比阿培南与亚胺培南/西司他丁治疗中、重度下呼吸道感染的Meta分析

目的:系统评价比阿培南与亚胺培南/西司他丁治疗中、重度下呼吸道感染(LRTIs)的有效性和安全性。方法:计算机检索截至2011年12月Pubmed、Science Direct、中国期刊全文数据库(CNKI)、万方数据库、维普数据库和中国生物医学文献数据库中关于比阿培南与亚胺培南/西司他丁随机对照治疗中、重度LRTIs的文献,对检索文献进行质量评价及筛选,采用Rev Man 5.1软件对最终纳入文献的研究结果进行Meta分析。结果:共纳入10项随机对照试验,总共949例患者。Meta分析结果显示,比阿培南在中、重度LRTIs治疗中的临床有效率显著高于亚胺培南/西司他丁[OR=1.53,95%CI(1.09,2.14),P=0.01],细菌清除率亦显著高于亚胺培南/西司他丁[OR=2.05,95%CI(1.31,3.23),P=0.002];二者临床痊愈率[OR=1.19,95%CI(0.90,1.59),P=0.22]及总不良反应发生率[OR=0.70,95%C(I0.41,1.18),P=0.18]比较差异无统计学意义,但亚胺培南/西司他丁中枢神经系统不良反应发生率较高(P<0.05)。结论:比阿培南在中、重度LRTIs治疗中的临床有效率和细菌清除率均优于亚胺培南/西司他丁,且中枢神经系统不良反应发生率低于亚胺培南/西司他丁。

Meta-analysis of the Treatment of Moderate or Severe Lower Respiratory Tract Infections with Biapenem and Imipenem/Cilastatin

OBJECTIVE：To evaluate the efficacy and safety of biapenem and imipenem/cilastatin in the treatment of moderate or severe lower respiratory tract infections.METHODS：The randomized controlled trials（RCTs） about biapenem and imipenem/cilastatin in the treatment of moderate or severe lower respiratory tract infections were collected from Pubmed,Science Direct,CNKI,Wanfang database,VIP and CBM.The quality of the trials was evaluated and selected,and the results of the studies were reviewed and analyzed using Rev Man 5.1 software.RESULTS：10 RCTs were included,involving 949 patient.Meta-analysis showed that effective rate of biapenem was higher than that of imipenem/cilastatin in the treatment of moderate or severe lower respiratory tract infections [OR=1.53,95%CI（1.09,2.14）,P=0.01].The rate of bacterial clearance of biapenem was higher than that of imipenem/cilastatin [OR=2.05,95%CI（1.31,3.23）,P=0.002].There was no statistical significance in cure rate [OR=1.19,95%CI（0.90,1.59）,P=0.22] and total incidence of ADR [OR=0.70,95%CI（0.41,1.18）,P=0.18],but the incidence of adverse reaction in central nervous system was higher in imipenem/cilastatin group（P0.05）.CONCLUSION：The effective rate and bacterial eradication rate of biapenem is better than imipenem/cilastatin in the treatment of moderate or severe lower respiratory tract infections.Moreover,biapenem shows significantly lower incidence of adverse reaction in central nervous system than imipenem/cilastatin.