摘要
目的比较利奈唑胺和万古霉素治疗革兰氏阳性菌血症的疗效和安全性。方法计算机检索Cochrane图书馆(2009年第1期)、Cochrane图书馆临床对照试验资料库(2009年第1期)、MEDLINE、EMbase、Current Controlled Trials、The National Research Register、中国生物医学文献数据库、中文科技期刊全文数据库和中文学术期刊全文数据库,手工检索相关会议的中英文论文集。纳入比较利奈唑胺和万古霉素治疗革兰氏阳性菌血症疗效和安全性的随机对照试验(RCT),评价纳入研究的内部真实性。检索时间均从建库至2009年3月10日,并采用RevMan5.0进行Meta分析。结果共纳入8个RCT,共670例患者。Meta分析结果显示,利奈唑胺在治疗革兰氏阳性菌血症方面与万古霉素疗效相当[RR=1.07,95%CI(0.98,1.17),P=0.15]。对于耐甲氧西林金葡菌引起的菌血症,尽管利奈唑胺临床治愈率略高于万古霉素,但差异并无统计学意义[RR=1.22,95%CI(0.97,1.53),P=0.10]。在治疗导管相关性菌血症中,利奈唑胺与万古霉素疗效相当[RR=1.01,95%CI(0.86,1.19),P=0.90]。利奈唑胺和万古霉素不良反应发生率无明显差异(P=0.64),两种药物引起贫血的发生率也无明显差异(P=0.48)。万古霉素组发生肾功能不全的几率为2.51%,明显高于利奈唑胺组的0.47%(P=0.0003),而利奈唑胺引起血小板减少症的几率为4.39%,明显高于万古霉素组的1.35%(P=0.01)。结论目前的研究提示,利奈唑胺在治疗革兰氏阳性菌血症方面的疗效与万古霉素相当。考虑到利奈唑胺较好的耐受性和较小的肾毒性,在治疗万古霉素耐药患者、重症患者,尤其合并肾功能不全时,可以考虑选用利奈唑胺替代万古霉素进行治疗。
Objective To compare the effectiveness and safety of linezolid with vancomycin for the treatment of people with Gram-positive bacteraemia. Methods We electronically searched The Cochrane Library （Issue 1, 2009）, MEDLINE, EMbase, Current Controlled Trials, The National Research Register, CBM disc and CNKI. We also handsearched some relevant journals. The search time was up to March 10, 2009. Randomized controlled trials of linezolid versus vancomycin for treatment of Gram-positive bacteraemia were included. Meta-analyses were performed for the results of homogeneous studies using the Cochrane Collaboration＇s RevMan 5.0 software. Results A total of 8 randomized controlled trials involving 670 patients with Gram-positive bacteraemia were included. The results indicated that there was no significant difference between linezolid and vancomycin groups in treatment of Gram- positive bacteraemia [RR= 1.07, 95%CI （0.98,1.17）, P= 0.15], MRSA bacteraemia [RR=l.22, 95%CI （0.97,1.53）, P= 0.10] or catheter-related bacteraemia [RR= 1.01, 95%CI （0.86,1.19）, P= 0.90]. There was no difference between groups in the total adverse effect （P=0.64）. The rate of renal dysfunction was higher in vancomycin group （ P=0.0003 ） and the rate of thrombopenia was higher in linezolid group （P=0.01）. Conclusion Linezolid is associated with the outcomes that are not inferior to those of vancomycin in the patients with Gram-positive bacteraemia. More high-quality, large-scale randomized controlled trials exclusive for the bacteraemia are required.
出处
《中国循证医学杂志》
CSCD
2009年第6期646-651,共6页
Chinese Journal of Evidence-based Medicine
