两性霉素B、氟康唑和伊曲康唑治疗AIDS合并马尔尼菲青霉病疗效的Meta分析

目的采用Meta分析评价两性霉素B、氟康唑与伊曲康唑对AIDS合并马尔尼菲青霉病(penicilliosis marneffei,PSM)的治疗效果。方法检索Cochrane图书馆、美国国立医学图书馆Pub Med数据库、美国Ovid数据库、荷兰医学文摘数据库、万方数据库、中国知网CNKI全文数据库和中国生物医学文献数据库,按照Cochrane协作网推荐的纳入标准筛选文献并进行质量评价,采用Stata 12.0进行Meta分析。结果纳入文献6篇,AIDS合并PSM共893例,其中两性霉素B治疗467例,氟康唑治疗152例,伊曲康唑治疗274例。Meta分析结果显示:两性霉素B治疗好转率高于氟康唑OR=7.138(95%CI 1.761~28.932),P0.05],病死率低于氟康唑OR=0.507(95%CI 0.294~0.875),P0.05],差异均具有统计学意义;两性霉素B与伊曲康唑对比,治疗好转率OR=0.777(95%CI 0.498~1.212),P0.05]和病死率OR=1.427(95%CI 0.890~2.287),P0.05]差异均无统计学意。结论两性霉素B治疗AIDS合并PSM效果优于氟康唑,与伊曲康唑比较疗效无明显差异。今后应积累更多前瞻性资料进一步证实。

Efficacy of amphotericin B,fluconazole and itraconazole in treatment of AIDS complicated by penicilliosis marneffei: a meta-analysis

Objective To evaluate the efficacy of amphotericin B, fluconazole and itraconazole in treatment of AIDS complicated by penicilliosis marneffei (PSM) with meta-analysis.Methods Cochrane Library, PubMed, Ovid database, Embase database, Wanfang database, National Knowledge Infrastructure full-text database and China BioMedical Literature database were searched. Literatures were selected according to the criteria recommended by Cochrane Method Group and evaluated according to the quality. Meta-analysis was performed with Stata version 12.0.Results Six papers were identified, in which a total of 893 AIDS patients with PSM were recruited, 467 patients receiving amphotericin B, 152 patients fluconazole and 274 patients itraconazole. Meta-analysis showed that patients receiving amphotericin B had a higher recovery rate OR=7.138 (95%CI 1.761-28.932),P<0.05] and a lower mortality rate OR=0.507 (95%CI0.294-0.875),P<0.05] than patients receiving fluconazole, and the differences between the two patient groups were significant. The recovery rate OR=0.777 (95%CI 0.498-1.212),P>0.05] and mortality rate OR=1.427 (95%CI 0.890-2.287),P>0.05] were not significantly different between patients receiving amphotericin B and those receiving itraconazole.Conclusions Amphotericin B has a better efficacy in treatment of AIDS complicated by PSM than fluconazole, and the treatment efficacy is not significantly different between amphotericin B and itraconazole. More prospective data need to be accumulated for further verification.