激素联合吗替麦考酚酯与环磷酰胺对成人难治性肾病综合征疗效的Meta分析

发布时间：2018-03-14 09:13

本文选题：环磷酰胺　切入点：泼尼松　出处：《天津医药》2015年05期 　论文类型：期刊论文

【摘要】：目的系统评价激素联合吗替麦考酚酯与环磷酰胺对成人难治性肾病综合征的有效性及不良反应。方法电子检索Embase、Pubmed、Cochrane library、中国知网、万方和维普中文科技期刊数据库,检索时间范围为建库至2014年3月,纳入涉及激素联合吗替麦考酚酯与环磷酰胺对比治疗成人难治性肾病综合征的随机对照试验(RCT),根据纳入标准和排除标准筛选文献,经质量评价及提取数据后,使用Rev Man5.2软件对经治疗后的成人难治性肾病综合征的完全缓解率、有效率、血清白蛋白、相关不良反应等指标进行数据统计分析。结果共纳入RCT 9篇,467例患者,其中吗替麦考酚酯组235例,环磷酰胺组232例。Meta分析结果显示吗替麦考酚酯组完全缓解率(RR=1.45,95%CI为1.17~1.81,P=0.000 7)、有效率(RR=1.23,95%CI为1.11~1.36,P0.000 1)、血清白蛋白(WMD=2.73,95%CI为1.42~4.04,P0.000 1)高于环磷酰胺组,24 h尿蛋白定量(SMD=-0.63,95%CI为-1.16~-0.10,P=0.02)低于环磷酰胺组,血清胆固醇水平(SMD=0.31,95%CI为-0.23~0.84),P=0.26)与环磷酰胺组差异无统计学意义。吗替麦考酚酯组肝功能损害(RR=0.13,95%CI为0.06~0.28)、白细胞下降(RR=0.10,95%CI为0.04~0.23)、胃肠道反应(RR=0.21,95%CI为0.11~0.39)和脱发(RR=0.08,95%CI为0.02~0.29)的发生率均低于环磷酰胺组(均P0.05);2组上呼吸道感染(RR=0.68,95%CI为0.41~1.14)和肺部感染(RR=0.58,95%CI为0.31~1.08)的发生率差异无统计学意义。结论吗替麦考酚酯治疗成人难治性肾病综合征的有效性和安全性优于环磷酰胺。
[Abstract]:Objective to systematically evaluate the efficacy and adverse reactions of steroids combined with metocophenolate mofetil and cyclophosphamide in the treatment of intractable nephrotic syndrome in adults. Methods the databases of Embase Pubmedmedmeda Cochrane library, Chinese Journal of Science and Technology of China, Wanfang and Weipu were searched electronically. The search time ranged from the establishment of the bank to March 2014, and included in the randomized controlled trial (RCTT) involving the combination of hormones and cytophosphamide in the treatment of intractable nephrotic syndrome in adults. The literature was screened according to the inclusion criteria and exclusion criteria. After quality evaluation and data extraction, the complete remission rate, effective rate, serum albumin and serum albumin were obtained by using Rev Man5.2 software in the treatment of refractory nephrotic syndrome in adults. The data of related adverse reactions were statistically analyzed. Results totally 467 patients with RCT were included in the study. Meta-analysis of 232 cases in cyclophosphamide group showed that the complete remission rate (RR1.455-95 CI = 1.17 ~ 1.81), the effective rate (RRX 1.23995 CI = 1.111.36) and the serum albumin (WMD2.739 / 95 CI = 1.42 卤4.04 / P0.000) were higher than those in cyclophosphamide group (CI = -1.16 ~ -0.39 ~ (95) CI = -1.16 ~ -0.10 P ~ (0.02)) and higher than that in cyclophosphamide group (P = -1.16 ~ -0.39 ~ 95 CI = -1.16 ~ -0.10 P ~ (0.02)). There was no significant difference between the serum cholesterol level and the cyclophosphamide group. The incidence of liver dysfunction in the Mutimefen group was 0.06 卤0.28, RR0.1095 CI was 0.040.23, the incidence of gastrointestinal reaction was 0.21 / 95 CI was 0.110.39) and the incidence of alopecia was 0.0895CI was 0.020.29). There was no significant difference between the two groups in the incidence of upper respiratory tract infection (RRN 0.6895 CI = 0.41 卤1.14) and pulmonary infection (RRX 0.5895 CI = 0.31V 1.08). Conclusion the efficacy and safety of mycophenolate mofetil in the treatment of refractory nephrotic syndrome in adults is better than that of cyclophosphamide.
【作者单位】：广西医科大学第一附属医院肾内科;
【分类号】：R692.3

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