伊曲康唑预防血液病患者侵袭性真菌感染疗效的Meta分析

摘要

OBJECTIVE: To evaluate the therapeutic efficacy of itraconazole agansit invasive fungal infection (IFI) in hematology patients underwent chemotherapy or hematopoietic stem cell transplantation (HSCT). METHODS: Retrieved from Cochrane library, Medline, EMbase, PubMed, CBM Database, CNKI, VIP database and Wanfang database and manual retrieval, related proceedings were collected. The Meta-analysis was performed by Rev Man 5.1 software. RESULTS: 14 literatures were included, involving 4 020 patients. Results of Meta-analysis indicated that the incidence of fungal infection in itraconazole group was lower than that of fluconazole group [OR=0.72, 95%CI(0.54, 0.96), P=0.02; OR=0.60, 95%CI(0.39, 0.93) , P=0.02] and higher than that of posaconazole [OR=4.90, 95%CI (1.58,15.15), P=0.006; OR=14.25, 95%CI (2.69,75.34), P=0.002], but there was no statistical significance, compared with amphotericin B group, caspofungin group and voriconazole group. There was no statistical significance in the difference of overall mortality and infection rate of Candidiasis spp. between itraconazole group and control group. CONCLUSION: The therapeutic efficacy of itraconazole against invasive fungal infection in hematology patients underwent chemotherapy and HSCT is better than fluconazole and worse than posaconazole, and equivalent with amphotericin B, caspofungin, voriconazole.%目的:系统评价伊曲康唑预防血液病患者化疗或造血干细胞移植(HSCT)后侵袭性真菌感染的有效性.方法:计算机检索Cochranc图书馆、Medline、EMbase、PubMed、中国生物医学文献光盘数据库(CBM)、中国科技期刊全文数据库(CNKI)、维普电子期刊全文数据库、万方数据库等,并手工检索相关会议的论文集,采用Rev Man 5.1软件进行Meta分析.结果:纳入14项研究,共4020例患者.Meta分析结果显示,伊曲康唑组真菌感染发生率和曲霉检出率均低于氟康唑组[OR=0.72,95％CI(0.54,0.96),P=0.02;OR=0.60,95％CI(0.39,0.93),P=0.02],高于泊沙康唑组[OR=4.90,95％CI(1.58,15.15),P=0.006；OR=14.25,95％CI(2.69,75.34),P=0.002],而与两性霉素B、卡泊芬净、伏立康唑组比较差异均无统计学意义.伊曲康唑组的总死亡率、念珠菌检出率与各对照组比较差异亦无统计学意义.结论:伊曲康唑预防血液病患者化疗或HSCT后侵袭性真菌感染优于氟康唑,较泊沙康唑差,与两性霉素B、伏立康唑、卡泊芬净等相当.