Goddard Jonathan Charles, Janssen Dick A W
Department of Urology, Leicester General Hospital, Leicester, UK.
Department of Urology, Radboud University Medical Center, Geert Grootteplein Zuid 10, 6525, Nijmegen, GA, Netherlands.
Int Urogynecol J. 2018 Jul;29(7):933-942. doi: 10.1007/s00192-017-3508-z. Epub 2017 Nov 27.
The objective was to assess the efficacy of intravesical hyaluronic acid (HA) and chondroitin sulfate (CS), alone or in combination, for recurrent urinary tract infections (RUTIs) in adult female patients using a systematic review and meta-analysis.
English-language articles were obtained from the MEDLINE, Embase, and Cochrane databases through November 2016, by manual searching and cross-referencing. Randomized and nonrandomized trials of adult female patients with a documented history of RUTIs who received HA, CS or HA plus CS were included. The random effects model was applied to all pooled analyses. Risk of bias was assessed for individual studies and across studies.
Two randomized (n = 85) and six nonrandomized (n = 715) studies met the inclusion criteria. These studies assessed HA ± CS; studies of CS alone were not identified in the search. HA ± CS decreased the UTI rate per patient-year (pooled mean difference [MD] -2.56; 95% confidence interval [CI] -3.86, -1.26; p < 0.001) and increased the time to first UTI recurrence (pooled MD 130.05 days; 95% CI 5.84, 254.26; p = 0.04). There was heterogeneity in most outcomes considered, and publication bias in many studies. The standard of trial reporting was low. The patient population size, and the number of studies included, were small.
HA ± CS appears to reduce the rate of UTI and increase the time to recurrence in women with RUTI. As randomized controlled studies are available only for HA plus CS, the quality of evidence is higher for the combination than for HA alone.
目的是通过系统评价和荟萃分析，评估膀胱内注射透明质酸（HA）和硫酸软骨素（CS）单独或联合使用对成年女性复发性尿路感染（RUTI）的疗效。
通过手工检索和交叉引用，从MEDLINE、Embase和Cochrane数据库中获取截至2016年11月的英文文章。纳入有RUTI病史记录的成年女性患者接受HA、CS或HA加CS的随机和非随机试验。所有汇总分析均采用随机效应模型。对单个研究和所有研究进行偏倚风险评估。
两项随机试验（n = 85）和六项非随机试验（n = 715）符合纳入标准。这些研究评估了HA ± CS；检索中未发现单独使用CS的研究。HA ± CS降低了每位患者每年的UTI发生率（汇总平均差[MD] -2.56；95%置信区间[CI] -3.86，-1.26；p < 0.001），并延长了首次UTI复发时间（汇总MD 130.05天；95% CI 5.84，254.26；p = 0.04）。在大多数考虑的结局中存在异质性，许多研究存在发表偏倚。试验报告的标准较低。患者群体规模和纳入的研究数量较少。
HA ± CS似乎可降低RUTI女性的UTI发生率并延长复发时间。由于仅存在HA加CS的随机对照研究，联合使用的证据质量高于单独使用HA。
