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目的系统评价膦甲酸钠与更昔洛韦治疗艾滋病相关巨细胞病毒视网膜炎的疗效及安全性。方法电子检索PubMed(1966-2005．12)、EMbase(1974～2005．12)、 Cochrane图书馆(2005第4期)、中国生物医学文献数据库 (1978～2005．12)、中文生物医学期刊文献数据库(1994-2005．12)、中国学术期刊全文数据库(1994～2005．12)、中文科技期刊数据库 (1989～2005．12)。纳入比较膦甲酸钠和更昔洛韦治疗艾滋病相关巨细胞病毒视网膜炎的随机对照试验。由2名评价者对研究人群、干预措施与结果的详细资料独立地进行分析评价。对于同质数据进行Meta分析。结果共纳入5篇文献,其中3篇的研究对象虽来自同一研究人群,但采用了不同结局指标,故仍按3篇文献纳入,只是不合并相同指标在同一时间点的结果。Meta分析结果表明,膦甲酸钠在减少死亡人数[RR=0．84,95％CI( 0．70,1．00),P=0．05]和降低男性生殖器溃疡发生率[RR=1．29,95％CI(0．60,2．82), P=0．002]方面优于更昔洛韦;但在减轻眼部症状、延缓复发及其他副作用方面,两组间差异无统计学意义。结论本系统评价提示,膦甲酸钠在降低艾滋病合并巨细胞病毒视网膜炎患者死亡率及男性生殖器溃疡发生率方面比更昔洛韦可能更有效。但纳入研究数较少,证据强度有限,需更多高质量研究证实。
Objective To evaluate the efficacy and safety of foscarnet and ganciclovir in the treatment of AIDS-related cytomegalovirus retinitis. Methods PubMed (1966-2005.12), EMbase (1974 ~ 2005.12), Cochrane Library (2005 issue 4), China Biomedical Literature Database (1978 ~ 2005.12), Chinese Biomedical Journal Literature Database (1994-2005.12), Chinese Academic Journal Full-text Database (1994 ~ 2005.12), Chinese Science and Technology Periodical Database (1989 ~ 2005.12). Randomized controlled trials comparing foscarnet and ganciclovir in the treatment of AIDS-related cytomegalovirus retinitis were included. Two reviewers independently analyzed and evaluated the study population, interventions and details of the results. Meta-analysis of homogenous data. Results A total of 5 articles were included. Although 3 of them were from the same study population, they adopted different outcome measures. Therefore, they are still included in the three articles, but they are the result of not combining the same indicators at the same time point. Meta-analysis showed that foscarnet decreased the number of deaths [RR = 0.84, 95% CI (0.70, 1.00), P = 0.05] and decreased the incidence of male genital ulcers [RR = 1.29 , 95% CI (0.60,2.82), P = 0.002], but there was no significant difference between the two groups in reducing eye symptoms, relapse delay and other side effects . Conclusions This systematic review suggests that foscarnet may be more effective than ganciclovir in reducing mortality and genital ulcers in HIV-infected patients with cytomegalovirus retinitis. However, fewer studies were included and the evidence was of limited strength, requiring more high-quality studies to confirm.