系统评价更昔洛韦在肾移植术后巨细胞病毒感染普遍预防中的临床价值 Clinical Values of Ganciclovir in the Universal Prophylaxis of Cytomegalovirus Infection Post-Kidney Transplantation:A Systematic Review and Meta-Analysis
目的:系统评价更昔洛韦(GCV)在肾移植术后巨细胞病毒(CMV)普遍预防中的临床价值。方法:计算机检索Cochrane Library、Pubmed、EMbase、中国知网、万方及维普数据库,纳入比较GCV和其他抗病毒药物降低肾移植受者术后CMV感染和CMV病的发生率的随机对照试验。检索时限均从建库至2016年12月。应用比值比(OR)和95%CI评价结局指标。用Rev Man 5.3.0软件进行Meta分析。结果:本系统评价共纳入10项研究,其中GCV与空白对照对比5项、GCV与阿昔洛韦(ACV)4项、GCV与伐昔洛韦(VCV)3项。Meta分析结果表明,更昔洛韦与空白对照组、ACV组以及VCV组相比并不能降低肾移植术后总的CMV感染率(OR=3.38,95%CI0.19-61.28,P=0.41;OR=1.33,95%CI0.52-3.41,P=0.55;OR=1.73,95%CI 0.95-3.16,P=0.07)、CMV病的发生率(OR=3.68,95%CI0.62-21.87,P=0.15;OR=2.51,95%CI 0.76-8.30,P=0.13;OR=1.49,95%CI0.63-3.51,P=0.36)以及急性排斥反应的发生率(OR=1.19,95%CI 0.38-3.71,P=0.77;OR=2.71,95%CI0.08-87.51,P=0.57;OR=0.52,95%CI 0.28-0.99,P=0.05)。另外,与空白对照组相比,GCV总的副作用发生率为9.2%(P=0.03);与ACV相比,两者无明显差异(P=0.09)。结论:GCV在肾移植术后CMV感染的普遍预防中并没有显著优势,但目前尚缺乏充足的循证医学证据支持
References
[1]
Reischig T,Opatrny JK,Treska V,et al.Prospective comparison of valacyclovir and oral ganciclovir for prevention of cytomegalovirus disease in high-risk renal transplant recipients[J].Kidney Blood Press Res,2005,28(4):218-225.
[2]
Kalpoe JS,Schippers EF,Eling Y,et al.Similar reduction of cytomegalovirus DNA load by oral valganciclovir and intravenous ganciclovir on pre-emptive therapy after renal and renal-pancreas transplantation[J].Antivir Ther,2005,10(1):119-123.
[3]
陈兰兰,倪安平,崔京涛,等.肾移植后巨细胞病毒感染的先驱治疗和普遍预防方案的荟萃分析[J].中华器官移植杂志,2014,35(4):216-220.Chen LL,Ni AP,Cui JT,et al.Meta-analysis on the two medications to prevent cytomegalovirus infection in recipients of renal transplants[J].Chin J Organ Transplant,2014,35(4):216-220.
[4]
杨典东,张智宇,吴吉涛,等.缬更昔洛韦与更昔洛韦在肾移植后预防和减少巨细胞病毒感染发生率的比较[J].中华器官移植杂志,2014,35(8):507-508.Yang DD,Zhang ZY,WU JT,et al.Comparison between valganciclovir and ganciclovir in the prevention and decreasing of cytomegalovirus infection incidence rate after renal transplantation[J].Chin J Organ Transplant,2014,35(8):507-508.
[5]
Said T,Nampoory MR,Pacsa AS,et al.Oral valgancyclovir versus intravenous gancyclovir for cytomegalovirus prophylaxis in kidney transplant recipients[J].Transplant Proc,2007,39(4):997-999.
[6]
Young PG,Rubin J,Angarone M,et al.Ganciclovirresistant cytomegalovirus infection in solid organ transplant recipients:a single-center retrospective cohort study[J].Transpl Infect Dis,2016,18(3):390-395.
石炳毅.肾移植术后巨细胞病毒感染的“普遍预防”和“抢先治疗”应个体化[J].肾脏病与透析肾移植杂志,2013,22(5):449-450.Shi BY.Universal prophylaxis or preemptive therapy in the prevention of cytomegalovirus infection after renal transplantation should be personalized[J].J Nephrol Dialy Transplant,2013,22(5):449-450.
[9]
Kir O,Zeytinoglu A,Arda B,et al.Impact of Prophylaxis vs Pre-emptive Approach for Cytomegalovirus Infection in Kidney Transplant Recipients[J].Transplant Proc,2017,49(3):537-540.
