沙利度胺治疗克罗恩病疗效的系统评价

发布时间：2018-08-29 19:25

【摘要】：目的:利用现有的文献评价沙利度胺治疗克罗恩病(Crohn,s disease)的疗效与安全性,为临床治疗提供参考依据。方法:利用计算机系统地检索国内外公开发表的所有关于沙利度胺治疗克罗恩的相关文献,检索日期为2016年8月以前。严格按照纳入排除标准进行文献筛选、质量评价和提取相关数据后,应用Rev Man5.3软件进行Meta分析。采用I 2检验异质性,计数资料采用相对危险度(relative risk,RR)及95%可信区间(95%confidence interval,95%CI)表示。单组率采用公式RR/(1+RR)合并,相应的95%CI区间(上限值RR/(1+上限值RR),下限值RR/(1+下限值RR)。对不能进行定量Meta分析的指标,可进行描述性研究。结果:最终符合纳入标准的研究共18项,病人总数为381人。Meta分析结果显示:沙利度胺治疗克罗恩病的临床缓解率合并RR=0.88,95%CI(0.53~1.48),合并率为46.8%,95%CI(34.6%~59.6%);实现激素减量率合并RR=1.97,95%CI(0.55~7.09),其合并率66.3%,95%CI(35.4%~87.6%);实现瘘管闭合率合并RR=0.69,95%CI(0.38~1.26),其总体率为41%,95%CI(27.5%~55.8%);实现黏膜愈合率合并RR=0.50,95%CI(0.23~1.11),合并率为33%,95%CI(18.7%~52.6%);生物制剂治疗失败后获得临床缓解率合并RR=1.72,95%CI(0.88~3.36),其合并率为63.2%,95%CI(46.8%~77.1%)。一共有64.5%的病人发生了不良反应,其中25.2%的病人因不良反应而停药。结论:沙利度胺治疗克罗恩病有一定疗效,但使用时需注意其不良反应。
[Abstract]:Objective: to evaluate the efficacy and safety of thalidomide in the treatment of Crohn's disease (Crohn,s disease). Methods: all the published literatures on thalidomide therapy for Crohn were systematically searched by computer before August 2016. Literature screening, quality evaluation and extraction of relevant data were carried out strictly according to exclusion criteria. Meta analysis was carried out with Rev Man5.3 software. I 2 was used to test the heterogeneity. The count data were expressed by relative risk (relative risk,RR) and 95% confidence interval (95%confidence interval,95%CI). The univariate rate is combined with the formula RR/ (1 RR), and the corresponding 95%CI interval (upper value RR/ (1 upper value RR), lower limit value RR/ (1 lower limit value RR).) Descriptive studies can be carried out on indicators that cannot be analyzed by quantitative Meta. Results: there were 18 studies that eventually met the inclusion criteria, The results of meta-analysis showed that the clinical remission rate of thalidomide in the treatment of Crohn's disease combined with RR=0.88,95%CI (0.531.48), and the combined rate was 46.8 / 95CI (34.6 / 59.6%), a hormone reduction rate combined with RR=1.97,95%CI (0.557.09), and a combined rate of 66.395CI (35.47.6%), a fistula closure rate combined with RR=0.69,95%CI (0.381.26), and a total rate of 41C _ (95) CI (27.55.58%). The rate of mucosal healing combined with RR=0.50,95%CI (0.231.11), the combined rate was 330.95 CI (18.7%, 52.6%), the rate of clinical remission after the failure of biological agent therapy and RR=1.72,95%CI (0.883.36), the combined rate was 63.2% with 95 CI (77.1%). A total of 64.5% of the patients had adverse reactions, of which 25.2% stopped taking drugs because of adverse reactions. Conclusion: thalidomide is effective in the treatment of Crohn's disease, but attention should be paid to its adverse reactions.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.62

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