抗肿瘤坏死因子α制剂治疗溃疡性结肠炎的疗效和安全性的Meta分析

发布时间：2019-03-14 19:30

【摘要】：目的采用Meta分析方法评价抗肿瘤坏死因子α(TNF-α)制剂治疗中重度溃疡性结肠炎(UC)的疗效和安全性。方法全面检索Cochrane图书馆、PubMed、Embase、ISI、OVID和中国生物医学文献数据库、中国知网、万方数据库、维普数据库中有关抗TNF-α制剂治疗UC的临床随机对照试验(RCT),按照纳入与排除标准选择文献、提取资料并进行方法学质量评价后,采用Revman 5.1软件进行Meta分析。结果共纳入11项RCT,共3 334例患者。Meta分析结果显示,抗TNF-α制剂在治疗UC的短期应答(OR=2.51,95%CI 1.73,3.64)与短期缓解(OR=2.74,95%CI1.80,4.16),长期应答(OR=2.98,95%CI1.98,4.47)与长期缓解(OR=2.64,95%CI 1.89,3.67),黏膜愈合率(OR=1.89,95%CI 1.39,2.59)各个方面均优于对照组,并可以降低结肠手术切除率(OR=0.61,95%CI 0.41,0.89),改善生活质量[IBDQ评分的均数差(MD)为14.74,95%CI 11.43,18.06],在所有报道不良反应(OR=1.14,95%CI0.97,1.34)与严重不良反应(OR=0.78,95%CI0.56,1.09)发生方面与对照组差异无统计学意义。结论抗肿瘤坏死因子α制剂治疗中重度UC不仅可以诱导缓解及长期维持,而且可以促进黏膜愈合、降低结肠手术切除率、提高生活质量,长期使用也较为安全。上述结论仍需要更多高质量RCT证实。
[Abstract]:Objective to evaluate the efficacy and safety of anti-tumor necrosis factor 伪 (TNF- 伪) preparation in the treatment of moderate or severe ulcerative colitis (UC) by Meta analysis. Methods A comprehensive search of Cochrane Library, PubMed,Embase,ISI,OVID and Chinese Biomedical Literature Database, China knowledge Network, Wanfang Database and Vip Database were conducted on the clinical randomized controlled trials (RCT),) of anti-TNF- 伪 agents for treatment of UC. After selecting the literature according to the inclusion and exclusion criteria, extracting the data and evaluating the methodological quality, Meta analysis was carried out with Revman 5.1 software. Results A total of 3 334 patients with 11 RCT, were enrolled. Meta-analysis showed that the short-term response (OR=2.51,95%CI 1.73, 3.64) and short-term remission (OR=2.74,95%CI1.80,4.16) of anti-TNF- 伪 in the treatment of UC. Long-term response (OR=2.98,95%CI1.98,4.47), long-term remission (OR=2.64,95%CI 1.89, 3.67) and mucosal healing rate (OR=1.89,95%CI 1.39, 2.59) were better than those in the control group. It could reduce the resection rate of colon (OR=0.61,95%CI 0.41, 0.89) and improve the quality of life [the mean difference of IBDQ score (MD) was 14.74, 95% CI 11.43, 18.06], and improved the quality of life (MD) = 14.74, 95% CI 11.43, 18.06). There was no significant difference in the incidence of all reported adverse reactions (OR=1.14,95%CI0.97,1.34) and severe adverse reactions (OR=0.78,95%CI0.56,1.09) between the two groups. Conclusion Anti-tumor necrosis factor-伪 preparation can not only induce remission and long-term maintenance of moderate or severe UC, but also promote mucosal healing, reduce resection rate of colon and improve quality of life. Long-term use of TNF-伪 is also safe. The above conclusions still need to be confirmed by more high-quality RCT.
【作者单位】：西安交通大学医学部第一附属医院消化内科;西安交通大学医学部第一附属医院肿瘤外科;西安交通大学医学部第一附属医院神经内科脑血管病区;
【分类号】：R574.62

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