环孢素和他克莫司对丙肝复发治疗影响的Meta分析

发布时间：2018-03-07 18:26

本文选题：环孢素　切入点：他克莫司　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的在全球范围内,慢性丙肝病毒感染是肝移植术后重要的指标之一。尽管肝移植为丙肝病毒相关的末期肝病和早期肝癌提供了最佳的治疗方案。常见的移植后丙肝病毒再感染是我们主要的关注点。移植后丙肝病毒感染的重发生进程会加速,5年内移植患者再感染的发生率已上升到30%。长期移植存活率和患者生存率受到严重的影响。在体外,环孢素A,而非他克莫司,抑制丙肝病毒的复制。做为肝移植受者的基础免疫抑制剂,他克莫司和环孢素A对HCV复发及其结局是否有不同影响移植后针对丙肝病毒复发,分别使用环孢素A和他克莫司结合干扰素的抗病毒临床治疗效果报告显示,二者的的疗效报告有冲突的地方。本研究的目的通过检索既往发表的文献并进行Meta分析,评估肝移植术后环孢素A和他克莫司对丙型肝炎病毒感染及结局的影响。方法计算机检索pubmed、MEDLINE、EMbase、Science Citation Index、中国生物医学文献数据库(CBM)、万方数据库、中国知网(CNKI)、维普网(VIP)、Cochrane library,检索时间从建库至2013年02月。英文检索词为FK506, TAC, tacrolimus,Cyclosprin, Cyclosprin A,CSA, hepatitis C, hep C, or HCV, LT, transplantation, transplant, graft,Interferon, IFN,pegylated-interferon, PEG-IFN, ribavirin,RBV。中文检索词以“他克莫司、环孢素或环孢素A、肝移植、丙型肝炎、丙肝、干扰素,聚乙二醇干扰素,利巴韦林”为检索词。将检索到的文献按照预定标准进行筛选后,使用Cochrane协作网提供的专用RevMan4.2进行统计数据分析。记数资料在随机效应模式下以相关风险和95%置信区间的方式表达。结果总计查到2764篇文献,17篇观察性研究达到预先设定的筛选标准并被运用到本次荟萃分析研究中。经过数据分析后的结果为使用环孢素的持续病毒反应率为42%(395/945),而使用他克莫司的持续病毒反应率为35%(471/1364)(RR=1.18,95%CI=1.00-1.39,P=0.05)。尽管统计数据反映出一定的异质性(12=45%,P=0.02),但是在随机对照试验中的持续病毒反应发生率有一定的比较意义(环孢素的持续病毒反应发生率为39%,他克莫司的持续病毒反应发生率为35%)。使用每组患者人数在40人或以上的7个使用环孢素的研究(共计1634人),异质性消失(12=0%,P=0.62)。结论针对肝移植后复发丙型肝炎的治疗,由于研究存在一定的异质性,我们目前只能说环孢素较之他克莫司可能有少许的优势。
[Abstract]:On a global scale, Chronic hepatitis C virus infection is one of the important indicators after liver transplantation. Although liver transplantation provides the best treatment for hepatitis C virus related terminal liver disease and early liver cancer. Our main concern is that the process of reinfection of hepatitis C virus after transplantation will accelerate, and the incidence of re-infection in transplant patients has risen to 30% within 5 years. The long-term transplant survival rate and patient survival rate are seriously affected. Cyclosporine A, rather than tacrolimus, inhibits HCV replication. As a basic immunosuppressive agent for liver transplant recipients, tacrolimus and cyclosporine A have different effects on HCV recurrence and its outcome. The clinical results of antiviral therapy using cyclosporine A and tacrolimus combined with interferon showed that there was a conflict between the two reports. To evaluate the effect of cyclosporine A and tacrolimus on hepatitis C virus infection and outcome after liver transplantation. Methods computer search was conducted for pubmedum MEDLINEN EMbase Science Citation Index, Chinese Biomedical Literature Database (CBM), and Wanfang Database. The search time is from FK506, TAC, TAC, tacrolimus Cyclosprint, Cyclosprin AcanCSA, hepatitis C, hep C, or HCV, LTT, transtplanation, transplantte, graftInterferon, IFNpegylated-interferon, PEG-IFN, ribavirinRBV.Chinese keywords for "tacrolimus, liver transplantation, hepatitis C, hepatitis C", Chinese for "tacrolimus, cyclosporin or cyclosporine, liver transplantation, hepatitis C, hepatitis C", the Chinese key words: "tacrolimus, cyclosporin or cyclosporin, liver transplantation, hepatitis C, hepatitis C". Hepatitis C, interferon, pegylated interferon, ribavirin are the key words. The statistical data are analyzed by using the special RevMan4.2 provided by the Cochrane Cooperative Network. The statistical data are expressed as correlation risk and 95% confidence interval under the random effect model. Results A total of 2764 articles were found and 17 of the observational studies met the pre-set screening criteria and were used in this meta-analysis study. The results of the data analysis showed that the persistent viral response rate of cyclosporine use was 422g / 945%. The rate of persistent viral response to tacrolimus was 35% 471 / 1364% RN 1.1895 CIQ 1.00-1.39% P0. 05%. Although the statistical data showed a certain heterogeneity, the incidence of persistent viral reaction in randomized controlled trials had some comparative significance (Cyclosporine persistent virus). The incidence of response was 39 and the rate of persistent viral reaction of tacrolimus was 35. 7 patients with 40 or more patients in each group were treated with cyclosporine (1634 patients in total). Conclusion for the treatment of recurrent hepatitis C after liver transplantation, we can only say that cyclosporine may have a little advantage over tacrolimus because of the heterogeneity of the study.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.63

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