降钙素原指导小儿呼吸道感染抗生素应用的系统评价

目的系统评价降钙素原指导小儿呼吸道感染抗生素应用的有效性、安全性和经济性。方法对中英文数据库进行计算机检索,英文数据库为PubMed、EMBase、The Cochrane Library(2018年3期),中文数据库为CNKI、CBM、VIP和Wan Fang Data。搜集降钙素原指导小儿呼吸道感染抗生素应用的随机对照试验,检索自建库截止至2018年3月。由2位研究人员独立进行文献筛选、数据提取和质量评价后,采用RevMan5.3软件进行Meta分析。结果共纳入8个随机对照试验,包括1601例患者,Meta分析结果显示:在有效性方面,降钙素原指导小儿呼吸道感染抗生素应用与常规应用抗生素相比,可显著提高患者治疗后的有效率RR=1.10,95%CI(1.04,1.16),P=0.001],降低咳嗽时间MD=-0.46,95%CI(-0.78,-0.14),P=0.004]、抗生素使用时间MD=-2.28,95%CI(-2.59,-1.97),P<0.00001]、住院时间MD=-2.12,95%CI(-3.13,-1.11),P<0.0001],且差异均具有统计学意义;在安全性方面,不良反应发生率差异不具有统计学意义RR=0.99,95%CI(0.81,1.22),P=0.96];经济性方面,应用降钙素原指导可以降低抗生素使用费用SMD=-3.39,95%CI(-4.51,-2.26),P<0.00001]。结论当前证据表明,降钙素原指导小儿呼吸道感染抗生素应用效果显著,可以使患儿获得持续的临床缓解,并降低患儿抗生素使用费用。受纳入研究数量和质量的影响,上述结论尚需大样本高质量临床研究予以证实。

Procalcitonin guided antibiotic application of respiratory tract infections in children: A systematic review

Objective To systematically review the effectiveness, safety, and economics of procalcitonin in the use of antibiotics in children with respiratory tract infections. Methods Databases including PubMed, EMBase, The Cochrane Library (Issue 3, 2018), CBM, CNKI, VIP, and Wan Fang Data were searched to collect randomized controlled trials (RCTs) about the effectiveness, safety, and economics of procalcitonin in the use of antibiotics in children with respiratory tract infections till March 2018. Two reviewers independently screened literatures, extracted data, and assessed the quality of included studies. Then Meta-analysis was conducted by the RevMan 5.3 software. Results A total of eight studies involving 1,601 patients were included. The results of Meta-analysis showed that in terms of effectiveness, the use of procalcitonin in the treatment of antibiotics in children with respiratory tract infections could significantly improve the efficacy of post-treatment patients compared with the routine use of antibiotics RR=1.10, 95%CI(1.04, 1.16), P=0.001], reduce cough time MD=-0.46, 95%CI(-0.78, -0.14), P=0.004], antibiotic use time MD=-2.28, 95%CI(-2.59, -1.97), P＜0.00001], hospital stay MD=-2.12, 95%CI(-3.13, -1.11), P＜0.0001], and the difference was statistically significant. In terms of safety, the difference in the incidence of adverse reactions was not statistically significant RR=0.99, 95%CI(0.81, 1.22), P=0.96]. In terms of economy, the application of calcitonin guide can reduce antibiotic use costsSMD=-3.39, 95%CI(-4.51, -2.26), P＜0.00001]. Conclusion Current evidence shows that the procalcitonin has a significant effect on the use of antibiotics in the treatment of respiratory tract infections in children. It can provide sustained clinical remission for children and reduce the use of antibiotics in children. Due to the limited quality of included studies, the above conclusion still needs to be verified by more high quality