霉酚酸酯与环磷酰胺治疗难治性肾病综合征疗效和安全性比较的Meta分析  

Meta-analysis on the efficacy and safety between mycophenolate mofetil and cyclophosphamide in the treatment of refractory nephrotic syndrome

作　　者：杨伟伟[1] 张晓波[1] 季晓琪[1] 张丽琴[1] 

机构地区：[1]南京医科大学附属淮安市第一人民医院肾内科,江苏淮安223300

出　　处：《南京医科大学学报（自然科学版）》2010年第8期1172-1177,共6页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:总结近年来霉酚酸酯(mycophenolate mofetil,MMF)和环磷酰胺(cyclophosphamide,CTX)治疗难治性肾病综合征(refractory nephrotic cyndrome,RNS)的随机对照试验(randomized controlled trial,RCT),采用Meta分析法评估MMF和CTX在治疗RNS中的疗效以及安全性,为临床治疗提供指导。方法:制定原始文献的纳入标准、排除标准及检索策略,在中国生物医学文献数据库(1979～2009)、中国期刊全文数据库(1994～2009)、中文科技期刊全文数据库(1989～2009)、中文生物医学期刊数据库(1994～2009)、万方数据库(1982～2009)、PubMed(1966～2009)、EMBASE(1984～2009)内进行相关的随机对照试验检索、质量评价和资料提取,对符合入选标准的研究用RevMan4.2.9软件进行Meta分析。结果:共纳入8个RCT。除了肝损害研究以外,其它研究经Begg's Test检验未见显著发表偏倚。符合纳入标准的患者Meta分析结果示,在治疗后MMF组的临床缓解率(完全+部分缓解率)显著高于CTX组(P<0.05),不良反应明显减少(P<0.05)。结论:与CTX结合激素治疗相比较,MMF结合激素治疗RNS的更为有效、安全。Objective：To assess the therapeutic effects and adverse effects of mycophenolate mofetil （MMF）and cyclophosphamide （CTX）in the treatment of refractory nephrotic syndrome（RNS） in the systematic review of randomized controlled trials. Methods：We searched PubMed（1966～2009）,EMBASE（1984～2009）,CBM（1979～2009）,CNKI（1994～2009）,VIP（1984～2009）,CMCC （1994 ～ 2009）and Wanfang database （1982 ～2009）with Keywords of ＂mycophenolate mofetil＂, ＂cyclophosphamide＂ and ＂refractory nephrotic syndrome＂ to identify randomized controlled trials of mycophenolate mofetil versus cyclophosphamide for refractory nephrotic syndrome patients. The quality of literature was evaluated,and Meta-analysis was conducted using RevMan 4.2.9 software. Results： Eight RCTs were identified. There was no evidence showing a publication bias except hepatic lesion’s study after Begg’s test analysis. Compared with CTX groups,MMF increased the clinical remission rate,including complete remission rate and partial remission rate （P 0.05）. It also significantly reduced the adverse effects（P 0.05）. Conclusion：The therapy of MMF plus steroids were more effective than that of CTX plus steroids in clinical remission of RNS,and had fewer adverse effects.

关 键 词：霉酚酸酯 环磷酰胺 难治性肾病综合征 META分析 

分 类 号：R593.2[医药卫生—内科学]