布病抗生素治疗的Meta分析

摘要

目的:系统评价目前最常用布病疗法的有效性和安全性.方法:检索PubMed和Cochrane协作网的CENTRAL数据库中1985年至今全部有关布病治疗的英文文献以及CBM数据库中所有有关布病的中文随机对照试验.使用Cochrane协作网推荐的随机对照实验偏倚风险评估工具评估纳入研究质量.使用固定效应模型M-H法合并和分析不同抗生素组合治疗布病的复发率,总体治疗失败率和不良反应率.结果:共纳入随机对照实验17篇.比较了DR、DS、QR、DG等抗生素联合治疗方案.DS治疗方案总体治疗失败率(RR合并:2.53,95%CI:1.51~4.23)和复发率(RR合并:2.69,95%CI:1.46~4.98)低于DR方案,不良反应率二者无显著差别(RR合并:1.40, 95%CI:0.97~2.01);QR组和DR组的复发率(RR合并:1.24,95%CI:0.67~2.30)和总体治疗失败率(RR合并:1.41,95%CI:0.86~2.32)并无显著差异.不良反应方面,QR组低于DR组(RR合并:1.79,95%CI:1.17~2.74).结论:DS治疗方案治疗布病优于DR;QR组与DR组疗效相差无几,但QR方案不良反应更少;双抗治疗的基础上再增加一种抗生素可以提高治疗效果,不良反应率没有明显升高,但仍需更多临床证据证明.%Objective:To evaluate the effectiveness and safety of most common used regimens against brucellosis.Methods: Search PubMed and CENTRAL database of Cochrane library for all literatures written in English about treatment of brucellosis and CBM database for all RCTs for Brucellosis in Chinese from the year 1985 till now.Assess the quality of the included literatures using Cochrane Collaboration Risk of Bias form.Combine data of relapse,total therapeutic failure,and adverse reaction of regimens for treating human brucellosis.Results: 17 literatures were included.Combined antibiotic therapeutic regimens such as DR,DS,QR and DG were compared.Rate of total therapeutic failure(RRcb:2.53,95%CI:1.51-4.23) and relapse(RRcb:2.69,95%CI:1.46-4.98) of DS regimen was lower than those of DR regimen,while adverse reaction did not show any significant differences between them(RRcb:1.40,95%CI:0.97-2.01).No significant differences were seen in rate of relapse(RRcb:1.24,95%CI:0.67-2.30) and total therapeutic failure(RRcb:1.41,95%CI:0.86-2.32) between QR and DR regimen.QR regimen had lower rate of adverse reaction than DR regimen(RRcb:1.79,95%CI:1.17-2.74).Conclusion: DS regimen priors to DR regimen.QR equals DR in treatment outcome,has fewer adverse reactions meanwhile.Triple antimicrobial based on double regimens seemed to provide better outcomes without a significant increase in adverse reaction,but more clinical evidences are still needed.