[10]
Weclawiak H,Kamar N,Mengelle C,et al.Pre-emptive intravenous ganciclovir versus valganciclovir prophylaxis for de novo cytomegalovirus-seropositive kidneytransplant recipients[J].Transplant International Official Journal of the European Society for Organ Transplantation,2010,23(10):1 056-1 064.
[11]
张李峰,田金徽,移康,等.更昔洛韦对防治肾移植后巨细胞病毒感染预防性治疗的系统评价[J].复旦学报:医学版,2010,37(2):131-139.Zhang LF,Tian JH,Yi K,et al.Prophylactictreatment of ganciclovir to prevent and cure cytomegalovirus infection after renal transplantation:a systematic review[J].Fudan Univ J Med Sci,2010,37(2):131-139.
[12]
Yango A,Morrissey P,Zanabli A,et al.Comparative study of prophylactic oral ganciclovir and valacyclovir in high-risk kidney transplant recipients[J].Nephrol Dial Transplant,2003,18(4):809-813.
[13]
Pavlopoulou ID,Syriopoulou VP,Chelioti H,et al.A comparative randomised study of valacyclovir vs.oral ganciclovir for cytomegalovirus prophylaxis in renal transplant recipients[J].Clin Microbiol Infect,2005,11(9):736-743.
[14]
李宁,武小桐,黄丽萍,等.应用更昔洛韦预防肾移植术后的巨细胞病毒肺炎[J].中华器官移植杂志,2005,26(9):569-570.Li N,Wu XT,Huang LP,et al.Application of ganciclovir in the prevention of cytomegalovirus pneumonia after renal transplantation[J].Chin J Organ Transplant,2005,26(9):569-570.
[15]
Reischig T,Jindra P,Mares J,et al.Valacyclovir for cytomegalovirus prophylaxis reduces the risk of acute renal allograft rejection[J].Transplantation,2005,79(3):317-324.
[16]
Flechner SM,Avery RK,Fisher R,et al.A randomized prospective controlled trial of oral acyclovir versus oral ganciclovir for cytomegalovirus prophylaxis in high-risk kidney transplant recipients[J].Transplantation,1998,66(12):1 682-1 688.
[17]
薛武军,燕航,田普训,等.更昔洛韦防治肾移植术后CMV感染的对照研究[J].西安交通大学学报:医学版,1999,20(2):178-181.Xue WJ,Yan H,Tian PX,et al.Comparative study of ganciclovir in the prevention of CMV infection after renal transplantation[J].Journal of Xi’An Medical University,1999,20(2):178-181.
[18]
邱江,陈立中,王长希,等.不同抗病毒药物对肾移植受者巨细胞病毒感染的预防疗效:附996例分析[J].南方医科大学学报,2009,29(9):1 949-1 950;1 954.Qiu J,Chen LZ,Wang CX,et al.Prophylactic effects of different antivirus drugs on the cytomegalovirus infection after renal transplantation[J].J South Med Univ,2009,29(9):1 949-1 950;1954.
[19]
Bruminhent J,Rotjanapan P,Watcharananan SP.Epidemiology and outcome of ganciclovir-resistant cytomegalovirus infection after solid organ transplantation:a single transplant center experience in Thailand[J].Transplant Proc,2017,49(5):1 048-1 052.
[20]
Reischig T,Opatrny KJ,Bouda M,et al.A randomized prospective controlled trial of oral ganciclovir versus oral valacyclovir for prophylaxis of cytomegalovirus disease after renal transplantation[J].Transpl Int,2002,15(12):615-622.
[21]
侯小飞,马潞林,李宇,等.更昔洛韦预防肾移植术后巨细胞病毒感染的效果观察[J].中华器官移植杂志,2009,30(8):500-501.Hou XF,Ma LL,Li Y,et al.Observation of ganciclovir effect on the prevention of cytomegalovirus infection after renal transplantation[J].Chin J Organ Transplant,2009,30(8):500-501.
[22]
张明,钟建泳,瞿连喜,等.更昔洛韦预防肾移植术后巨细胞病毒感染的前瞻性随机对照研究[J].中华器官移植杂志,2006,27(8):452-455.Zhang M,Zhong JY,Qu LX,et al.Prophylaxis of cytomegalovirus infection with ganciclovir in renal transplant recipients:a retrospective randomized controlled study[J].Chin J Organ Transplant,2006,27(8):452-455.
[23]
齐隽,郭义峰,闵志廉.更昔洛韦预防肾移植术后巨细胞病毒感染[J].中国新药与临床杂志,2005,24(1):47-49.Qi J,Guo YF,Min ZL.Ganciclovir in the prophylaxis of cytomegalovirus infection after renal transplantation[J].Chin J New Durgs Clin Rem,2005,24(1):47-49.
