日,文献质量采用GRADE分级。结果:共纳入16篇文献,涉及4365例患者。在疗效方面,两性霉素B脂质体>两性霉素B脱氧胆酸盐>两性霉素B胶体分散体,差异有统计学意义(P<0.05),两性霉素B脂质体复合物与其他剂型相比差异暂无统计学意义(P>0.05);在总不良反应发生率方面,四种两性霉素B静脉剂型的差异无统计学意义(P>0.05)。亚组分析结果显示,两性霉素B脱氧胆酸盐相比两性霉素B胶体分散体具有更高的神经系统毒性,差异有统计学意义(P<0.05)。结论:四种两性霉素B静脉剂型中,脂质体剂型的疗效优于脱氧胆酸盐传统剂型;胶体分散体剂型的疗效显著低于传统剂型,同时神经系统毒性也较低。由于研究纳入文献数量有限,可能存在发表偏倚,故仍需更多大样本量、高质量的临床研究进一步证实本研究的结果和结论。展开更多
Amphotericin B（AmB） has been widely used in antifungal therapy. AraB molecules combine with cholesterol to form pores that can be toxic to human cells, thus greatly limiting its clinical application. The interaction...Amphotericin B（AmB） has been widely used in antifungal therapy. AraB molecules combine with cholesterol to form pores that can be toxic to human cells, thus greatly limiting its clinical application. The interaction between Arab and the cell membrane may be influenced by potassimn, sodium and calcium ions. Lq this study, the bilayer in large unilamellar lipid-drug liposomes with or without cholesterol was employed as a model membrane. N-（7-Nitrobenz-2-oxa-1,3-diazol-4-yl）-1,2-dipalmitoyl-sn-glycero-3-phosphoetheanolamine（N-BD-PE） and 1-palmi-toyl-2-[6（7-nitrobenz-2-oxa-1,3-diazol-4-yl）aminodoclecanoyl]-sn-glysero-3-phosphocholine（6-NBD-PC） are two kinds of fluorescent lipid probes, and the NBD group is attached to the polar lipid headgroup in the former, but to the sn-2 fatty acyl chain in the latter. The effect of these metal cations on the lipid-drug membrane was monitored by red edge excitation shift（REES）, fluorescence polarization, and the fluorescence lifetime of lipid probes in hydrophilic and hydrophobic areas of the membrane. These ions have different effects on the lipid-AraB membrane. Cholesterol can strengthen the packing ability of the membrane, which is influenced differently by potassium, sodium and calcium ions. Moreover, the influence of these ions on the membrane may be relative to the method of ion transportation through the membrane. This study is significant to understand the reduction of AraB＇s cellular toxicity.展开更多
文摘目的:通过网状Meta分析,评价四种两性霉素B静脉剂型在治疗真菌感染方面的疗效和安全性。方法:检索中英文电子数据库(PubMed、Scopus、Web of Science、the Cochrane Library、Embase、中国知网、万方数据库、维普数据库和中国生物医学文献数据库),纳入比较两性霉素B与三唑类或棘白菌素类药物治疗真菌感染的随机对照试验(RCT)进行网状Meta分析。检索时间为建库至2023年8月5日,文献质量采用GRADE分级。结果:共纳入16篇文献,涉及4365例患者。在疗效方面,两性霉素B脂质体>两性霉素B脱氧胆酸盐>两性霉素B胶体分散体,差异有统计学意义(P<0.05),两性霉素B脂质体复合物与其他剂型相比差异暂无统计学意义(P>0.05);在总不良反应发生率方面,四种两性霉素B静脉剂型的差异无统计学意义(P>0.05)。亚组分析结果显示,两性霉素B脱氧胆酸盐相比两性霉素B胶体分散体具有更高的神经系统毒性,差异有统计学意义(P<0.05)。结论:四种两性霉素B静脉剂型中,脂质体剂型的疗效优于脱氧胆酸盐传统剂型;胶体分散体剂型的疗效显著低于传统剂型,同时神经系统毒性也较低。由于研究纳入文献数量有限,可能存在发表偏倚,故仍需更多大样本量、高质量的临床研究进一步证实本研究的结果和结论。
基金Supported by the National Natural Science Foundation of China（No.21402114）.
文摘Amphotericin B（AmB） has been widely used in antifungal therapy. AraB molecules combine with cholesterol to form pores that can be toxic to human cells, thus greatly limiting its clinical application. The interaction between Arab and the cell membrane may be influenced by potassimn, sodium and calcium ions. Lq this study, the bilayer in large unilamellar lipid-drug liposomes with or without cholesterol was employed as a model membrane. N-（7-Nitrobenz-2-oxa-1,3-diazol-4-yl）-1,2-dipalmitoyl-sn-glycero-3-phosphoetheanolamine（N-BD-PE） and 1-palmi-toyl-2-[6（7-nitrobenz-2-oxa-1,3-diazol-4-yl）aminodoclecanoyl]-sn-glysero-3-phosphocholine（6-NBD-PC） are two kinds of fluorescent lipid probes, and the NBD group is attached to the polar lipid headgroup in the former, but to the sn-2 fatty acyl chain in the latter. The effect of these metal cations on the lipid-drug membrane was monitored by red edge excitation shift（REES）, fluorescence polarization, and the fluorescence lifetime of lipid probes in hydrophilic and hydrophobic areas of the membrane. These ions have different effects on the lipid-AraB membrane. Cholesterol can strengthen the packing ability of the membrane, which is influenced differently by potassium, sodium and calcium ions. Moreover, the influence of these ions on the membrane may be relative to the method of ion transportation through the membrane. This study is significant to understand the reduction of AraB＇s cellular toxicity.
