特比萘芬治疗甲真菌病的系统评价

发布时间：2018-09-14 18:04

【摘要】：目的特比萘芬标准持续治疗方案是治疗甲真菌病的经典方法,但由于其多个方面的缺陷,研究者们尝试了多种其他治疗方案。文中拟对特比萘芬标准持续治疗方案对比其他方案治疗甲真菌病的有效性和安全性进行系统评价。方法计算机检索Pubmed、Cochrane图书馆、EMbase、CNKI、CBMdisc和万方数据库中关于特比萘芬治疗甲真菌病的随机对照试验(randomized controlled trial,RCT)。由2名研究者按照计划书进行选择文献、提取数据、核对,而后进行Meta分析。结果共纳入20个RCT。Meta分析结果提示,标准持续治疗方案在长期真菌学治愈要优于冲击治疗方案[P=0.01,RR=0.81(0.69,0.96)]、COMBO方案[P=0.05,RR=0.68(0.46,1.01)]和间歇给药方案[P=0.0001,RR=0.81(0.73,0.90)]。而标准持续治疗方案在长期真菌学治愈方面要亚于持续治疗联合局部治疗方案[P=0.005,RR=1.19(1.05,1.35)]和持续治疗3月方案[P=0.02,RR=1.12(1.02,1.24)]。对中-重度甲真菌病患,持续治疗联合清创术方案与标准方案相比有潜在的优势。在安全性方面,持续联合局部治疗方案在胃肠道反应发生低于标准方案[P=0.03,RR=0.24(0.07,0.90)],间歇给药方案在所有不良事件[P=0.03,RR=0.81(0.67,0.98)]和味觉障碍[P=0.05,RR=0.44(0.19,1.00)]发生低于标准治疗方案。在评价研究质量方面,根据Cochrane图书馆推荐的"偏倚风险评估"工具评估后发现某些高度偏倚可能对结果影响较大。结论特比萘芬治疗甲真菌病的最佳治疗方案尚待更多高质量的RCT来证实。
[Abstract]:Objective Terbinafine standard continuous therapy is a classic treatment for onychomycosis, but due to its shortcomings in many aspects, researchers have tried a variety of other treatments. The efficacy and safety of terbinafine in the treatment of onychomycosis were systematically evaluated. Methods A computerized search was conducted for the Pubmed,Cochrane library and (randomized controlled trial,RCT, a randomized controlled trial of terbinafine for the treatment of onychomycosis. According to the plan, two researchers selected documents, extracted data, checked them, and then analyzed them by Meta. Results A total of 20 RCT.Meta analysis showed that the standard continuous therapy regimen was superior to the impact therapy regimen [P0. 01 RRN 0. 81 (0. 69 0. 96)] Combo regimen [P0. 05 RN 0. 68 (0. 46 卤1. 01)] and intermittent administration regimen [P0. 0001 RRN 0. 81 (0. 73 ~ 0. 90)]. However, the standard continuous therapy regimen was less than that of continuous therapy combined with local treatment (P0. 005 RRN 1. 19 (1. 05 卤1. 35) and continuous therapy regimen of 3 months [P0. 02 RRN 1. 12 (1. 02 卤1. 24)] in the long term mycological cure. For moderate-severe onychomycosis patients, continuous therapy combined with debridement has potential advantages over standard protocols. In terms of safety, the incidence of continuous combined local therapy was lower than the standard regimen [P0. 03 RRR 0.24 (0. 07 卤0. 90)], intermittent administration regimen was lower than the standard treatment regimen in all adverse events [P0. 03 RRR 0. 61 (0. 67 0. 98)] and taste disorder [P0. 05 RR0. 44 (0. 19 卤1. 00)]. In terms of evaluation of research quality, according to the "bias risk assessment" tool recommended by Cochrane library, it is found that some high bias may have a great impact on the results. Conclusion Terbinafine is the best treatment for onychomycosis and needs more high quality RCT.
【作者单位】：南京军区南京总医院皮肤科;
【基金】：国家自然科学基金(81071331)
【分类号】：R756.4

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