特发性膜性肾病的免疫抑制疗法的系统综述与meta分析  

A systematic review and meta-analysis of immunity in idiopathic membranous nephropathy inhibition

作　　者：侯静[1] 曹灵[1] 刘进[1] 陈昕[1] 

机构地区：[1]泸州医学院附属医院肾病内科,四川泸州646000

出　　处：《中国生化药物杂志》2014年第5期74-78,82,共6页Chinese Journal of Biochemical Pharmaceutics

基　　金：国家自然科学基金(30870903);四川省卫生厅立项(130259)

摘　　要：目的进行关于表现为肾病综合症的成人特发性膜性肾病的免疫抑制疗法的系统综述与meta分析。方法检索cochrane图书馆、PUBMED、EMBASE、CNKI等数据库,收集关于伴有肾病综合症的特发性膜性肾病的免疫抑制疗法的RCT研究论文。结果免疫抑制疗法能够提高患者完全缓解率与部分缓解率(16项RCT研究,864例患者;1.31[1.01~1.70];P=0.04),但却更容易造成停药与入院治疗(16项RCT研究,880例患者;5.35[2.19~13.02];P=0.002)。皮质类固醇+烷化剂疗法能够显著降低全死因死亡率与终末期肾病发生率(8项RCT研究,448例患者;0.44[0.26~0.75];P=0.002),提高患者完全缓解率与部分缓解率(7项RCT研究,422例患者;1.46[1.13~1.89];P=0.004),但会导致更多不良反应发生(4项RCT研究,303例患者;4.20[1.15~15.32];P=0.03)。环磷酰胺较苯丁酸氮芥安全性更好(3项RCT研究,147例患者;0.48[0.26~0.90];P=0.02)。未发现环磷酰胺与霉酚酸酯优于烷化剂疗法。他克莫司+促肾上腺皮质激素能够显著减少蛋白尿。结论烷化剂+皮质类固醇疗法对于成年人的特发性膜性肾病有着较好的远期及近期疗效,但更易造成患者入院或停药。Objective To perform a systematic review and meta-analysis of randomized controlled trials(RCTs). Methods The Cochrane Library,PUBMED,EMBASE and CNKI were searched to identify RCTs investigating the effect of immuno-suppression on adults with IMN and nephrotic syndrome. Results Immunosuppression increased complete or partial remission(CR + PR)(16 RCTs,864 participants; 1. 31[1. 01 ~ 1. 70]; P = 0. 04)but resulted in more withdrawls or hospitalizations(16 RCTs,880 participants; 5. 35[2. 19 ~ 13. 02]; P = 0. 002). Corticosteroids combined with alkylating agents significantly reduced all-cause mortality or ESRD(8 RCTs,448 participants; 0. 44 [0. 26 ~ 0. 75]; P = 0. 002)and increased CR + PR(7 RCTs,422 participants; 1. 46 [1. 13 ~ 1. 89]; P = 0. 004) but led to more adverse events(4 RCTs,303 participants; 4. 20 [1. 15 ~ 15. 32]; P = 0. 03).Cyclophosphamide was safer than chlorambucil(3 RCTs,147 participants; 0. 48 [0. 26 ~ 0. 90]; P = 0. 02). Cyclosporine and mycophenolate mofetil failed to show superiority over alkylating agents. Tacrolimus and adrenocorticotropic hormone significantly reduced proteinuria. Conclusion Alkylating agents plus corticosteroids have long-term and short-term benefits for adult IMN,but result in more withdrawls or hospitalizations.

关 键 词：特发性膜性肾病 免疫抑制疗法 META分析 

分 类 号：R587[医药卫生—内分泌]