泼尼松联合霉酚酸酯对比环磷酰胺治疗狼疮性肾炎的系统评价  

Mycophenolate mofetil versus cyclophosphamide combined with prednisone in induction therapy for lupus nephritis: a systematic review

作　　者：张培敏[1,2] 樊蓉[1] 李想[1] 孙宇[1] 任健[1,2] 姜珊[1,2] 史国兵[1] 

机构地区：[1]沈阳军区总医院药学部,沈阳110016 [2]沈阳药科大学,沈阳110016

出　　处：《实用药物与临床》2015年第2期130-135,共6页Practical Pharmacy and Clinical Remedies

基　　金："十二五"国家科技支撑计划课题(2013BAI06B04)

摘　　要：目的系统评价泼尼松联合霉酚酸酯与环磷酰胺治疗狼疮性肾炎的疗效及安全性。方法检索Pub Med、MEDLINE、Embase、Cochrance图书馆临床对照试验资料库、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(维普)和万方数字化期刊全文库等,检索泼尼松联合霉酚酸酯(MMF)与环磷酰胺(CTX)治疗狼疮性肾炎的随机对照临床试验(检索时间均从建库至2013年12月),对完全缓解率、部分缓解率、总缓解率、感染、白细胞减少、胃肠道反应进行Meta分析。结果共纳入22篇文献(共1 641例),Meta分析结果显示,与泼尼松+CTX组比较,泼尼松+MMF组的完全缓解率及总缓解率高(P<0.01),而感染率、白细胞减少发生率低(P<0.01),两组间部分缓解率及胃肠道反应比较差异无统计学意义(P>0.05)。结论泼尼松联合MMF治疗狼疮性肾炎的缓解率较泼尼松联合CTX高,感染及白细胞减少的风险较小。Objective To assess the efficacy and safety of mycophenolate mofetil（ MMF） versus cyclophosphamide（ CTX） combined with prednisone in the induction treatment for lupus nephritis（ LN）. Methods The database such as PubM ed,M EDLINE,Embase,the Cochrane Controlled Trials Register,CNKI,VIP and Wanfang were searched from their establishment date to December 2013,in order to retrieve the randomized controlled trials（ RCTs）about MMF versus CTX combined with prednisone for LN. Meta-analysis was made to assess the complete remission,partial remission,total remission,infection,leucopenia,gastrointestinal symptoms. Results 22 studies involving 1641 participants were included. Meta-analysis showed： compared with CTX ＋ predsione,M MF ＋ predsione was more effective in complete remission and total remission（ P 〈 0. 01）,and the incidence of infection and leucopenia was lower（ P 〈 0. 01）,while there was no significant difference in partial remission and gastrointestinal symptoms between the two groups（ P 〉 0. 05）. Conclusion Prednisone ＋ MM F treatment has higher renal remission rate than that of prednisone ＋ CTX for LN patients,with lower risks of leukopenia and infection.

关 键 词：泼尼松 环磷酰胺 霉酚酸酯 狼疮性肾炎 META分析 

分 类 号：R593.242[医药卫生—内科学]