新型冠状病毒肺炎患者使用羟氯喹：系统评价与荟萃分析

"Hydroxychloroquine in patients with COVID-19: A Systematic Review and meta-analysis.".

作者信息

Singh Awadhesh Kumar, Singh Akriti, Singh Ritu, Misra Anoop

机构信息

Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, West Bengal, India.

College of Medicine and JNM Hospital, Kalyani, Nadia, West Bengal, India.

出版信息

Diabetes Metab Syndr. 2020 Jul-Aug;14(4):589-596. doi: 10.1016/j.dsx.2020.05.017. Epub 2020 May 12.

BACKGROUNDS AND AIMS

The role of hydroxychloroquine (HCQ) in the treatment of COVID-19 is not fully known. We studied the efficacy of HCQ compared to the control in COVID-19 subjects on - a. viral clearance measured by reverse transcriptase polymerase chain reaction (RT-PCR) and, b. death due to all cause.

METHODS

PubMed, Scopus, Cochrane and MedRxiv database were searched using the specific keywords up to April 30, 2020. Studies that met our objectives were assessed for the risk of bias applying various tools as indicated. Three studies each that reported the outcome of viral clearance by RT-PCR and death due to all cause, were meta-analyzed by applying inverse variance-weighted averages of logarithmic risk ratio (RR) using a random effects model. Heterogeneity and publication bias were assessed using the I statistic and funnel plots, respectively.

RESULTS

Meta-analysis of 3 studies (n = 210) on viral clearance assessed by RT-PCR showed no benefit (RR, 1.05; 95% CI, 0.79 to 1.38; p = 0.74), although with a moderate heterogeneity (I = 61.7%, p = 0.07). While meta-analysis of 3 studies (n = 474) showed a significant increase in death with HCQ, compared to the control (RR, 2.17; 95% 1.32 to 3.57; p = 0.002), without any heterogeneity (I = 0.0%, p = 0.43).

CONCLUSIONS

No benefit on viral clearance but a significant increase in mortality was observed with HCQ compared to control in patients with COVID-19.

背景与目的

羟氯喹（HCQ）在治疗2019冠状病毒病（COVID - 19）中的作用尚不完全清楚。我们研究了HCQ与对照组相比，在COVID - 19患者中的疗效，具体如下：a. 通过逆转录聚合酶链反应（RT - PCR）测量的病毒清除情况；b. 全因死亡情况。

方法

截至2020年4月30日，使用特定关键词检索了PubMed、Scopus、Cochrane和MedRxiv数据库。对符合我们目标的研究，使用指定的各种工具评估偏倚风险。对三项分别报告了通过RT - PCR检测的病毒清除结果和全因死亡情况的研究，采用随机效应模型，应用对数风险比（RR）的逆方差加权平均值进行荟萃分析。分别使用I统计量和漏斗图评估异质性和发表偏倚。

结果

对三项关于通过RT - PCR评估病毒清除的研究（n = 210）进行的荟萃分析显示，没有益处（RR，1.05；95%置信区间，0.79至1.38；p = 0.74），尽管存在中度异质性（I = 61.7%，p = 0.07）。而对三项研究（n = 474）的荟萃分析显示，与对照组相比，使用HCQ的患者死亡显著增加（RR，2.17；95% 1.32至3.57；p = 0.002），且无任何异质性（I = 0.0%，p = 0.43）。