伊曲康唑预防血液病患者侵袭性真菌感染疗效的Meta分析

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Cochrane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RevMan5.1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%C(I0.54,0.96),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。

Meta-analysis of Therapeutic Efficacy of Itraconazole against Invasive Fungal Infection in Hematology Pa- tients

OBJECTIVE： To evaluate the therapeutic efficacy of itraconazole agansit invasive fungal infection （IFI） in hematol- ogy patients underwent chemotherapy or hematopoietic stem cell transplantation （HSCT）. METHODS： Retrieved from Cochrane li- brary, Medline, EMbase, PubMed, CBM Database, CNKI, VIP database and Wanfang database and manual retrieval, related pro- ceedings were collected. The Meta-analysis was performed by Rev Man 5.1 software. RESULTS： 14 literatures were included, in- volving 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 sta- tistical significance in the difference of overall mortality and infection rate of Candidiasis spp. between itraconazole group and con- trol group. CONCLUSION： The therapeutic efficacy of itraconazole against invasive fungal infection in hematology patients under- went chemotherapy and HSCT is better than fluconazole and worse than posaconazole, and equivalent with amphotericin B, caspo- ftmgin, voriconazole.