加替沙星和左氧氟沙星对急性细菌性结膜炎有效性与安全性的Meta分析

目的:运用Meta分析系统评价加替沙星滴眼液和左氧氟沙星滴眼液对急性细菌性结膜炎的临床疗效及安全性。方法:按Cochrane系统评价方法,以“加替沙星”“左氧氟沙星”“急性细菌性结膜炎”为关键词,检索Embase、Cochrane library、Pubmed、Medline、中国知网数据库、万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库,从建库开始时间检索至2021-03-01。纳入比较加替沙星滴眼液和左氧氟沙星滴眼液治疗急性细菌性结膜炎的随机对照研究。采用Cochrane偏倚风险评估工具对纳入研究进行质量评价,使用RevMan5.3统计软件进行Meta分析,运用Stata12中Egger检验分析发表性偏倚,并按照GRADE系统评估证据水平。结果:共纳入10项随机对照研究,合计1149例患者。对照组采用左氧氟沙星滴眼液治疗,试验组采用加替沙星滴眼液滴眼液治疗。Meta分析结果表明加替沙星滴眼液组对于急性细菌性结膜炎临床有效率优于左氧氟沙星滴眼液组(OR=3.75,95%CI:2.52~5.58,P<0.00001),Egger检验提示存在发表偏倚,且GRADE评价结果显示该证据水平为“很低”;加替沙星滴眼液组药物不良反应发生率低于左氧氟沙星滴眼液组(OR=0.37,95%CI:0.19~0.71,P=0.003);Egger检验提示不存在发表偏倚,且根据GRADE方法评价,该证据水平为“低”。结论:加替沙星滴眼液对于急性细菌性结膜炎的疗效优于左氧氟沙星滴眼液,且不良反应发生率较低;但由于纳入的研究证据水平较低,需要更多的多中心、随机双盲临床试验,从而提高加替沙星滴眼液治疗急性细菌性结膜炎临床疗效的证据强度。

Meta-analysis of the efficacy and safety of Gatifloxacin and Levofloxacin in the acute bacterial conjunctivitis

AIM:To compare the clinical efficacy and safety of gatifloxacin eye drops and levofloxacin eye drops in the treatment of acute bacterial conjunctivitis using Meta-analysis.METHODS:According to the Cochrane systematic evaluation method,“gatifloxacin”“levofloxacin”and“acute bacterial conjunctivitis”were used as keywords for literature search in Embase,Cochrane library,Pubmed,Medline,CNKI,Wanfang,VIP and CBMdisc from the establishment of the database to March 1,2021.Randomized controlled trials(RCTs)gatifloxacin eye drops and levofloxacin eye drops in the treatment of acute bacterial conjunctivitis were included.Cochrane bias risk assessment tool was used to evaluate the quality of the included studies.RevMan5.3 software was used for combined analysis.Egger’s test in Stata12 was used to assess publication bias,and the level of evidence was evaluated according to the GRADE system.RESULTS:A total of 10 RCTs were included in this study with 1149 patients.The control group was treated with levofloxacin and the experimental group was treated with gatifloxacin.The results of Meta-analysis showed that the clinical effective rate of acute bacterial conjunctivitis in gatifloxacin group was higher than that in levofloxacin group(OR=3.75,95%CI:2.52-5.58,P<0.00001).Egger’s test suggested there was publication bias among studies.And GRADE rating results indicated,the level of evidence was VERY LOW.The incidence of adverse drug reactions in the gatifloxacin group was lower than that in levofloxacin group(OR=0.37,95%CI:0.19-0.71,P=0.003).No publication bias was observed in Egger’s test and GRADE showed the level of evidence was LOW.CONCLUSION:Gatifloxacin eye drops is more effective than levofloxacin eye drops in the treatment of acute bacterial conjunctivitis,and has lower adverse effect rates.And due to the low levels of evidence included,more multicenter,randomized double-blind clinical trials are needed to improve the strength of evidence for the clinical efficacy of gatifloxacin eye drops in the treatment of acute bacterial conjunctivitis.