免疫抑制剂在穿透性角膜移植术后应用的系统评价  

Systematic review of penetrating keratoplasty rejection treated by immunosuppressants

作　　者：孙亚杰[1] 李爱朋[1] 潘志强[1] 骆非[1] 邹留河[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730

出　　处：《中华眼科杂志》2010年第12期1122-1127,共6页Chinese Journal of Ophthalmology

基　　金：国家高技术发展计划（863计划）（2006AA02A131）;北京市自然科学基金（7082025）

摘　　要：目的 探讨临床研究中角膜移植术后免疫抑制剂防治排斥反应的用药方式有效性及副作用.方法 应用循证医学的研究方法检索美国国立医学图书馆（Pubmed数据库）,荷兰医学文摘（Embase.com）,循证医学数据库（Cochrane Library）,中国知网（CNKI）以及万方数据库,纳入关于角膜移植术后应用免疫抑制剂防治排斥反应的随机对照与非随机对照试验的临床研究,进行方法学质量评价,并根据评价结果对其进行Meta分析.结果 共有31篇文献纳入研究,其中关于穿透性角膜移植术后免疫排斥预防用药的文献23篇,关于穿透性角膜移植术后发生排斥反应治疗的文献有9篇.糖皮质激素用于常规穿透性角膜移植术后预防排斥反应,单独局部应用的发生率为4.9%～28.9%,长期局部应用可明显降低排斥反应的发生率.对其中符合合并条件的文献进行定量分析表明,局部应用环孢素A（CsA）和他克莫司（FK-506）预防穿透性角膜移植排斥反应有效,且FK-506更强于CsA;全身应用CsA和霉酚酸酯均能有效预防高危穿透性角膜移植术后排斥反应的发生.在排斥反应的治疗方面,糖皮质激素局部和全身治疗均有效,而局部加用CsA疗效无明显提高.结论 眼局部和（或）全身应用免疫抑制剂（如糖皮质激素、CsA等）能有效预防高危穿透性角膜移植术后排斥反应的发生.Objective To investigate the validity and side-effect of immunosuppressnts for preventing and treating of immune rejection after penetrating keratoplasty （PKP）. Methods Randomized and non-randomizd controlled trials of immunosuppressants after PKP were searched from Pubmed,Embase. Com, Cochrane library, CNKI and Wanfang database; methodological quality and meta-analysis were carried out according to Evidence-Based Medicine （ EBM ）. Results Thirty-one studies in all were evaluated, of which twenty-three were about the prevention, and nine were about the treatment after PKP.The rate of immune rejection after normal PKP is 4. 9%-28. 9% when using corticosteroids to prevent immune rejection, especially for long-time use. According to meta-analysis： the effectiveness of local cyclosporine A and local FK-506 in preventing immune rejection after PKP is significant, and FK-506 is more effective than CsA topically; systemic CsA and MMF could effectively prevent immune rejection after high-risk PKP; as far as treating immune rejection, corticosteroid, whether topical or systemic, was effective; however additional topical CsA could not improve the treatment effect. Conclusion The use of immunosuppressants such as corticosteroids and CsA whether topical or systemic can effectively prevent the occurrence of immune rejection after high-risk PKP.

关 键 词：角膜移植 穿透性 免疫抑制剂 评价研究 

分 类 号：R686[医药卫生—骨科学]