目的系统评价不同抗真菌药物治疗真菌性角膜炎(FK)的有效性及安全性。
方法采用网状meta分析方法，检索PubMed、Cochrane Library、Embase、Web of Science共4个数据库，检索时限为建库至2023年3月16日。由2名研究者遵循纳入和排除标准筛选随机对照试验(RCT)研究文献，完成质量评估和信息提取。采用Review Manager 5.4偏移风险评估工具进行文献质量评估，采用Stata 14.0软件对不同抗真菌药物治疗FK的治愈率、治愈时间、治疗前后视力变化及安全性进行网状meta分析。
结果最终纳入14项RCT研究，共1 681例患者。网状meta分析显示，在治愈率方面，0.2%洗必泰滴眼液、5%那他霉素＋伏立康唑(口服)较其他药物显示出更好的疗效，累计排序曲线下面积(SUCRA)为86.1%和63.3%，且1%伏立康唑滴眼液治愈率低于0.2%洗必泰滴眼液、5%那他霉素滴眼液＋伏立康唑(口服)、0.05%洗必泰滴眼液、0.1%洗必泰滴眼液、5%那他霉素滴眼液＋酮康唑(口服)、5%那他霉素滴眼液，差异均有统计学意义(均 P<0.05)；1%伏立康唑滴眼液、5%那他霉素＋伏立康唑(口服)在治愈时间方面表现最好(SUCRA＝66.9%、55.7%)；5%那他霉素滴眼液、1%伏立康唑滴眼液和伏立康唑口服三联治疗在改善视力和安全性方面优于其他药物(SUCRA分别为74.8%、79.7%)。在安全性方面，5%那他霉素滴眼液优于1%伏立康唑滴眼液和0.2%洗必泰滴眼液，差异均有统计学意义(均 P<0.05)。此外，此次分析可能存在潜在的发表偏倚。
结论0.2%洗必泰滴眼液、1%伏立康唑滴眼液在FK治疗中具有较好的疗效，5%那他霉素滴眼液、1%伏立康唑滴眼液和伏立康唑口服三联治疗对FK患者具有较好的视力改善率及安全性。
ObjectiveTo systematically evaluate the efficacy and safety of different antifungal medications for fungal keratitis (FK).
MethodsA network meta-analysis was conducted.Four databases including PubMed, Cochrane Library, Embase, Web of Science were searched.The publication period was from inception to March 16, 2023.Two researchers followed the inclusion and exclusion criteria to screen randomized controlled trial (RCT), completed the quality assessment and extracted the information.Literature quality assessment was performed using Review Manager 5.4 bias risk assessment tool, and network meta-analysis was performed using Stata 14.0 software for cure rate, healing time, visual acuity improvement and safety of different antifungal drugs for fungal keratitis.
ResultsA total of 14 RCTs involving 1 681 patients were finally included in this study.The network meta-analysis showed that 0.2% chlorhexidine eye drops and 5% natamycin eye drops+ oral voriconazole had better efficacy than other interventions in cure rate, and the surface under the cumulative ranking (SUCRA) were 86.1% and 63.3%, respectively.The cure rate of 1% voriconazole eye drops was lower than that of 0.2% chlorhexidine eye drops, 5% natamycin eye drops+ oral voriconazole, 0.05% chlorhexidine eye drops, 0.1% chlorhexidine eye drops, 5% natamycin eye drops+ oral ketoconazole and 5% natamycin eye drops, showing statistically significant differences (all at P<0.05).1% voriconazole eye drops and 5% natamycin eye drops+ oral voriconazole showed better efficacy than other interventions in terms of healing time (SUCRA=66.9%, 55.7%).The combination of 5% natamycin eye drops, 1% voriconazole eye drops and oral voriconazole showed a better efficacy than others in improving visual acuity and safety (SUCRA=74.8%, 79.7%).For safety, 5% natamycin eye drops was superior to 1% voriconazole eye drops and 0.2% chlorhexidine eye drops, with statistically significant differences (both at P<0.05).In addition, there may be potential publication bias in this analysis.
Conclusions0.2% chlorhexidine eye drops and 1% voriconazole eye drops are effective in the treatment of FK.The combination use of 5% natamycin eye drops, 1% voriconazole eye drops and oral voriconazole can improve visual acuity and had good safety.
庞金鼎,韦振宇,曹凯,等. 不同抗真菌药物治疗真菌性角膜炎有效性和安全性的网状meta分析[J]. 中华实验眼科杂志,2024,42(07)：629-637.
DOI:10.3760/cma.j.cn115989-20230408-00124版权归中华医学会所有。
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庞金鼎：采集数据、起草文章、分析/解释数据；韦振宇：采集数据、分析/解释数据、对文章的知识性内容作批评性审阅；曹凯、徐西占：统计分析及研究指导；梁庆丰：酝酿和设计试验、指导研究、对文章的知识性内容作批评性审阅及定稿
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