利巴韦林治疗拉沙热的疗效：系统评价和荟萃分析。
Ribavirin for the treatment of Lassa fever: A systematic review and meta-analysis.
机构信息
Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
出版信息
Int J Infect Dis. 2019 Oct;87:15-20. doi: 10.1016/j.ijid.2019.07.015. Epub 2019 Jul 26.
OBJECTIVES
Lassa fever (LF) causes annual outbreaks in endemic regions with high mortality of symptomatic patients. Ribavirin is recommended as standard treatment for LF in national and international guidelines but the evidence base for this recommendation has been questioned recently.
METHODS
We conducted a systematic review and included 6 studies providing efficacy data of ribavirin treatment for LF (PROSPERO protocol CRD42018103994).
RESULTS
Besides retrospective case series, the evidence mostly relies on a single prospective clinical trial with critical risk of bias. In this trial, LF associated mortality is reduced for patients with elevated aspartate aminotransferase (AST) when treated with ribavirin (OR 0.41, 95% CI 0.23-0.73), while mortality is higher for patients without elevated AST (OR 2.37, 95% CI 1.07-5.25).
CONCLUSIONS
Based on the available data, current treatment guidelines may therefore put patients with mild LF at increased risk of death. The role of ribavirin in the treatment of LF requires urgent reassessment.
目的
拉沙热（LF）在流行地区每年都会爆发，症状患者的死亡率很高。利巴韦林被推荐为 LF 的标准治疗方法，这在国家和国际指南中都有规定，但最近对这一推荐的证据基础提出了质疑。
方法
我们进行了系统评价，共纳入了 6 项提供利巴韦林治疗 LF 的疗效数据的研究（PROSPERO 方案 CRD42018103994）。
结果
除了回顾性病例系列研究外，证据主要依赖于一项具有严重偏倚风险的单一样本前瞻性临床试验。在该试验中，对于 AST 升高的 LF 患者，利巴韦林治疗可降低 LF 相关死亡率（OR 0.41，95%CI 0.23-0.73），而 AST 正常的患者死亡率更高（OR 2.37，95%CI 1.07-5.25）。
结论
因此，根据现有数据，现行治疗指南可能会使 LF 轻症患者面临更高的死亡风险。利巴韦林在 LF 治疗中的作用需要紧急重新评估。
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