摘要
目的：利福昔明在预防自发性细菌性腹膜炎（SBP）中的作用尚未得到很好的研究。这项荟萃分析的目的是评估利福昔明在预防SBP中的作用。 方法：2017年8月进行相关临床试验的计算机文献检索。提取SBP频率，预防SBP成功率，死亡率，肝肾综合征，感染性休克，肝性脑病和GIT出血的数据，并作为在荟萃分析模型中风险比（RR）及其95％置信区间（CI）。通过卡方检验评估异质性。 结果：最终分析纳入6项涉及973名患者的研究。汇总效应估计显示利福昔明加诺氟沙星组SBP发生率较低（RR 0.58,95％CI [0.37,0.92]，P = 0.02）和肝性脑病（RR 0.38,95％CI [0.17,0.84]，P基于诺氟沙星的方案组比= 0.02）。利福昔明和诺氟沙星在SBP频率和SBP一级预防成功率方面无显着差异（RR 0.49,95％CI [0.24,1.01]，P = 0.05; RR1.21,95％CI [0.95,1.55] ，P = 0.13，分别）。 结论：根据我们的分析，利福昔明是一种很有前途的药物，似乎是诺氟沙星预防SBP的良好替代品。
关键词: 利福昔明，诺氟沙星，SBP，脑病，预防，肝肾综合征。
图形摘要
[1]
Elfert A, Abo Ali L, Soliman S, Ibrahim S, Abd-Elsalam S. Randomized-controlled trial of rifaximin versus norfloxacin for secondary prophylaxis of spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol 2016; 28(12): 1450-4.
[2]
Wiest R, Krag A, Gerbes A. Spontaneous bacterial peritonitis: Recent guidelines and beyond. Gut 2012; 61(2): 297-310.
[3]
Fernandez J, Navasa M, Gomez J, et al. Bacterial infections in cirrhosis: Epidemiological changes with invasive procedures and norfloxacin prophylaxis. Hepatology 2000; 35(1): 140-8.
[4]
Runyon BA, Squier S, Borzio M. Translocation of gut bacteria in rats with cirrhosis to mesenteric lymph nodes partially explains the pathogenesis of spontaneous bacterial peritonitis. J Hepatol 1994; 21(5): 792-6.
[5]
Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension : Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Dig Dis 2016; 34(4): 382-6.
[6]
Fernández J, Gustot T. Management of bacterial infections in cirrhosis. J Hepatol 2012; 56(Suppl. 1): S1-S12.
[7]
Piroth L, Pechinot A, Di Martino V, Hansmann Y, Putot A, Patry I, et al. Evolving epidemiology and antimicrobial resistance in spontaneous bacterial peritonitis : A two-year observational study. BMC Infect Dis 2014; 14: 287.
[8]
Kalambokis GN, Mouzaki A, Rodi M, Tsianos EV. Rifaximin for the prevention of spontaneous bacterial peritonitis. World J Gastroenterol 2012; 18(14): 1700-2.
[9]
Green S, Higgins PTJ, Alderson P, Clarke M, Mulrow DC, Oxman DA. Cochrane Handbook: Cochrane Reviews: Ch 8: Assessing risk of bias in included studies. In: Cochrane Handbook for: Systematic Reviews of Interventions. 2011; p. 3–10.
[10]
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-34.
[11]
Terrin N, Schmid CH, Lau J, Olkin I. Adjusting for publication bias in the presence of heterogeneity. Stat Med 2003; 22(13): 2113-26.
[12]
Mostafa T, Badra G, Abdallah M. The efficacy and the immunomodulatory effect of rifaximin in prophylaxis of spontaneous bacterial peritonitis in cirrhotic Egyptian patients. Turk J Gastroenterol 2015; 26(2): 163-9.
[13]
Assem M, Elsabaawy M, Abdelrashed M, Elemam S, Khodeer S, Hamed W, et al. Efficacy and safety of alternating norfloxacin and rifaximin as primary prophylaxis for spontaneous bacterial peritonitis in cirrhotic ascites: A prospective randomized open-label comparative multicenter study. Hepatol Int 2016; 10(2): 377-85.
[14]
Vlachogiannakos J, Viazis N, Vasianopoulou P, Vafiadis I, Karamanolis DG, Ladas SD. Long-term administration of rifaximin improves the prognosis of patients with decompensated alcoholic cirrhosis. J Gastroenterol Hepatol 2013; 28(3): 450-5.
[15]
Shamseya MM, Madkour MA. Rifaximin: A reasonable alternative for norfloxacin in the prevention of spontaneous bacterial peritonitis in patients with HCV-related liver cirrhosis. Alexandria J Med 2016; 52(3): 219-26.
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