美罗培南与亚胺培南/西司他丁在治疗重症感染患者中的安全性Meta分析

目的通过对目前文献的评价,比较碳青霉烯类药物美罗培南(MPEM)与亚胺培南/西司他丁(IPM/CST)在治疗重症感染中的安全性,为临床选择药物提供一定的安全依据。方法利用计算机检索中国知网全文数据库(CNKI)、维普、万方、中国生物医学文献数据库(CBM)、PubMed5大数据库,收集自1990年以来国内外公开发表的关于MPEM与IPM/CST治疗重症感染的随机对照试验RCTs;剔除不符合纳入标准的文献,提取文献中关于不良反应例数、症状数据并采用Rev-Man5.3软件对纳入文献进行安全性评价。结果通过筛选纳入41个文献,整体结果不能说明美罗培南在治疗重症感染中的不良反应发生率比亚胺培南/西司他丁低(Z=1.99,P=0.05)。亚组分析中,在治疗下呼吸道感染时,美罗培南的不良反应发生率低于亚胺培南/西司他丁(Z=2.54,P=0.01<0.05)。在治疗腹腔感染的不良反应发生率无显著性差异(Z=0.79,P=0.43>0.05)。不良反应发生症状显示两者消化系统最多,循环系统、皮肤及注射部分依次。美罗培南引起皮疹多于亚胺培南/西司他丁;而亚胺培南/西司他丁在其他系统中发生的不良反应例数都高于美罗培南。结论美罗培南与亚胺培南/西司他丁在治疗重症患者时不良反应发生率相当,仅发生在治疗下呼吸道感染时。皮疹的发生美罗培南多于亚胺培南/西司他丁,其他症状都低于亚胺培南/西司他丁。

Safety evaluation of meropenem and imipenem/cilastatin in the treatment of severe infections

Objective To compare the safety of carbapenem drug meropenem (MPEM) and imipenem-cilastatin (IPM/CST) in the treatment of severe infections and to provide a safety basis for clinical drug selection. Methods CNKI, Weipu, Wanfang, CBM, and Pubmed were searched to collects RCTs of randomized controlled trials on MPEM and IPM / CST in the treatment of severe infections published at home and abroad since 1990. RevMan 5.3 software was used to evaluate the safety. Results 41 literatures were selected. The overall results showed that the incidence of adverse reactions of meropenem in the treatment of severe infections was not lower than imipenem/cilastatin (Z=1.99, P=0.05). In subgroup analysis, the incidence of adverse reactions of meropenem was lower than that of imipenem/cilastatin in the treatment of lower respiratory tract infections (Z=2.54, P=0.01<0.05). There was no significant difference in the incidence of adverse reactions in the treatment of abdominal infections (Z=0.79, P=0.43>0.05). Symptoms of adverse reactions showed that digestive system was the most common, followed bythe circulatory system, skin, and the injection part. Meropenem caused more rashes than imipenem/cilastatin, while imipenem/cilastatin caused more adverse reactions in other systems. Conclusions The rate of adverse reactions of meropenem and imipenem/cilastatin in the treatment of severe infections was similar, it was lower only in the lower respiratory tract infections. Meropenem was more common than imipenem/cilastatin in the occurrence of rash, but other symptoms were lower than