万古霉素血药谷浓度和临床结局相关性的系统评价和Meta分析（英文）

发布时间：2018-01-04 16:42

  本文关键词：万古霉素血药谷浓度和临床结局相关性的系统评价和Meta分析（英文）　出处：《药物流行病学杂志》2016年04期 　论文类型：期刊论文

  更多相关文章： 万古霉素 谷浓度 死亡率 治疗失败率 肾毒性

【摘要】：目的:研究万古霉素血药谷浓度与死亡率、治疗失败率和肾毒性之间的关系。方法:系统检索Pub Med、Embase、Cochrane图书馆和三个中文数据库(CNKI、CBM和万方数据),检索时间范围均为建库到2014年1月16日。纳入所有研究万古霉素谷浓度与临床结局相关性的文章,由两位研究者独立提取数据,并采用Newcastle-Ottawa评分评价观察性研究的质量,二分类变量结果选用相对危险比(RRs)和95%可信区间(95%CI)表示,如无统计学异质性则采用固定效应模型。主要终点结局是死亡率和治疗失败率,次要终点结局是肾毒性。结果:共纳入40个队列研究。与万古霉素谷浓度15 mg·L~(-1)的患者相比,谷浓度≥15 mg·L~(-1)的患者的治疗失败率更低(RR=0.83,95%CI:0.70~0.97,P=0.02),肾毒性发生率更高(RR=1.99,95%CI:1.56~2.53,P0.000 01);与万古霉素谷浓度10 mg·L~(-1)或20 mg·L~(-1)相比,万古霉素谷浓度≥10 mg·L~(-1)或≥20 mg·L~(-1)与肾毒性发生率增加明显相关;万古霉素谷浓度与死亡率不相关。结论:与万古霉素谷浓度15 mg·L~(-1)相比,万古霉素谷浓度≥15 mg·L~(-1)与降低治疗失败率和肾毒性发生率增加明显相关。当患者的万古霉素谷浓度≥15 mg·L~(-1)时,应注意患者增加的肾毒性发生风险。
[Abstract]:Objective: to study the relationship between serum vancomycin concentration and mortality, failure rate of treatment and nephrotoxicity. Cochrane Library and three Chinese databases, CNKI, CBM and Wanfang data. The retrieval time range was from the establishment of the database to January 16th 2014. All articles on the correlation between vancomycin valley concentration and clinical outcome were included, and the data were extracted independently by two researchers. The Newcastle-Ottawa score was used to evaluate the quality of the observational study. The relative risk ratio (RRs) and the 95% confidence interval (95 CI) were used to indicate the results of the two classification variables. If there is no statistical heterogeneity, the fixed effect model is used. The main endpoints are mortality and treatment failure rate. Secondary endpoints were nephrotoxicity. Results: a total of 40 cohort studies were conducted, compared with patients with vancomycin valley concentration of 15 mg 路L ~ (-1). The failure rate of patients with valley concentration 鈮，

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