无激素免疫抑制方案对肝移植患者术后常见并发症的影响的系统评价  

Systematic Review of the Effects of Hormone-free Immunosuppression Regimen on Common Complica tions in Liver Transplant Recipients

作　　者：魏晓晨[1] 朱立勤[1] 王春革[1] 

机构地区：[1]天津市第一中心医院,天津300192

出　　处：《中国药房》2013年第40期3808-3812,共5页China Pharmacy

摘　　要：目的:系统评价无激素免疫抑制方案对肝移植患者术后常见并发症的影响。方法:计算机检索PubMed、EMbase、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库、维普数据库和万方数据库,收集评价无激素免疫抑制方案对肝移植患者术后常见并发症的影响的随机对照试验(RCT)。对符合纳入标准的临床研究进行质量评价和资料提取后,采用Rev Man5.1统计学软件进行Meta分析。结果:共纳入15项RCT,合计1 914例患者。Meta分析结果显示,与含激素免疫抑制方案比较,用白细胞介素2受体单克隆抗体(巴利昔单抗、达利珠单抗)或抗胸腺细胞球蛋白代替激素的免疫抑制方案能有效降低肝移植患者术后的总感染率[RR=0.81,95%CI(0.68,0.97),P=0.02],且不会增加患者术后急性排斥反应的发生率;不加用激素的免疫抑制方案在肝移植患者术后总感染率方面差异无统计学意义,但会增加患者术后急性排斥反应的发生率[RR=1.62,95%CI(1.19,2.22),P<0.01];无激素免疫抑制方案能有效降低肝移植患者术后糖尿病发生率[RR=0.48,95%CI(0.37,0.62),P<0.01];无激素免疫抑制方案能有效降低肝移植患者术后高血压发生率[RR=0.82,95%CI(0.71,0.95),P<0.01]。结论:建议临床肝移植患者术后应用的免疫抑制方案为他克莫司/环孢素A(+吗替麦考酚酯)+白细胞介素2受体单克隆抗体/抗胸腺细胞球蛋白。OBJECTIVE： To evaluate the effect of hormone-free immunosuppression （IS） regimen on common complications in liver transplant recipients. METHODS： Related literatures were retrieved from PubMed, EMbase, Cochrane library, CBM, CNKI, VIP and Wanfang database, randomized controlled trials （RCT） about the effect of hormone-free IS regimen on common complications in liver transplant recipients were collected and evaluated. Statistical analysis was performed with Rev Man 5.1 soft- ware after quality evaluation and information extraction were used to the test publication bias. RESULTS： 15 RCTs were included, involving 1 914 patients. Results of Meta-analyses showed： compared with hormone IS regimen, IS regimen in which hormones were replaced by IL-2 receptor antibody or antithymocyte globulin could decrease total infection rate [RR=0.81, 95% CI（0.68, 0.97）, P=0.02]; while the incidence of postoperative acute rejections had no increase; there was no statistical significance in post- operative total infection rate of liver transplant recipients in hormone-free IS regimen in which hormone were not replaced by anoth- er IS agent; while the incidence of postoperative acute rejections was increased [RR= 1.62, 95% CI （1.19, 2.22）, P〈0.01]. hor- mone-free IS regimen could effectively decrease the incidence of postoperative transplant diabetes mellitus （PTDM） [RR=0.48, 95%CI（0.37, 0.62）,P〈0.01]. hormone-free IS regimen could effectively decrease the incidence of hypertension [RR=0.82, 95% CI（0.71, 0.95）, P〈0.01]. CONCLUSIONS： Suggested IS regimen include Tac/CsA （＋MMF）＋IL-2 receptor antibody/ATG.

关 键 词：肝移植 激素 并发症 META分析 

分 类 号：R96[医药卫生—药理学] R575[医药卫生—药学]