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两性霉素B膀胱冲洗治疗真菌尿的荟萃分析

白向荣 程红勤 张雁 金颖

白向荣, 程红勤, 张雁, 金颖. 两性霉素B膀胱冲洗治疗真菌尿的荟萃分析[J]. 药学实践与服务, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
引用本文: 白向荣, 程红勤, 张雁, 金颖. 两性霉素B膀胱冲洗治疗真菌尿的荟萃分析[J]. 药学实践与服务, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
BAI Xiangrong, CHENG Hongqin, ZHANG Yan, JIN Yin. A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
Citation: BAI Xiangrong, CHENG Hongqin, ZHANG Yan, JIN Yin. A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021

两性霉素B膀胱冲洗治疗真菌尿的荟萃分析

doi: 10.3969/j.issn.1006-0111.2018.04.021

A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection

  • 摘要: 目的 系统评价两性霉素B膀胱冲洗真菌尿路感染的有效性和安全性。 方法 检索Pubmed、Embase、WEB OF SCIENCE、Cochrane图书馆、万方数据库、维普数据库、中国生物医学文献服务系统数据库。纳入两性霉素B膀胱冲洗治疗真菌尿路感染作用的横断面或对照研究。 结果 共纳入12个随机对照研究,853例患者,荟萃(Meta)分析结果表明,两性霉素B膀胱冲洗后24 h和 > 5 d,真菌清除率分别为0.81[0.75,0.87]和0.71[0.63, 0.79],具有统计学意义。冲洗后24 h真菌清除率结果:持续冲洗的真菌清除率为0.83[0.75,0.91],间断冲洗的真菌清除率为0.78[0.68,0.88]。冲洗后 > 5 d真菌清除率结果:持续冲洗的真菌清除率为0.74[0.65,0.84],而间断冲洗的真菌清除率为0.60[0.44,0.76]。差异均具有统计学意义。两性霉素B膀胱冲洗与氟康唑相比,在冲洗后24 h真菌清除率和冲洗后 > 5 d真菌清除率分别为1.27[1.07,1.50]和0.92[0.78,1.10]。安全性方面有血尿的报道。 结论 两性霉素B膀胱冲洗具有真菌清除作用,持续冲洗方式优于间断冲洗。具有与全身使用氟康唑相同的真菌清除效果,可以作为尿路感染的治疗方案。但由于受纳入文献的数质量的限制,仍然需要大规模、设计严谨的随机、对照、双盲的临床试验去进一步验证其效果。
  • [1] WISE GJ,WAINSTEIN S,GOLDBERG P,et al. Candidal cystitis. Management by continuous bladder irrigation with amphotericin B[J]. JAMA,1973,224(12):1636-1637.
    [2] WISE GJ,KOZINN PJ,GOLDBERG P. Amphotericin B as a urologic irrigant in the management of noninvasive candiduria[J]. J Urol,1982,128(1):82-84.
    [3] HSU CC,UKLEJA B. Clearance of Candida colonizing the urinary bladder by a two-day amphotericin B irrigation[J]. Infection,1990,18(5):280-282.
    [4] JACOBS LG,SKIDMORE EA,CARDOSO LA,et al. Bladder irrigation with amphotericin B for treatment of fungal urinary tract infections[J]. Clin Infect Dis,1994,18(3):313-318.
    [5] TRINH T,SIMONIAN J,VIGIL S,et al. Continuous versus intermittent bladder irrigation of amphotericin B for the treatment of candiduria[J]. J Urol,1995,154(6):2032-2034.
    [6] LEU HS,HUANG CT. Clearance of funguria with short-course antifungal regimens:a prospective,randomized,controlled study[J]. Clin Infect Dis,1995,20(5):1152-1157.
    [7] FAN-HAVARD P,O'DONOVAN C,SMITH SM,et al. Oral fluconazole versus amphotericin B bladder irrigation for treatment of candidal funguria[J]. Clin Infect Dis,1995,21(4):960-965.
    [8] FONG IW. The value of a single amphotericin B bladder washout in candiduria[J]. J Antimicrob Chemother,1995,36(6):1067-1071.
    [9] JACOBS LG,SKIDMORE EA,FREEMAN K,et al. Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients[J]. Clin Infect Dis,1996,22(1):30-35.
    [10] NESBIT SA,KATZ LE,MCCLAIN BW,et al. Comparison of two concentrations of amphotericin B bladder irrigation in the treatment of funguria in patients with indwelling urinary catheters[J]. Am J Health Syst Pharm,1999,56(9):872-875.
    [11] 朱卫华,马峰. 两性霉素B膀胱冲洗治疗尿路真菌感染临床分析[J]. 中外医疗,2015,34(18):127-128,131.
    [12] SULLIVAN KA,CAYLOR MM,LIN FC,et al. Comparison of amphotericin B bladder irrigations versus fluconazole for the treatment of candiduria in intensive care unit patients[J]. J Pharm Pract,2017,30(3):347-352.
    [13] PAPPAS PG,KAUFFMAN CA,ANDES DR,et al. Clinical practice guideline for the management of candidiasis:2016 update by the Infectious Diseases Society of America[J]. Clin Infect Dis,2016,62(4):e1-50.
    [14] 李延鸿,朱怀军. 膀胱冲洗对预防留置导尿管引起尿路感染作用的系统评价[J]. 实用药物与临床,2012,15(8):494-496.
    [15] SOBEL JD,KAUFFMAN CA,MCKINSEY D,et al. Candiduria:a randomized,double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group[J]. Clin Infect Dis,2000,30(1):19-24.
    [16] TUON FF,AMATO VS,PENTEADO FILHO SR. Bladder irrigation with amphotericin B and fungal urinary tract infection systematic review with Meta-analysis[J]. Int J Infect Dis,2009,13(6):701-706.
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  • 收稿日期:  2017-07-03
  • 修回日期:  2018-01-19

