他克莫司与环孢素A对肾移植术后患者急性排斥反应抑制效果的Meta分析  

Meta-analysis on inhibitory effectiveness of tacrolimus and ciclosporin on acute rejection in patients after kidney transplatation

作　　者：叶琴[1] 毛建华[1] 傅海东[1] 

机构地区：[1]浙江大学附属儿童医院肾内科,浙江杭州310001

出　　处：《吉林大学学报（医学版）》2013年第1期92-98,共7页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金资助课题(30971365;81070561;81170664;81270792);浙江省科技厅自然科学基金资助课题(LY21H050037);浙江省科技厅医药卫生重大科技计划项目资助课题(WKJ2010-2-014);浙江省科技厅医药卫生科技计划项目资助课题(2012KYA119)

摘　　要：目的:探讨免疫抑制剂他克莫司(Tac)与环孢素A(CsA)抑制肾移植术后患者急性排斥反应的效果,为临床肾移植术后免疫抑制剂方案的选择提供指导。方法:采用计算机检索进行文献初检,计算机检索数据库包括Medline数据库和中国学术期刊全文数据库(CNKI)。纳入涉及肾移植术后使用Tac与CsA作为主要免疫抑制剂的随机对照试验(RCTs),数据由2名作者独立提取,纳入研究的方法学质量采用Jadad质量评分标准,使用Rev Man 5.0软件进行统计数据分析。结果:初检文献226篇,最终纳入31篇RCTs涉及Tac与CsA抑制肾移植术后急性排斥反应效果的对照研究。Meta分析,分别有2篇及14篇研究报道肾移植术后半年内及1年内肾活检证实的急性排斥反应,Tac组肾脏活检证实的急性排斥反应发生率在半年和1年随访中均低于CsA组,差异具有统计学意义,半年相对危险度(RR)0.49,95%CI(0.37～0.67),P<0.01;1年RR 0.65,95%CI(0.56～0.75),P<0.01。分别有4篇及7篇研究报道肾移植术后半年内及1年内激素治疗抵抗的急性排斥反应,Tac组激素治疗抵抗的急性排斥反应发生率在半年和1年随访中均低于CsA组,差异具有统计学意义,半年RR 0.41,95%CI(0.30～0.57),P<0.01;1年RR 0.54,95%CI(0.37～0.78),P<0.01。结论:Tac反应抑制肾移植术后急性排斥反应的效果优于CsA。Objective To explore the inhibitory effectiveness of tacrolimus （Tac） and ciclosporin （Csa） on acute rejection in patients after kidney transplantation and to provide guidance for the selection of immunosuppression medicine after kidney transplantation. Methods Computer searches were in Medline and CNKI. The randomized controlled trials （RCT） comparing Tac with CsA in treatment of acute rejection after transplantation were included. Data was extracted independently by two reviewers. The methodological quality was assessed by the Jadad Score. Statistical analysis was performed with RavMan 5.0. Results 226 studies were found at first, and 31 RCTs comparing Tac with CsA in treatment of acute rejection after kidney transplantation were identified at last. Meta- analysis showed that 2 and 14 studies about biopsy-proved acute rejection during half a year and 1 year after transplantation were included. The morbidities of acute rejection during half a year and 1 year after transplantation in Tae group were lower than those in CsA group with statistical difference, half a year RR 0.49, 95%CI （0.37, 0.67）, P〈0.01; 1 year RR 0.65, 95%CI （0.56, 0.75）, P〈0.01. For steriod-resistant acute rejection 4 and 7 studies were included during half a year and 1 year after transplantation. The morbidities of acute rejection during half a year and 1 year after transplantation in Tac group were lower than those in CsA group with statistical difference, half a year RR 0. 41, 95%CI （0.30, 0.57）, P〈0.01; 1 year RR 0. 54, 95%CI （0.37, 0.78）, P= 0.01. Conclusion The effectiveness of Tae in inhibiting acute rejection after kidney transplantation is better than CsA.

关 键 词：肾移植 他克莫司 环孢素 META分析 系统评价 急性排斥反应 

分 类 号：R617[医药卫生—外科学] R692[医药卫生—临床医学]