Zhang Yanxia, Lin Xiao, Lu Fangli
Department of Parasitology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China; Key Laboratory of Tropical Disease Control (Sun Yat-sen University), Ministry of Education, Guangzhou, Guangdong 510080, China; Provincial Engineering Technology Research Center for Biological Vector Control, Guangzhou, Guangdong 510080, China.
Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Acta Trop. 2018 Sep;185:52-62. doi: 10.1016/j.actatropica.2018.04.026. Epub 2018 Apr 25.
Ocular toxoplasmosis (OT) is the most frequent form of infectious posterior uveitis caused by the protozoan parasite Toxoplasma gondii. To evaluate the available evidence in peer-reviewed publications about the most effective therapy for OT in immunocompetent patients, herein a systematic literature search was conducted using Embase, PubMed, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) database from January 1987 to October 2017, with search terms "OT", "retinochoroiditis", "treatment", and "immunocompetent"; search filters "controlled clinical trial", "randomized clinical trial", and "clinical trial". The included studies were performed to evaluate the various treatment modalities of OT. Different treatment regimens were compared with regard to the improvement of visual acuity, the resolution of vitreous inflammation, recurrence, and side-effects. We independently extracted data and assessed eligibility and risk of bias using the preferred reporting items for systematic reviews and meta-analysis, and resolved any disagreement through discussion. A Bayesian network meta-analysis model was used to evaluate the interesting outcomes of all the interventions. Total 10 trials of treatments for OT were found to meet the inclusion criteria. Six trials of treatments including clindamycin, azithromycin, and trimethoprim-sulfamethoxazole (TMP-SMX) were compared with conventional therapy (the combination of pyrimethamine, sulfadiazine, and corticosteroids) for evaluation of the effect on visual acuity, vitreous inflammation, recurrence of OT, and side-effects. Two trials were compared TMP-SMX with placebo. One trial was compared azithromycin with TMP-SMX. And another trial was compared among treatments with clindamycin, P-S, TMP-SMX, and placebo. Based on our network meta-analysis, therapy with TMP-SMX seems to be an alternative treatment of OT in immunocompetent patients.
眼部弓形虫病（OT）是由原生动物寄生虫刚地弓形虫引起的感染性后葡萄膜炎最常见的形式。为了评估同行评审出版物中关于免疫功能正常患者OT最有效治疗方法的现有证据，我们于1987年1月至2017年10月使用Embase、PubMed、谷歌学术和Cochrane对照试验中央注册库（CENTRAL）数据库进行了系统的文献检索，检索词为“OT”、“视网膜脉络膜炎”、“治疗”和“免疫功能正常”；检索过滤器为“对照临床试验”、“随机临床试验”和“临床试验”。纳入的研究旨在评估OT的各种治疗方式。比较了不同治疗方案在视力改善、玻璃体炎症消退、复发和副作用方面的情况。我们独立提取数据，并使用系统评价和荟萃分析的首选报告项目评估纳入资格和偏倚风险，并通过讨论解决任何分歧。采用贝叶斯网络荟萃分析模型评估所有干预措施的有趣结果。共发现10项OT治疗试验符合纳入标准。将包括克林霉素、阿奇霉素和甲氧苄啶-磺胺甲恶唑（TMP-SMX）在内的6项治疗试验与传统疗法（乙胺嘧啶、磺胺嘧啶和皮质类固醇联合使用）进行比较，以评估对视力、玻璃体炎症、OT复发和副作用的影响。两项试验将TMP-SMX与安慰剂进行比较。一项试验将阿奇霉素与TMP-SMX进行比较。另一项试验在克林霉素、P-S、TMP-SMX和安慰剂治疗之间进行比较。基于我们的网络荟萃分析，TMP-SMX治疗似乎是免疫功能正常患者OT的替代治疗方法。
