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)行循證評價.
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,評價研究質(zhì)量,綜合分析現(xiàn)有證據(jù).若數(shù)據(jù)間無明顯異質(zhì)性,則進(jìn)行數(shù)據(jù)合并.
結(jié)果 　納入4個CSRs(38 RCT,n=22835),5個HTA(28 RCT,n=139281).但由于納入的文獻(xiàn)存在明顯異質(zhì)性,無法進(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)時間,對無基礎(chǔ)疾病患者療效有限.對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)熱時間,對甲型流感有良好預(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價(一). 中國循證醫(yī)學(xué)雜志, 2003, 03(2): 121-127. doi: 復(fù)制

1. ［1］Kimberlin DW, Coen DW, et al. Molecular mechanism of antiviralresistance Antiviral R es, 1995; 26(4): 369-401. 10. PintoLH , Holsingcr LJ. et al. Influenza virus M2 protein has ion channel activity [J ]. Cell 1992,69(3) :517-528.
2. ［2］Hay AJ. The action of adamantanamines against influenza A virus es: inhibition of the M2 ion channel protein [J]. Semin Virol 1992; 3: 21- 30.
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］Fleming DM. Managing influenza: amantadine rimantadine and beyond [ J]. Int 1 Clin Pract 2001 ;55(3): 189 - 195.
5. ［5］Waghorn SL, Goa kl. Zanarmivir [J]. Drugs 1998;55(5):721 -725.
6. ［6］利巴書林滴鼻治療感冒優(yōu)于靜脈滴注[J].中國新藥與臨床雜志2000;19(2).
7. ［7］國家藥物目錄.2000.國家食品與藥品監(jiān)督管理局.
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］Jefferson TO, Tyrrell D Antivirals for the Common Cold CSR CL 2003-1.
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］Randolph AG, Wang EEL Ribavirin for respiratory syncylalvirus infection of the lower respiratory tract CSR CL 2003-1.
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］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］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］Do neuraminidase inhibitors prevent influenza Issue 27 November2001 CCOHTA.
16. ［16］Treating influenza by medication - Zanamivir SBU Alert May22, 2001.
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］SARS: experience at Prince of Wales Hospital, Hong Kong [J].THE LANCET Vol 361 May 3, 2003.
  1. 1. ［1］Kimberlin DW, Coen DW, et al. Molecular mechanism of antiviralresistance Antiviral R es, 1995; 26(4): 369-401. 10. PintoLH , Holsingcr LJ. et al. Influenza virus M2 protein has ion channel activity [J ]. Cell 1992,69(3) :517-528.
  2. 2. ［2］Hay AJ. The action of adamantanamines against influenza A virus es: inhibition of the M2 ion channel protein [J]. Semin Virol 1992; 3: 21- 30.
  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］利巴書林滴鼻治療感冒優(yōu)于靜脈滴注[J].中國新藥與臨床雜志2000;19(2).
  7. 7. ［7］國家藥物目錄.2000.國家食品與藥品監(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.