Kamal Faisal, Khan Muhammad Ali, Khan Zubair, Cholankeril George, Hammad Tariq A, Lee Wade M, Ahmed Aijaz, Waters Bradford, Howden Colin W, Nair Satheesh, Satapathy Sanjaya K
aDivision of Gastroenterology and Hepatology bMethodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, Tennessee cDivision of Gastroenterology and Hepatology dCarlson and Mulford Libraries, University of Toledo, Toledo, Ohio eDivision of Gastroenterology and Hepatology, Stanford University, Stanford, California, USA.
Eur J Gastroenterol Hepatol. 2017 Oct;29(10):1109-1117. doi: 10.1097/MEG.0000000000000940.
Prophylactic antibiotics have been recommended in patients with a previous history of spontaneous bacterial peritonitis (SBP). Recently, there has been interest in the use of rifaximin for the prevention of SBP and hepatorenal syndrome (HRS). We conducted a meta-analysis to evaluate this association of rifaximin. We searched several databases from inception through 24 January 2017, to identify comparative studies evaluating the effect of rifaximin on the occurrence of SBP and HRS. We performed predetermined subgroup analyses based on the type of control group, design of the study, and type of prophylaxis. Pooled odds ratios (ORs) were calculated using a random effects model. We included 13 studies with 1703 patients in the meta-analysis of SBP prevention. Pooled OR [95% confidence interval (CI)] was 0.40 (95% CI: 0.22-0.73) (I=58%). On sensitivity analysis, adjusted OR was 0.29 (95% CI: 0.20-0.44) (I=0%). The results of the subgroup analysis based on type of control was as follows: in the quinolone group, pooled OR was 0.42 (95% CI: 0.14-1.25) (I=55%), and in the no antibiotic group, pooled OR was 0.40 (95% CI: 0.18-0.86) (I=64%). However, with sensitivity analysis, benefit of rifaximin was demonstrable; pooled ORs were 0.32 (95% CI: 0.17-0.63) (I=0%) and 0.28 (95% CI: 0.17-0.45) (I=0%) for the comparison with quinolones and no antibiotics, respectively. Pooled OR based on randomized controlled trials was 0.41 (95% CI: 0.22-0.75) (I=13%). For the prevention of HRS, the pooled OR was 0.25 (95% CI: 0.13-0.50) (I=0%). Rifaximin has a protective effect against the development of SBP in cirrhosis. However, the quality of the evidence as per the GRADE framework was very low. Rifaximin appeared effective for the prevention of HRS.
对于既往有自发性细菌性腹膜炎（SBP）病史的患者，推荐使用预防性抗生素。最近，人们对利福昔明用于预防SBP和肝肾综合征（HRS）产生了兴趣。我们进行了一项荟萃分析以评估利福昔明的这种关联。我们检索了从数据库建立至2017年1月24日的多个数据库，以确定评估利福昔明对SBP和HRS发生影响的比较研究。我们根据对照组类型、研究设计和预防类型进行了预先设定的亚组分析。使用随机效应模型计算合并比值比（OR）。在预防SBP的荟萃分析中，我们纳入了13项研究共1703例患者。合并OR[95%置信区间（CI）]为0.40（95%CI：0.22 - 0.73）（I² = 58%）。敏感性分析中，校正后的OR为0.29（95%CI：0.20 - 0.44）（I² = 0%）。基于对照组类型的亚组分析结果如下：在喹诺酮组中，合并OR为0.42（95%CI：0.14 - 1.25）（I² = 55%），在无抗生素组中，合并OR为0.40（95%CI：0.18 - 0.86）（I² = 64%）。然而，经敏感性分析，利福昔明的益处是明显的；与喹诺酮类和无抗生素类比较的合并OR分别为0.32（95%CI：0.17 - 0.63）（I² = 0%）和0.28（95%CI：0.17 - 0.45）（I² = 0%）。基于随机对照试验的合并OR为0.41（95%CI：0.22 - 0.75）（I² = 13%）。对于预防HRS，合并OR为0.25（95%CI：0.13 - 0.50）（I² = 0%）。利福昔明对肝硬化患者发生SBP具有保护作用。然而，根据GRADE框架，证据质量非常低。利福昔明似乎对预防HRS有效。
