目的:系统评价泊沙康唑预防血液病儿童侵袭性真菌感染的有效性和安全性。方法:在PubMed、Embase、Web of Science、Cochrane Library、Clinical Trials、中国生物医学文献数据库、中国知网、万方和维普等数据库中检索国内外公开发表的关于泊沙康唑预防血液病儿童侵袭性真菌感染的有效性和安全性的随机对照试验文献，对纳入的文献采用RevMan5。3软件进行文献质量评价和Meta分析。结果:共纳入7篇文献，740例患者。结果显示，泊沙康唑预防血液病儿童侵袭性真菌感染疗效优于对照组[OR=0。24，95％CI(0。14，0。40)，P＜0。000 01]和氟康唑组[OR=0。24，95％CI(0。14，0。41)，P＜0。000 01]。纳入研究中的不良反应均为轻度，泊沙康唑组总体不良反应发生率[OR=0。59，95％CI(0。36，0。95)，P=0。03]以及低血钾[OR=0。23，95％CI(0。11，0。50)，P=0。000 2]明显低于对照组，泊沙康唑组消化道[OR=0。85，95％CI(0。52，1。37)，P=0。50]、肝损伤[OR=0。85，95％CI(0。56，1。29)，P=0。45]、皮疹[OR=0。96，95％CI(0。32，2。86)，P=0。94]等不良反应发生率与对照组无显著性差异。结论:有限证据表明，泊沙康唑预防血液病儿童侵袭性真菌感染的有效性和安全性良好，更多有效性和安全性评价需要更多随机对照研究。
Efficacy and safety of posaconazole in the prevention of invasive fungal infections in children with hemato-logical diseases:a Meta-analysis
OBJECTIVE To systematically evaluate the efficacy and safety of posaconazole in the prevention of invasive fun-gal infections in children with hematological diseases.METHODS Randomized controlled trials(RCTs)on posaconazole in the prevention of invasive fungal infections in children with hematological diseases were retrieved from the databases of PubMed,Embase,Web of Science,Cochrane Library,Clinical Trials,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang and VIP.Revman 5.3 was utilized for literature quality evaluations and Meta-analysis.RESULTS Seven trials involv-ing 740 patients were included.The results of Meta-analysis showed that posaconazole was more effective than control group[OR=0.24,95％CI(0.14,0.40),P＜0.000 01]and fluconazole[OR=0.24,95％CI(0.14,0.41),P＜0.000 01].All adverse events were mild and overall rates of adverse events[OR=0.59,95％CI(0.36,0.95),P=0.03]and hypokalemia[OR=0.23,95％CI(0.11,0.50),P=0.000 2]were significantly lower in posaconazole group than those in control group.No significant inter-group difference existed in gastrointestinal tract[OR=0.85,95％CI(0.52,1.37),P=0.50],liver injury[OR=0.85,95％CI(0.56,1.29),P=0.45]or skin rash[OR=0.96,95％CI(0.32,2.86),P=0.94].CONCLUSION Limited evidence suggests that posaconazole is both effective and safe in preventing invasive fungal infections in children with hematological dis-eases.More randomized controlled studies are required for evaluating their efficacy and safety.
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