神经钙调蛋白抑制剂、环磷酰胺治疗儿童激素耐药型肾病综合征疗效差异的系统评价

发布时间：2018-09-04 10:34

【摘要】：目的系统评价神经钙调蛋白抑制剂(CNI)、环磷酰胺(CTX)治疗儿童激素耐药型肾病综合征疗效的差异。方法检索Pubmed数据库和CNKI、万方数据库、维普数据库中有关CNI(环孢素A或者他克莫司)、CTX治疗儿童激素耐药型肾病综合征疗效差异的随机对照研究。由两位独立的研究者对入选的文献按纳入标准和排除标准进行筛选,并评价文献质量。提取纳入文献中儿童激素耐药型肾病综合征患者的治疗方案、治疗6个月时的有效(完全缓解+部分缓解)率和完全缓解率。其中采用CNI治疗者为CNI组,CTX治疗者为CTX组。采用Reviewer Manager5.2软件比较CNI、CTX组治疗6个月时的有效率、完全缓解率。对纳入研究的文献数据进行异质性检验,I~240%表示各研究之间无显著异质性。结果共检索到67篇文献,根据纳入和排除标准最终11篇文献纳入本研究,共912例患者,其中CNI组497例、CTX组415例。随访6个月时,CNI组56例、CTX组49例失访。治疗6个月时CNI组、CTX组有效率分别为81.2%(358/441)、41.3%(151/366),CNI组有效率高于CTX组(RR为2.13,95%CI为1.64~2.78,I~2=32%,P0.05);治疗6个月时CNI组、CTX组完全缓解率分别为45.1%(199/441)、13.1%(48/366),CNI组完全缓解率高于CTX组(RR为2.63,95%CI为1.47~3.80,I~2=17%,P0.05)。结论 CNI治疗儿童激素耐药型肾病综合征的疗效优于CTX。
[Abstract]:Objective to evaluate the efficacy of neurocalmodulin inhibitor (CNI), cyclophosphamide (CTX) in the treatment of steroid-resistant nephrotic syndrome in children. Methods A randomized controlled study was conducted to search Pubmed database, CNKI, Wanfang database and Wiper database about the difference of the efficacy of CNI (cyclosporine A or tacrolimus) in the treatment of steroid-resistant nephrotic syndrome in children. The selected literature was screened by two independent researchers according to inclusion criteria and exclusion criteria, and the quality of the literature was evaluated. The effective (complete remission) rate and complete remission rate at 6 months after treatment of steroid-resistant nephrotic syndrome in children were extracted and included in the literature. The patients treated with CNI were CNI group and CTX group. Reviewer Manager5.2 software was used to compare the effective rate and complete remission rate of CNI,CTX group at 6 months. The heterogeneity test of the literature data included in the study indicated that there was no significant heterogeneity among the studies. Results A total of 67 articles were retrieved. According to the inclusion and exclusion criteria, 11 articles were included in this study. A total of 912 patients were included in the study, including 497 cases in CNI group and 415 cases in CTX group. At 6 months follow-up, there were 56 cases in CNI group and 49 cases in CTX group. At 6 months after treatment, the effective rate of CNI group was 81.2% (358 / 441) and 41.3% (151366) respectively. The effective rate of CNI group was higher than that of CTX group (RR = 2.13395 CI = 1.64 卤2.78CI = 1.64 卤2.78CI = 1.64), and the complete remission rate of CNI group was 45.1% (199441) 13.1% (48 / 366) compared with CTX group (RR = 2.6395CI = 1.473.80I-1 / 217P 0.05) at 6 months after treatment, the complete remission rate of CNI group was higher than that of CTX group (RR = 2.6395CI = 1.473.80I217P 0.05). Conclusion CNI is superior to CTX. in the treatment of steroid-resistant nephrotic syndrome in children.
【作者单位】： 中国医学科学院北京协和医学院北京协和医院;
【分类号】：R726.9
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本文编号：2221821