两性霉素B膀胱冲洗治疗真菌尿的荟萃分析

doi: 10.3969/j.issn.1006-0111.2018.04.021

摘要: 目的 系统评价两性霉素B膀胱冲洗真菌尿路感染的有效性和安全性。 方法 检索Pubmed、Embase、WEB OF SCIENCE、Cochrane图书馆、万方数据库、维普数据库、中国生物医学文献服务系统数据库。纳入两性霉素B膀胱冲洗治疗真菌尿路感染作用的横断面或对照研究。 结果 共纳入12个随机对照研究,853例患者,荟萃(Meta)分析结果表明,两性霉素B膀胱冲洗后24 h和 > 5 d,真菌清除率分别为0.81[0.75,0.87]和0.71[0.63, 0.79],具有统计学意义。冲洗后24 h真菌清除率结果:持续冲洗的真菌清除率为0.83[0.75,0.91],间断冲洗的真菌清除率为0.78[0.68,0.88]。冲洗后 > 5 d真菌清除率结果:持续冲洗的真菌清除率为0.74[0.65,0.84],而间断冲洗的真菌清除率为0.60[0.44,0.76]。差异均具有统计学意义。两性霉素B膀胱冲洗与氟康唑相比,在冲洗后24 h真菌清除率和冲洗后 > 5 d真菌清除率分别为1.27[1.07,1.50]和0.92[0.78,1.10]。安全性方面有血尿的报道。 结论 两性霉素B膀胱冲洗具有真菌清除作用,持续冲洗方式优于间断冲洗。具有与全身使用氟康唑相同的真菌清除效果,可以作为尿路感染的治疗方案。但由于受纳入文献的数质量的限制,仍然需要大规模、设计严谨的随机、对照、双盲的临床试验去进一步验证其效果。

English Abstract

白向荣, 程红勤, 张雁, 金颖. 两性霉素B膀胱冲洗治疗真菌尿的荟萃分析[J]. 药学实践与服务, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
引用本文: 白向荣, 程红勤, 张雁, 金颖. 两性霉素B膀胱冲洗治疗真菌尿的荟萃分析[J]. 药学实践与服务, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
BAI Xiangrong, CHENG Hongqin, ZHANG Yan, JIN Yin. A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
Citation: BAI Xiangrong, CHENG Hongqin, ZHANG Yan, JIN Yin. A Meta-analysis on the efficacy and safety of amphotericin B bladder irrigation in the treatment of urinary fungal infection[J]. Journal of Pharmaceutical Practice and Service, 2018, 36(4): 379-384. doi: 10.3969/j.issn.1006-0111.2018.04.021
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