27)加替沙星治疗难治耐多药肺结核有效性和安全性的系统评价余文韬.doc

*在读硕士研究生 研究方向：临床药学。 电话 E-mail:  HYPERLINK mailto:flyingpig211@ flyingpig211@。 #通讯作者：教授，硕士研究生导师。 研究方向：临床药学。 电话：028 E-mail:  HYPERLINK mailto:tangyao@ tangyao@。 加替沙星治疗难治、耐多药肺结核 有效性和安全性的系统评价 余文韬*，尹茜，吴斌，唐尧# （四川大学华西医院药剂科，成都市） 摘要 目的:系统评价加替沙星治疗难治、耐多药肺结核的疗效和安全性。方法：计算机检索Cochrane图书馆和PubMed、EMASE、CBM、VIP、CNKI数据库，按纳入排除标准选择试验，并对其进行质量评价。用RevMan5.0软件对数据进行Meta分析。结果：共纳入12篇研究， Meta分析结果显示加替沙星治疗组与对照组相比，痰菌转阴率、病灶吸收情况、空洞改变的情况均优于对照组，差异具有统计学意义（P0.05）。结论：目前现有的证据表明，加替沙星与一线抗结核药物联用治疗难治、耐多药肺结核的疗效优于一线抗结核药物的方案，且加替沙星可能是优于左氧氟沙星的氟喹诺酮类二线抗结核药物，但由于纳入的文献数量有限，质量普遍不高，存在潜在的发表偏倚上述结果有待高质量，大样本的随机双盲对照试验加以验证。 关键词 加替沙星；抗结核药物；肺结核；系统评价 Systematic review of combination regimens with gatifloxacin in treatment of MDR-TB ABSTRACT: OBJECTIVE: to assess the clinical efficacy of combination regimens with gatifloxacin in treatment of MDR-TB. METHOD: literatures were retrieved from PuMed, EMBASE, Cochrane, SCI, CBM, VIP, CNKI, WangFang databases by computer. Literatures were enrolled according to including criteria and excluding criteria, the quality were evaluated and meta-analysis was conducted by RevMan 5.0 software. RESULT: the meta-analysis of 12 included RCTs showed that sputum culture conversion rate, focus absoption rate, cavity change rate in trial group were significantly differenet from control group(P＜0.5).CONCLUSION:The analysis indicates gatifloxacin with first-line antituberculosis drugs has a better effect in treatment of MDR-TB than first-line antituberculosis drugs alone. Plus, gaitfloxacin, which belongs to fluoroquinolones, maybe a better choice than levofloxacin. However, the reliability of this review is affected by poor quality of included studys, large-scale randomized controlled trials of high quality are needed to confirm the above conclusions. KEY WORDS Gatifloxacin; Antituberculosis drug; Pulmonary tuberculosis; Systematic review 难治性、耐多药肺结核（MDR-TB）是近年来全球结核病疫情回升的重要原因之一【1】,而中国的MDR-TB患者数居全球第二[2]。加替沙星是氟喹诺酮类药物，对细胞内和细胞外结核菌抑菌活性均高于左氧氟沙星，其抗菌机制是抑制细菌DNA的复制、转录和修复过程，且与标准化疗抗结核