抗感染药物治疗药物监测的Meta分析

摘要

Objective:To evaluate the effect of therapeutic drug monitoring(TDM) on the clinical efficacy of anti-infective drugs.Methods:Databases were searched including Pubmed,EMbase,The Cochrane Library,CBMDISC and CNKI for random controlled trials and self-controlled studies.For homogeneous studies,meta-analysis was performed to compare the differences in duration of therapy,hospital stay,incidence of nephrotoxicity,total cumulative drug doses and the rate of reaching target concentration between TDM and non-TDM groups.Results:Twenty studies involving 17 755 participants were included.Four studies showed that the duration of vancomycin therapy of TDM group was significantly shorter than non-TDM group [MD =-2.85,95％ CI (-5.46,-0.23),P =0.03].Five studies showed that the hospital stay of the patients treated with aminoglycosides in TDM group was significantly shorter than non-TDM group [MD =-5.03,95％ CI (-7.18,-2.88),P ＜ 0.000 01].Six studies showed that the incidence of nephrotoxicity in TDM group was significantly lower than that of non-TDM group [OR =0.27,95％ C I (0.16,0.46),P ＜ 0.000 01].Six studies showed that the cumulative drug doses of TDM group were not significantly less than that of non-TDM group (P ＞ 0.05).Five studies showed that the rate of reaching target concentration in patients treated with aminoglycosides in TDM group was significantly higher than that of non-TDM group [OR =4.01,95 ％ CI (2.89,5.56),P ＜ 0.000 01].Conclusion:TDM can significantly decrease the duration of therapy,hospital stay,incidence of nephrotoxicity and increase the rate of reaching target concentration,which suggests that TDM might be beneficial to achieve better clinical effects.%目的:系统评价抗感染药物的治疗药物监测(TDM)对临床疗效的影响.方法:采用Cochrane系统评价方法,搜索世界医学文献数据库(Pubmed)、荷兰医学文摘(EMbase)、Cochrane图书馆、中国生物医学文献(C BMDisc)、中国期刊全文专题数据库(CNKI)等数据库.检索收集全世界范围内抗感染药物的治疗药物监测的随机对照研究和自身对照研究,对符合纳入标准的临床研究进行质量评价和资料提取后,采用RevMan 5.1进行Meta分析,比较其TDM组和非TDM组在使用抗感染药物治疗时间、住院日、药物使用剂量等方面的差异.结果:共纳入20个研究,合计17 755例患者.共评估了TDM对5项指标的影响,包括抗感染治疗药物时间,住院时间,肾毒性发生率,药物累计总剂量和血药浓度在靶浓度范围内的比率.4项研究结果显示,在使用万古霉素的研究中,进行TDM的患者与不进行TDM的患者相比,抗感染药物治疗时间显著缩短[MD=-2.85,95％ CI(-5.46,-0.23),P=0.03];5项研究结果显示,在使用氨基糖苷类药物的研究中,进行TDM的患者与不进行TDM的患者相比,住院时间显著缩短[MD=-5.03,95％ CI(-7.18,-2.88),P＜0.00001];6项研究结果显示,进行TDM的患者与不进行TDM的患者相比,肾毒性发生率显著降低[OR =0.27,95％ CI(0.16,0.46),P＜0.000 01];6项研究结果显示,在降低使用药物累计总剂量方面两组差异无统计学意义(P＞0.05);5项研究结果显示,在使用氨基糖苷类药物的研究中,进行TDM组的血药浓度在靶浓度范围内的比率显著高于非TDM组[OR =4.01,95％ CI(2.89,5.56),P＜0.000 01].结论:本系统评价结果表明,在使用抗感染药物进行治疗的患者中,TDM组与非TDM组相比,可缩短抗感染药物治疗时间、缩短住院日、降低肾毒性发生率、提高血药浓度达到靶浓度比率,但对于抗菌药物使用的累计剂量无显著影响,因此,抗感染药物的TDM可以提高临床疗效.