他克莫司联合激素治疗难治性肾病的系统评价

发布时间：2018-05-23 08:02

本文选题：他克莫司 + 难治性肾病　；参考：《新疆医科大学》2014年硕士论文

【摘要】：目的：系统评价他克莫司联合激素治疗难治性肾病的有效性和安全性。方法：计算机检索中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普、万方数据库、MEDLINE、PubMed、The Cochrane Library、EMBASE、Up To Date，时限为1984年他克莫司首次发现至2014年6月，同时手工检索相关杂志及研究资料，查找他克莫司联合激素治疗难治性肾病的随机对照试验或半随机对照试验，并且根据患者的年龄将研究对象分为成人和儿童两部分，分别进行评价，由两名评价员独立筛选文献、提取资料、评价质量并交叉核对，采用RevMan5.2软件进行Meta分析。结果：成人部分共有11篇文献纳入本研究，高质量文献2篇，对593例成人患者进行了Meta分析，结果显示总缓解率：他克莫司联合激素组高于对照组，不良反应：他克莫司联合激素组与对照组相比，具有相似的胃肠道不良反应、血糖耐受，但总体不良反应发生率的比较有统计学意义，低于对照组；儿童部分共有6篇文献纳入本研究，高质量文献2篇，对354例儿童患者进行了Meta分析，，结果显示总缓解率：他克莫司联合激素组优于单用他克莫司组，优于环磷酰胺联合激素组，不良反应：他克莫司联合激素组总体不良反应发生率低于对照组，严重不良反应发生率低于对照组，胃肠道不良反应的发生率与对照组无统计学意义。结论：他克莫司联合激素治疗难治性肾病对于成人和儿童患者均可提高总缓解率，降低总体不良反应发生率，但两者临床病理分型有所不同，儿童以微小病变型肾病多见，成人以膜性肾病多见。基于研究的局限性，仍需高质量的临床随机对照试验进一步论证。
[Abstract]:Objective: to evaluate the efficacy and safety of tacrolimus combined with hormone in the treatment of refractory nephropathy. Methods: the Chinese biomedical literature database was searched by computer. CNKI, Weip, Wanfang were searched by computer. The Cochrane Library EMBASEN up to date was first found in 1984 to June 2014, and the relevant journals and research materials were searched manually. A randomized controlled trial or a semi-randomized controlled trial of tacrolimus combined with hormone in the treatment of refractory nephropathy was found, and the subjects were divided into two groups, adults and children, according to the age of the patients. Two evaluators independently sifted the literature, extracted the data, evaluated the quality and cross-checked, and used RevMan5.2 software to carry out Meta analysis. Results: a total of 11 articles were included in this study in adults and 2 articles in high quality. Meta analysis was performed on 593 adult patients. The results showed that the total remission rate was higher in tacrolimus combined hormone group than in control group. Adverse reactions: compared with the control group, tacrolimus combined with hormone group had similar gastrointestinal adverse reactions and glucose tolerance, but the incidence of overall adverse reactions was significantly lower than that of the control group. A total of 6 articles were included in this study in the children's section, and 2 articles of high quality were included in the study. Meta analysis was performed in 354 children. The results showed that tacrolimus combined with steroid group was better than tacrolimus group alone. The overall adverse reaction rate of tacrolimus combined hormone group was lower than that of control group, and the incidence of severe adverse reaction was lower than that of control group. There was no significant difference between the incidence of gastrointestinal adverse reactions and the control group. Conclusion: tacrolimus combined with steroid therapy for refractory nephropathy can increase the total remission rate and decrease the overall adverse reaction rate in both adults and children. Membranous nephropathy is more common in adults. Due to the limitations of the study, high-quality randomized controlled trials are still needed.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692

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