程序性活检在肾移植受者中的应用

发布时间：2018-07-23 16:12

【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受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数据库、Embase和Cochrane图书馆。纳入涉及程序性活检在肾移植受者中应用的随机对照研究(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受者中的应用的RCT。在程序性活检对肾移植受者移植肾存活率、肾功能的影响进行了Meta分析,并从文献中提取亚临床排异、钙调神经蛋白抑制剂(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:程序性活检可提高移植肾存活率,降低移植肾丢失率(RR 0.43,95%CI 0.26~0.70,P0.001)。程序性活检可使血清肌酐降低38.21μmol/L(95%CI 54.83~21.60,P0.001)。结论:程序性活检可发现亚临床阶段的排异反应、BK病毒感染、CNI中毒等疾病。对这些疾病的发现和及时干预可提高移植肾存活率。程序性活检可能提高长期肾功能,尤其是以环孢素为主要基础免疫抑制剂的患者。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 transplant recipients by Meta analysis and systematic evaluation. Methods: Medline database and Cochrane library were used for the first examination of literature by electronic retrieval. In a randomized controlled study involving the use of procedural biopsies in renal transplant recipients, (RCT), data were extracted by two authors independently, and the bias risks in the study were assessed using a bias risk assessment tool recommended by the Cochrane collaboration Network. The special RevMan5.0 software provided by Cochrane cooperation network is used for statistical data analysis. Results: five RCTs were included on the use of procedural biopsies in renal transplant recipients. The effects of routine biopsy on the survival rate and renal function of renal transplantation recipients were analyzed by Meta, and subclinical rejection, calmodulin inhibitor (CNI) poisoning and BK virus associated nephropathy were extracted from the literature. The adverse reactions of procedural biopsy and the patients' compliance with procedural biopsy were analyzed. Meta-analysis showed that procedural biopsy could improve the survival rate and decrease the rate of renal allograft loss (RR 0.4395 CI 0.260.70 / P0.001). Programmed biopsy could reduce serum creatinine by 38.21 渭 mol/L (95%CI 54.83C21.60 P0.001). Conclusion: BK virus infection with CNI poisoning can be found in subclinical stage by programmed biopsy. The detection and prompt intervention of these diseases can improve the survival rate of transplanted kidney. Procedural biopsy may improve long-term renal function, especially in patients with cyclosporine as the primary immunosuppressant. The incidence of severe adverse reactions in procedural biopsy is relatively low, which can be considered as a safe clinical measure.
【作者单位】：浙江大学附属第一医院肾脏病中心浙江省肾脏病防治技术研究重点实验室国家中医药管理局三级实验室"肾脏免疫实验室";
【基金】：浙江省科技厅重大专项(2012C13G2010133)
【分类号】：R699.2

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