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目的:系统评价替考拉宁对比万古霉素治疗革兰阳性菌感染的疗效和安全性,以为临床提供循证参考。方法:计算机检索Medline、PubMed、EMBase、EBM、Cochrane抗生素组、中国学术期刊全文数据库、中国生物医学文献数据库、万方数据库、维普数据库、超星电子图书,全面收集替考拉宁(试验组)对比万古霉素(对照组)治疗革兰阳性菌感染的随机对照试验(RCT)。采用Jadad评分量表进行评价分析后,采用Cocharane协作网提供的Rev Man 5.0统计软件进行Meta分析。结果:共纳入18项RCT,合计1 451例患者。Meta分析结果显示,两组患者的临床治愈率[OR=1.14,95%CI(0.86,1.51),P=0.37]和细菌清除率[OR=0.98,95%CI(0.70,1.37),P=0.90]比较,差异无统计学意义;试验组患者不良反应发生率显著低于对照组,两组比较差异有统计学意义[OR=0.43,95%CI(0.29,0.65),P<0.000]。结论:替考拉宁治疗革兰阳性菌感染的疗效与万古霉素相当,但替考拉宁安全性优于万古霉素。由于纳入研究数量较少、质量偏低,该结论还有待高质量、大样本的RCT进一步证实。
OBJECTIVE: To systematically evaluate the efficacy and safety of teicoplanin versus vancomycin in the treatment of gram-positive infections in order to provide an evidence-based reference for clinical practice. Methods: Comparisons of Teicoplanin (experimental group), Medline, PubMed, EMBase, EBM, Cochrane antibiotic group, Chinese academic journal full-text database, Chinese biomedical literature database, Wanfang database, VIP database, Randomized controlled trial (RCT) of vancomycin (control group) for Gram-positive bacterial infections. After using the Jadad rating scale for evaluation analysis, Meta-analysis was performed using RevMan 5.0 statistical software provided by the Cocharane Collaboration. Results: A total of 18 RCTs were included, totaling 1 451 patients. Meta-analysis showed that the clinical cure rates of two groups were OR = 1.14, 95% CI (0.86,1.51), P = 0.37] and bacterial clearance rate [OR = 0.98,95% CI 0.70,1.37], P = 0.90], the difference was not statistically significant; the incidence of adverse reactions in the experimental group was significantly lower than that in the control group, the difference was statistically significant [OR = 0.43, 95% CI (0.29,0.65), P <0.000]. CONCLUSION: Teicoplanin is comparable to vancomycin in the treatment of Gram-positive infections, but teicoplanin is superior to vancomycin in safety. Due to the small number of studies included and the low quality, the conclusion remains to be seen. RCTs in large samples further confirm this conclusion.