本文關鍵詞：預防性應用唑類藥物對兩性霉素B治療侵襲性真菌感染影響的Meta分析　出處：《暨南大學》2014年碩士論文　論文類型：學位論文

  更多相關文章： 唑類藥物 兩性霉素B 抗真菌預防 中性粒細胞減少 Meta分析

【摘要】：目的 美國傳染病學會（2002年）和德國血液與腫瘤協(xié)會傳染病工作組（2008年）均對化療后中性粒細胞減少的患者推薦使用唑類藥物預防侵襲性真菌感染，患者一旦被診斷為侵襲性真菌感染，則選擇多烯類藥物進行治療。但其依據(jù)來源于對所有抗真菌藥物預防性應用的meta分析，缺乏單獨預防性應用唑類藥物的meta分析。本研究通過meta分析的方法驗證這種先后順序用藥的方法是否有可靠的循證醫(yī)學依據(jù)。 方法 1.檢索1966年1月至2014年2月的Pubmed、EMBASE、Web of Science、TheCochrane Central Register of Controlled Trials、EBSCO、Ovid、相關期刊論文、中國科技期刊數(shù)據(jù)庫（維普）、萬方數(shù)字化期刊全文數(shù)據(jù)庫、中國生物醫(yī)學文獻數(shù)據(jù)庫(CBM)等有關對化療后中性粒細胞減少患者預防性應用唑類藥物的臨床隨機對照試驗。以“fluconazole（氟康唑）”、“itraconazole（伊曲康唑）”、“ketoconazole(酮康唑)”、“miconazole(咪康唑)”，“voriconazole(伏立康唑)”，“posaconazole（泊沙康唑）”、“azoles(唑類藥物)”和“amphotericinB(兩性霉素B)”、“Ambisome,L-amB(兩性霉素B脂質體）”、“amphotericin Blipid complex（兩性霉素B脂質復合體）”、“amphotericin B colloidal dispersion（兩性霉素B膠狀分散體）”，“antifungal(抗真菌的)”，“candida(念珠菌屬)”、“yeast(酵母菌)”、“mold(霉菌)”、“aspergillus(曲霉菌屬)”、“zygomycosis(接合菌病)”、“mycoses（真菌�。保皀eutropenia（中性粒細胞減少癥）”、“chemotherapy（化學療法）”、“cancer(癌癥)”、“bone marrowtransplant(骨髓移植)”、“l(fā)eukemia（白血�。币约啊皃rophylaxis（預防）”等作為主題詞。 2.對符合納入標準的文獻，分別對預防性應用唑類藥物組與安慰劑或空白對照組患者的侵襲性真菌感染的死亡專率、全因死亡率的數(shù)據(jù)進行記錄。 3.采用RevMan5.2軟件對入選試驗進行Meta分析，得出合并后侵襲性真菌感染的死亡專率以及全因死亡率的相對危險度（RR）及其95%的可信區(qū)間（CI）。用漏斗圖結合Egger法、Begg法檢測潛在的發(fā)表偏倚。 結果 共納入8項隨機對照試驗（RCT），包含1435名化療后中性粒細胞減少患者符合入選標準。Meta分析結果顯示： 1.侵襲性真菌感染的死亡專率分析 預防應用唑類藥物組與安慰劑或空白對照組相比，結果顯示前期預防性應用唑類藥物，后期應用兩性霉素B進行治療，可以降低化療后中性粒細胞減少患者的侵襲性真菌感染的死亡專率，RR值為0.39（95%CI:0.18~0.86, P=0.21）。 2.全因死亡率的分析 預防應用唑類藥物組與安慰劑或空白對照組相比，結果顯示前期預防性應用唑類藥物，后期應用兩性霉素B進行治療，化療后中性粒細胞減少患者的全因死亡率無顯著統(tǒng)計學差異，RR值為1.14（95%CI:0.90~1.45, P=0.95）。結論 前期預防性應用唑類藥物，后期應用兩性霉素B進行治療，可以降低化療后中性粒細胞減少患者的侵襲性真菌感染的死亡專率，但對其全因死亡率無明顯影響。
[Abstract]:objective
The Infectious Diseases Society of America (2002) and the German Association of infectious diseases and tumor blood group (2008) of neutropenia after chemotherapy in patients with recommended azole prophylaxis of invasive fungal infection patients, once diagnosed with invasive fungal infection, then treatment of polyene drugs. But according to sources for all the antifungal drug preventive application of meta analysis, analysis of the lack of individual preventive use of azole meta. Methods this study through meta analysis and validation of this sequence of therapy is a reliable basis for evidence-based medicine.
Method
1. search from January 1966 to February 2014 Pubmed, EMBASE Web, of Science, TheCochrane Central Register of Controlled Trials, EBSCO, Ovid, Chinese CNKI, China scientific journal database (VIP), Wanfang digital periodical full-text database, China biomedical literature database (CBM) related to post chemotherapy neutropenia with preventive application of azoles in randomized clinical trials. "(Fu Kangzuo fluconazole)," itraconazole "(itraconazole)", "ketoconazole (Tong Kangzuo)," miconazole "(miconazole)", "voriconazole" (voriconazole), posaconazole (Bo Sha Kang Zuo) "," azoles (azoles) "and" amphotericinB (amphotericin B) "," Ambisome, L-amB (liposomal amphotericin B) "," amphotericin Blipid complex (amphotericin B lipid complex), "amphotericin B C" Olloidal dispersion (amphotericin B colloidal dispersion), "antifungal" (antifungal) "," Candida (Candida) "," yeast (yeast), "mold" (mould) "," Aspergillus (aspergillus) "," zygomycosis (zygomycosis) "," mycoses (fungi disease) "," neutropenia (neutropenia), "chemotherapy" (chemotherapy) "," cancer "(cancer), bone marrowtransplant (bone marrow transplant), leukemia (leukemia) and prophylaxis (prevention)" as the theme.
2., according to the inclusion criteria, the death rate and the all-cause mortality data of invasive fungal infection in the prophylactic application group were compared with those in placebo or blank control group.
3. Meta analysis was performed by RevMan5.2 software. The mortality rate and the relative risk (RR) of invasive fungal infection and the confidence interval of 95% (CI) were obtained. The potential publication bias was detected by funnel plot combined with Egger method and Begg method.
Result
A total of 8 randomized controlled trials (RCT), including 1435 patients with neutrophils after chemotherapy, were included in the.Meta analysis.
Analysis of death specificity of 1. invasive fungal infection
The application of azole prophylaxis compared with group with placebo or blank control group showed early prophylactic use of azoles, late application of amphotericin B treatment can reduce post chemotherapy neutropenia patients with invasive fungal infection of the death rate, the value of RR was 0.39 (95%CI:0.18~0.86, P=0.21).
Analysis of 2. total cause mortality
The application of azole prophylaxis compared with group with placebo or blank control group showed early prophylactic use of azoles, late application of amphotericin B treatment after chemotherapy neutropenia in patients with all-cause mortality had no significant difference. The RR value was 1.14 (95%CI,:0.90~1.45, P=0.95) conclusion.
Early prophylactic use of azole drugs and amphotericin B later can reduce the mortality rate of invasive fungal infection in patients with neutrophils after chemotherapy, but it has no significant effect on all-cause mortality.

【學位授予單位】：暨南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R519

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