莫西沙星联合卷曲霉素治疗耐多药肺结核的meta分析

Meta-analysis on Moxifloxacin Combined with Capreomycin in Treatment of Patients with Multi-drug Resistant Pulmonary Tuberculosis

关键词:  莫西沙星  卷曲霉素  耐多药肺结核  meta分析

Key words:  moxifloxacin  capreomycin  multi-drug resistant pulmonary tuberculosis  meta-analysis

摘要:

目的 系统评价莫西沙星联合卷曲霉素治疗耐多药肺结核的临床疗效及安全性。方法 计算机检索中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、中文科技期刊全文数据库（VIP）、万方数据库、PubMed、EMbase和Cochrane Library，纳入莫西沙星联合卷曲霉素治疗耐多药肺结核的随机对照试验（randomized control trial，RCT），检索日期截至2018年12月。按照纳入与排除标准，由2名研究者独立筛选文献、提取资料并对纳入研究进行质量评价。采用RevMan 5.2软件进行meta分析。结果 共纳入15篇RCTs，合计1 417例患者。Meta分析结果显示，莫西沙星与卷曲霉素联合治疗组的临床总体有效率、空洞闭合率、病灶吸收率及痰菌转阴率均高于对照组，差异具有统计学意义（P<0.05）。治疗组不良反应经对症处理可恢复，与对照组相比无统计学差异。结论 现有证据表明，含莫西沙星与卷曲霉素的联合方案可以更有效地治疗我国耐多药肺结核患者，能有效促进空洞闭合与病灶吸收，并提高痰菌阴转率，且未增加不良反应发生风险。

Abstract:

OBJECTIVE To systematically evaluate the clinical efficacy and safety of moxifloxacin combined with capreomycin in treatment of patients with multi-drug resistant pulmonary tuberculosis(MDR-PTB). METHODS China national knowledge infrastructure(CNKI), China biology medicine(CBM), VIP, WanFang database, PubMed, EMbase, Cochrane Library was searched by computer. Randomized controlled trial(RCT) of moxifloxacin combined with capreomycin in treating MDR-PTB were included before the deadline of December 2018. According to the inclusive and exclusive criteria, the literatures and data were independently screened and extracted by two researchers, meanwhile the quality of the included studies were assessed. Meta-analysis was conducted by RevMan 5.2 software. RESULTS A total of fifteen RCTs including 1 417 patients. Meta-analysis showed that the total clinical effective rate, cavity closure rate, focus absorption rate and sputum bacteria negative conversion rate in moxifloxacin combined with capreomycin group were superior to the control group, the difference was statistically significant(P<0.05). The adverse reactions in treatment group could be recovered after symptomatic treatment without significant differences compared with control group. CONCLUSION The current evidence indicates that moxifloxacin combined with capreomycin have a better effect in treating patients with MDR-PTB in China, and it can effectively promote cavity closure and lesion absorption, improve sputum bacteria negative conversion rate with no significance in adverse effect.