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目的通过Meta分析,对预防性使用抗生素(continuous antibiotic prophylaxis,CAP)在预防儿童原发性输尿管反流尿路感染(urinary tract infection,UTI)的临床应用疗效性以及安全性进行分析。方法检索Cochrane图书馆临床对照试验数据库、PubMed、EMBASE、Ovid、Springer、中国期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)、万方数据库、中国生物医学文献光盘数据库(截止到2015年5月)。评价文献质量用Cochrane协作网推荐的Jadad记分法,并用Rev Man5.1软件进行分析。筛选出所有已发表的关于比较预防性抗生素与空白(或安慰剂)对照预防原发性输尿管反流尿路感染的随机、对照试验,观察的主要指标:复发性尿路感染发生率;次要指标:新肾脏瘢痕发生率。结果 8项随机对照试验(抗生素组828例,对照组811例)纳入Meta分析,所有纳入文献均被评为A级质量。分析显示:1预防性使用抗生素组的尿路感染发生率明显降低(RR=0.69,95%CI:0.56~0.86,P<0.05)。2对于Ⅰ~Ⅱ级反流的患儿,预防性使用抗生素可降低复发性尿路感染率(RR=0.57,95%CI:0.37~0.87,P<0.05),对于Ⅲ~Ⅳ级反流的患儿,预防性使用抗生素可降低复发性尿路感染率(RR=0.76,95%CI:0.59~0.96,P<0.05)。35篇对于不同干预因素下UVR患者肾脏瘢痕的情况进行了详细说明,原发性输尿管反流的患儿预防性使用抗生素对肾脏瘢痕出现的影响无意义(RR=1,95%CI:0.61~1.64,P>0.05)。结论不论是对低等级还是高等级的反流,持续抗生素使用能有效预防原发性膀胱输尿管反流的尿路感染发生,对于肾脏瘢痕的发生没有显著意义。
Objective To analyze the clinical efficacy and safety of continuous antibiotic prophylaxis (CAP) in the prevention of urinary tract tract infection (UTI) in children through Meta-analysis. Methods The Cochrane Central Register of Controlled Trials (Cochrane Library) database was searched. PubMed, EMBASE, Ovid, Springer, CNKI, VIP, Wanfang database, CDC database of China Biomedical Literature month). The quality of the literature was evaluated using the Jadad scoring method recommended by the Cochrane Collaboration and analyzed using Rev Man 5.1 software. All published randomized, controlled trials comparing the prophylactic antibiotic versus the blank (or placebo) control against primary ureteral reflux urinary tract infection were screened for major incidences of recurrent urinary tract infections; secondary Indicators: New kidney scar incidence. Results Eight randomized controlled trials (828 cases of antibiotics and 811 cases of control group) were included in the Meta-analysis. All the included articles were rated as Grade A quality. Analysis showed that: 1 The incidence of urinary tract infection in the prophylactic antibiotic group was significantly lower (RR = 0.69, 95% CI: 0.56-0.86, P <0.05). For children with grade Ⅰ ~ Ⅱ reflux, prophylactic antibiotics can reduce the incidence of recurrent urinary tract infection (RR = 0.57, 95% CI: 0.37-0.87, P <0.05) Children with prophylactic use of antibiotics reduced the incidence of recurrent urinary tract infections (RR = 0.76, 95% CI: 0.59 to 0.96, P <0.05). Thirty-five studies of renal scarring in patients with UVR under various interventions were described in detail. Prophylactic use of antibiotics in children with primary ureteral reflux did not contribute significantly to renal scarring (RR = 1,95% CI: 0.61 ~ 1.64, P> 0.05). CONCLUSIONS: Whether for low-grade or high-grade reflux, the use of continuous antibiotics can effectively prevent urinary tract infection of primary vesicoureteral reflux and has no significant effect on the occurrence of renal scar.