Randolph A G, Wang E E
Department of Pediatrics, University of California, San Francisco, USA.
Arch Pediatr Adolesc Med. 1996 Sep;150(9):942-7. doi: 10.1001/archpedi.1996.02170340056011.
To systematically review the evidence evaluating the efficacy of aerosolized ribavirin for the treatment of infants with respiratory syncytial virus lower respiratory tract infection.
A computerized search of MEDLINE from 1975 to the present, a review of the reference lists of each retrieved article, and contact with experts.
infants with documented respiratory syncytial virus lower respiratory tract infection who were the subjects of 8 double-blind randomized placebo-controlled trials.
Two independent reviewers assessed study quality and extracted data on the study populations, the drug regimens, and clinically relevant outcome measurements.
Ribavirin does not significantly reduce mortality rate (relative risk [RR] = 0.42, 95% confidence interval [CI] = 0.13, 1.44) or lower the probability of respiratory deterioration (RR = 0.42, 95% CI = 0.16, 1.34) when meta-analysis is used to pool the outcomes of 3 trials, although strong trends in the direction of benefit are present. No study found ribavirin to shorten length of hospitalization. Results on length of ventilation and oxygen supplementation are conflicting.
Use of ribavirin in infants with respiratory syncytial virus lower respiratory tract infection is not supported by evidence of significant benefit. However, previous studies lack sufficient power to rule out a potential reduction in mortality rate or respiratory deterioration. A large randomized controlled trial of ribavirin for ventilated and other high-risk patients is needed.
系统评价雾化吸入利巴韦林治疗呼吸道合胞病毒引起的婴幼儿下呼吸道感染疗效的相关证据。
通过计算机检索1975年至今的MEDLINE数据库，查阅每篇检索到文章的参考文献列表，并与专家联系。
纳入8项双盲随机安慰剂对照试验中记录为呼吸道合胞病毒引起下呼吸道感染的婴幼儿。
两名独立的评价者评估研究质量，并提取有关研究人群、药物治疗方案和临床相关结局指标的数据。
对3项试验结果进行Meta分析时，利巴韦林未显著降低死亡率（相对危险度[RR]=0.42，95%可信区间[CI]=0.13，1.44），也未降低呼吸功能恶化的可能性（RR=0.42，95%CI=0.16，1.34），尽管存在明显的有益趋势。没有研究发现利巴韦林能缩短住院时间。关于通气时间和吸氧时间的结果存在矛盾。
尚无证据支持将利巴韦林用于治疗呼吸道合胞病毒引起的婴幼儿下呼吸道感染。然而，既往研究的效力不足以排除利巴韦林可能降低死亡率或呼吸功能恶化的作用。需要开展一项针对使用呼吸机的患儿及其他高危患儿的大型利巴韦林随机对照试验。
