四种抗真菌药物治疗甲癣疗效比较的文献系统复习

目的比较特比萘芬与伊曲康唑、氟康唑、灰黄霉素治疗甲癣疗效的差异。方法检索Medline文献数据库,查找所有比较特比萘芬与伊曲康唑、氟康唑、灰黄霉素治疗甲癣的双盲随机对照试验的文献,找出这4种药物治疗甲癣的真菌学治愈率并对其进行汇总,得出合并后真菌学治愈率的比值比(OR)及其95%可信区间(CI)。结果①有6篇比较特比萘芬与伊曲康唑、1篇特比萘芬与氟康唑、2篇特比萘芬与灰黄霉素治疗甲癣的双盲随机对照试验文献被纳入。②特比萘芬250mg/d连续疗法优于伊曲康唑400mg/d冲击疗法OR=5.01,95%CI(3.42～7.33)]和伊曲康唑200mg/d连续疗法OR=2.58,95%CI(1.91～3.49)]。特比萘芬的疗效亦优于氟康唑(P<0.001)和灰黄霉素OR=3.46,95%CI(1.89～6.31)]。结论特比萘芬治疗甲癣的疗效优于伊曲康唑、氟康唑和灰黄霉素。

The Efficacy of Four Antifungal Agents in the Treatment of Dermatophyte Onychomycosis: A Systemic Review

Objective To compare the efficacy of terbinafine with itraconazole,fluconazole and griseofulvin in the treatment of dermatophyte onychomycosis.Methods In order to find the double blind randomized clinical trials comparing the efficacy of terbinafine with itraconazole,fluconazole,and griseofulvin in the treatment of dermatophyte onychomycosis,the medical database of Medline was searched,and the data of the mycological cure rates of these four antifungal agents were extracted from the published papers and then were pooled.The odds ratios and the 95% confidence intervals of the mycological cure rates were calculated.Results ①Six,one and two double blind randomized clinical trials comparing the efficacy of terbinafine with itraconazole, fluconazole and griseofulvin in the treatment of dermatophyte onycomycosis were included into this article. ②Continuous terbinafine 250 mg per day was more effective than itraconazole pulse 400mg per day OR=5.01,95%CI (3.42～7.33)] and continuous itraconazole 200mg per day OR=2.58,95%CI (1.91～3.49)].Terbinafine was more effective than fluconazole (P﹤0.001) and griseofulvin OR=3.46,95%CI (1.89～6.31)], too.Conclusion Terbinafine is more effective than itraconazole, fluconazole and griseofulvin in the treatment of dermatophyte onychomycosis.