程序性活检在肾移植患者中的应用：meta分析与系统性评价

发布时间：2018-05-11 04:28

本文选题：肾移植 + 程序性活检　；参考：《浙江大学》2014年硕士论文

【摘要】：目的：通过meta分析及系统性评价的方法为程序性活检在肾移植患者中的应用价值提供循证医学依据。方法：采用电子检索进行文献初检,电子检索数据库有Medline、Embase数据库和Cochrane图书馆。纳入涉及程序性活检在肾移植患者中应用的随机对照试验(RCT),数据由两名作者独立提取,纳入研究的偏倚风险采用Cochrane协作网推荐的偏倚风险评估工具进行评估,使用Cochrane协作网提供的专用RevMan5.0软件进行统计数据分析。结果：纳入5篇关于程序性活检在肾移植患者中的应用的前瞻性病例对照研究。对程序性活检对肾移植患者移植肾存活率、肾功能、急性排斥反应的发生率的影响进行了meta分析,并从文献中提取亚临床排异、肾间质纤维化／小管萎缩、CNI中毒、BK病毒相关性肾病、程序性活检的不良反应及患者对程序性活检的顺应性等的发病学资料进行合并分析。Meta分析的结果提示：1.亚临床病理异常的发现与治疗可以提高移植肾长期存活率,降低移植肾丢失率,RR为0.40,95%CI(0.25,0.65),P0.001。2.亚临床病理异常的发现与治疗可以降低血肌酐WMD为-38.21,95%CI(-54.83,-21,60),p0.00001。3.在以他克莫司为主要维持性免疫抑制剂方案的一类受者中,亚临床病理异常的发现与治疗并不能明显提高患者肾小球滤过率／肌酐清除率。而对于那些文献中交代维持性免疫抑制剂以他克莫司或环孢素A为主的患者中,程序性活检组可以提高肾小球滤过率,SMD为0.78,95%CI(0.51,1.05)。4.亚临床病理异常的发现与治疗对急性排斥反应发生率并没有明显影响。从纳入的5篇文献中提取相关发病学资料汇总的结果：亚临床排异的发生率为3%-56%。程序性活检对CNI中毒的发现率,为0-29%。移植后BK病毒相关性肾病的发生率在2.0%-4.7%。程序性活检的不良反应发生率1.1%-10%。没有因不良反应而发生移植肾丢失或死亡的报道。结论：通过程序性活检发现并治疗亚临床排异可以提高移植肾存活率。程序性活检可能提高长期肾功能,尤其在以环孢素为主要基础免疫抑制剂的病人中。程序性活检并不能显著减少临床急性排斥反应的发生率。程序性活检严重不良反应发生率较低,可以认为是一个比较安全的临床措施。
[Abstract]:Objective: to provide evidence-based medical evidence for the application of procedural biopsy in renal transplantation by meta analysis and systematic evaluation. Methods: electronic retrieval was used to check the literature. There were Medline Embase database and Cochrane library. A randomized controlled trial involving the use of procedural biopsies in renal transplant patients was included. The data were extracted independently by two authors, and the bias risks in the study were assessed using the bias risk assessment tool recommended by the Cochrane Collaborative Network. The special RevMan5.0 software provided by Cochrane cooperation network is used for statistical data analysis. Results: five prospective case-control studies were included on the application of procedural biopsy in renal transplant patients. The effects of routine biopsy on the survival rate, renal function and incidence of acute rejection in renal transplantation patients were analyzed by meta, and subclinical rejection was extracted from the literature. The pathogenetic data of renal interstitial fibrosis / tubule atrophy caused by CNI poisoning and BK virus associated nephropathy, the adverse reactions of programmed biopsy and the compliance of patients with programmed biopsy were analyzed. The results of meta-analysis suggested that: 1. The detection and treatment of subclinical pathological abnormalities can improve the long-term survival rate and reduce the rate of renal allograft loss. The RR is 0.4095% ~ 0.25% ~ 0.65% ~ 0.65% P 0.001.2. The detection and treatment of subclinical pathological abnormalities can reduce the WMD of serum creatinine to -38.21 and 95. In a group of recipients with tacrolimus as the main maintenance immunosuppressant regimen, the detection and treatment of subclinical pathological abnormalities did not significantly improve the glomerular filtration rate / creatinine clearance rate. In those patients whose maintainable immunosuppressants were tacrolimus or cyclosporine A, the SMD of glomerular filtration rate was increased in the programmed biopsy group. The detection and treatment of subclinical pathological abnormalities had no significant effect on the incidence of acute rejection. A summary of relevant pathogenetic data was extracted from the 5 articles included: the incidence of subclinical rejection was 3-56. The detection rate of CNI poisoning by programmed biopsy ranged from 0 to 29. The incidence of BK virus associated nephropathy after transplantation ranged from 2.0 to 4.7. The incidence of adverse reactions in procedural biopsy was 1.1-10. No kidney graft loss or death was reported as a result of adverse reactions. Conclusion: subclinical rejection can be improved by routine biopsy. Procedural biopsies may improve long-term renal function, especially in patients with cyclosporine as the primary immunosuppressant. Procedural biopsy does not significantly reduce the incidence of clinical acute rejection. The incidence of severe adverse reactions in procedural biopsy is relatively low, which can be considered as a safe clinical measure.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2

【参考文献】