蔡羽嘉 1 , 孫鑫 2 , 李幼平 12 , 徐娟 3 , 唐光敏 3 , 馬濤 3 , 李夏 3 , 盧軍 3
  • 1. 四川大學(xué)華西醫(yī)院中國(guó)循證醫(yī)學(xué)中心2. 四川大學(xué)華西醫(yī)院衛(wèi)生部移植工程與移植免疫重點(diǎn)實(shí)驗(yàn)室3. 四川大學(xué)華西醫(yī)院臨床醫(yī)學(xué),成都,610041;

目的  對(duì)抗病毒藥物治療病毒性呼吸道傳染疾病的臨床有效性、安全性和衛(wèi)生經(jīng)濟(jì)學(xué)進(jìn)行循證評(píng)價(jià).
方法  檢索CL(2003 Issue 1)、Medline(1966-2003 5)、CCOHTA、SBU、NICE、NCCHTA.收集所有關(guān)于抗病毒藥物治療病毒性呼吸道傳染疾病的CSR和HTA,評(píng)價(jià)研究質(zhì)量,綜合分析現(xiàn)有證據(jù).若數(shù)據(jù)間無(wú)明顯異質(zhì)性,則進(jìn)行數(shù)據(jù)合并.
結(jié)果  納入4個(gè)CSRs(38 RCT,n=22835),5個(gè)HTA(28 RCT,n=139281).但由于納入的文獻(xiàn)存在明顯異質(zhì)性,無(wú)法進(jìn)行數(shù)據(jù)合并,儀作描述性分析.
結(jié)論  1.神經(jīng)氨酸苷酶抑制劑(扎拉米韋和奧塞米韋vs安慰劑)能有效縮短有基礎(chǔ)疾病患者的癥狀持續(xù)時(shí)間,對(duì)無(wú)基礎(chǔ)疾病患者療效有限.對(duì)所有人群均有良好的流感預(yù)防作用,且耐受性良好.但其防治成本太高,不宜作為流感治療的首選藥.2.金剛烷類較安慰劑能有效縮短發(fā)熱時(shí)間,對(duì)甲型流感有良好預(yù)防作用.金剛烷胺和金剛乙烷的預(yù)防有效性相當(dāng),但金剛乙烷副作用比金剛烷胺少.3.關(guān)于利巴韋林預(yù)防和治療小兒上呼吸道感染的RCT病例數(shù)太少,目前無(wú)法作出判斷.

引用本文: 蔡羽嘉,孫鑫,李幼平,徐娟,唐光敏,馬濤,李夏,盧軍. 抗病毒藥物治療病毒性呼吸道感染的循證評(píng)價(jià)(一). 中國(guó)循證醫(yī)學(xué)雜志, 2003, 03(2): 121-127. doi: 復(fù)制

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  3. 3. [3]Hay AJ, Zambon MC, et al. Molecular basis of resistance of influenza A viruses to amantadine [J]. J Antimicrob Chemother 1986; 18(suppl B): 19 - 29.
  4. 4. [4]Fleming DM. Managing influenza: amantadine rimantadine and beyond [ J]. Int 1 Clin Pract 2001 ;55(3): 189 - 195.
  5. 5. [5]Waghorn SL, Goa kl. Zanarmivir [J]. Drugs 1998;55(5):721 -725.
  6. 6. [6]利巴書(shū)林滴鼻治療感冒優(yōu)于靜脈滴注[J].中國(guó)新藥與臨床雜志2000;19(2).
  7. 7. [7]國(guó)家藥物目錄.2000.國(guó)家食品與藥品監(jiān)督管理局.
  8. 8. [8]Jefferson TO, Demicheli V, Deeks J J, Rivetti D Amantadine and rimantadine for preventing and treating influenza A in adults CSR. CL 2003 - 1.
  9. 9. [9]Jefferson TO, Tyrrell D Antivirals for the Common Cold CSR CL 2003-1.
  10. 10. [10]Jcfferson T, Demicheli V, Deeks J, Rivetti D Neuraminidase in hihitors for preventing and treating influenza in healthy adults CSR Cl 2003-1.
  11. 11. [11]Randolph AG, Wang EEL Ribavirin for respiratory syncylalvirus infection of the lower respiratory tract CSR CL 2003-1.
  12. 12. [12]Donald R. Husereau, B. Sc. Pharm M. Sc. 1Bruce Brady , M. A. , M. Sc. 1 Allison McGeer MD, FRCPC2 Oseltamivir for thetreament of suspected influenza-a clinical and economic assess ment. Issue 21 2001 CCOHTA.
  13. 13. [13]Burls A, Clark W, Stewart T, Preston C, Bryan S, JefferonT, et al. Zanamivir for the treatment of influenza in adults: a systematic review and economic evaluation. HTA 2002; 6 ( 9 ). N HSR&D HTA Programme.
  14. 14. [14]Full Guidance on the the use of zanamivir, oseltaamivir and amantadine for the treatment of influenza Technology Appraisal Guidance No. 58 NHS February 2003.
  15. 15. [15]Do neuraminidase inhibitors prevent influenza Issue 27 November2001 CCOHTA.
  16. 16. [16]Treating influenza by medication - Zanamivir SBU Alert May22, 2001.
  17. 17. [17]Gideon Koren, Susan King, Sandra Knowles, Elizabeth Phillips Ribavirin in the treatment of SARS: A new trick for anold drug [J]? JAMC 13 MAI 2003; 168 (10).
  18. 18. [18]SARS: experience at Prince of Wales Hospital, Hong Kong [J].THE LANCET Vol 361 May 3, 2003.