泊沙康唑预防血液恶性肿瘤患者侵袭性真菌感染的有效性和安全性:一项meta分析

国际输血及血液学杂志 Pub Date : 2019-11-20 DOI:10.3760/CMA.J.ISSN.1673-419X.2019.06.006

K. Tang, Zhiyong Wang, Chunhong Xin, Rui Jing, Yuping Dong, S. Feng

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引用次数: 0

摘要

目的系统评价泊沙康唑预防血液系统恶性肿瘤患者侵袭性真菌感染（IFI）的疗效和安全性。方法自数据库建立之日起至2018年10月，英文数据库如PubMed、Web of Science数据库等，中文数据库如万方数据知识服务平台、微普中文科技期刊数据库等，检索中国知网（CNKI）和中国生物医学文献数据库（CBM）等文献，确定泊沙康唑预防血液系统恶性肿瘤患者IFI的随机对照试验（RCT）的研究文献，研究组接受泊沙康，对照组接受其他抗真菌药物。两位研究人员根据本研究设定的文献纳入和排除标准，对文献进行了独立筛选，并对纳入文献的质量进行了评估，提取了材料。使用Revman 5.3软件对泊沙康唑预防血液系统恶性肿瘤患者IFI的有效性和安全性进行荟萃分析。泊沙康唑预防血液系统恶性肿瘤患者IFI的有效性和安全性的主要转归评价指标包括：有效性指标（IFI发生率）、安全性指标（不良反应发生率和全因死亡率）。结果通过文献筛选，共有6例随机对照试验符合本研究的纳入标准。共纳入血液系统恶性肿瘤患者1 994例，其中研究组1 057例，对照组937例泊沙唑预防血液系统恶性肿瘤患者IFI发生的Meta分析显示：研究组IFI发生率低于对照组，差异有统计学意义（OR=0.37，95%CI:0.27-0.51，P<0.0001）。泊沙康唑治疗组IFI发生率分别低于氟康唑和伊曲康唑治疗组，差异有统计学意义（OR=0.41，95%CI:0.27-0.63，P<0.0001；OR=0.31，95%CI:0.20-0.49，P<0.0001）。泊沙康唑与伏立康唑治疗组IFI发生率无统计学意义（OR=0.13，95%CI:0.01-2.67，P=0.019）研究组不良反应发生率低于对照组，差异有统计学意义（OR=0.80，95%CI:0.64-0.99，P=0.04）。③对泊沙康唑预防IFI患者全因死亡率的Meta分析显示，研究组全因死亡率低于对照组，结论泊沙康唑预防血液系统恶性肿瘤患者IFI的疗效优于其他抗真菌药物，安全性较高。关键词：泊沙康唑；氟康唑；伊曲康唑；伏立康唑；侵袭性真菌感染；Meta分析

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Efficacy and safety of posaconazole in prophylaxis against invasive fungal infections in patients with hematological malignancies: a Meta-analysis

Objective To systematically evaluate the efficacy and safety of posaconazole in prophylaxis against invasive fungal infection (IFI) in patirnts with hematological malignancies. Methods From the date of databases inception to October 2018, English databases, such as PubMed, Web of Science database and others, as well as Chinese databases, such as Wanfang Date Knowledge Service Platform, Weipu Chinese Science and Technology Journal Database, China National Knowledge Infrastructure (CNKI) and Chinese Biomedical Literature Database (CBM) and others were searched to identify research literature of the randomized controlled trials (RCT) of posaconazole in prophylaxis of IFI in patients with hematological malignancies with study group receiving posaconazole and control group receiving other anti-fungal drugs. The two researchers independently screened the literatures according to the inclusion and exclusion criteria of the literatures set in this study, and evaluated the quality of the included literatures and extracted the materials. Efficacy and safety of posaconazole for preventing IFI in patients with hematological malignancies were Meta analyzed with Revman 5.3 software. The main outcome evaluation indexes of effectiveness and safety of posaconazole in preventing IFI of patients with hematological malignancies include: effectiveness indicator (IFI incidence rate), safety indicators (adverse reactions incidence rate and all-cause mortality). Results Through literature screening, a total of 6 RCTs met the inclusion criteria in this study. A total of 1 994 patients with hematological malignancies were included, including 1 057 patients in study group and 937 patients in control group. ① Meta-analysis of posaconzole to prevent the incidence of IFI in patients with hematological malignancies showed that, incidence rate of IFI in study group was lower than that of control group, and the difference was statistically significant (OR=0.37, 95%CI: 0.27-0.51, P<0.0001). Incidence rate of IFI in patients treated with posaconazole was lower than that of patients treated with fluconazole and itraconazole, respectively, and the differences were statistically significant (OR=0.41, 95%CI: 0.27-0.63, P<0.0001; OR=0.31, 95%CI: 0.20-0.49, P<0.0001). There were no statistical significant difference in incidence rate of IFI between patients treated with posaconazole and voriconazole (OR=0.13, 95%CI: 0.01-2.67, P=0.19). ② Meta-analysis on the incidence rate of adverse reactions to prevent IFI by posaconazole showed that, incidence rate of adverse reactions in study group was lower than that in control group, and the difference was statistically significant (OR=0.80, 95%CI: 0.64-0.99, P=0.04). ③ Meta-analysis on all-cause mortality of posaconazole patients for prevention of IFI showed that, all-cause mortality in the study group was lower than that in control group, and the difference was statistically significant (OR=0.71, 95%CI: 0.55-0.91, P=0.007). Conclusion Posaconazole is more effective than other antifungal drugs in preventing IFI in patients with hematological malignancies, and has higher safety. Key words: Posaconazole; Fluconazole; Itraconazole; Voriconazole; Invasive fungal infections; Meta-analysis

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来源期刊

国际输血及血液学杂志

自引率

0.00%

发文量

10610

期刊介绍： The International Journal of Transfusion and Hematology was founded in September 1978. It is a comprehensive academic journal in the field of transfusion and hematology, supervised by the National Health Commission and co-sponsored by the Chinese Medical Association, West China Second Hospital of Sichuan University, and the Institute of Transfusion Medicine of the Chinese Academy of Medical Sciences. The journal is a comprehensive academic journal that combines the basic and clinical aspects of transfusion and hematology and is publicly distributed at home and abroad. The International Journal of Transfusion and Hematology mainly reports on the basic and clinical scientific research results and progress in the field of transfusion and hematology, new experiences, new methods, and new technologies in clinical diagnosis and treatment, introduces domestic and foreign research trends, conducts academic exchanges, and promotes the development of basic and clinical research in the field of transfusion and hematology.