吗替麦考酚酯诱导治疗狼疮性肾炎的Meta分析  

A Meta-Analysis Efficacy Observation of Mycophenolate Mofetil for Lupus Nephritis

作　　者：张任[1] 杨一菲[2] 

机构地区：[1]湖北医药学院附属东风总医院,湖北十堰442008 [2]武汉大学人民医院肾内科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2015年第5期831-838,共8页Medical Journal of Wuhan University

摘　　要：目的:用Meta分析方法评价吗替麦考酚酯与环磷酰胺治疗狼疮性肾炎(LN)的疗效和安全性。方法:运用万方数据库、Cochrane图书馆、PubMed和中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)检索吗替麦考酚酯治疗狼疮性肾炎的随机对照临床试验(RCTs),2014年3月25日检索文献截止,对符合标准的文献进行质量评价,用RevMan 5.1软件对符合质量标准的RCT进行Meta分析。结果:初步检索168篇相关文献中有7篇文献入选,共纳入699例患者,结果显示,实验组吗替麦考酚酯,治疗LN的总缓解率(OR=1.56,95%CI[1.13-2.14])、完全缓解率(OR=2.09,95%CI[1.08-4.05])均高于对照组环磷酰胺,且差异有统计学意义,两者部分缓解率无明显差异(OR=1.10,95%CI[0.80-1.51])。药物相关不良反应分析显示,吗替麦考酚酯组白细胞减少、月经紊乱、脱发发生率均明显低于环磷酰胺组,差异具有统计学意义。而其它不良反应如感染、胃肠道反应、带状疱疹发生率两者无明显差异。结论:吗替麦考酚酯治疗狼疮性肾炎疗效优于环磷酰胺,且药物不良反应白细胞减少、闭经、秃头发生率下降,较环磷酰胺具有更好的疗效及安全性。Objective： To analyze the efficacy and safety of mycophenolate mofetil （MMF） and cyclo- phosphamide （CPA） for lupus nephritis （LN） through meta-analysis. Methods： Pubmed, Co- ehrane Library, China National Knowledge Infrastructure （CNKI）, WanFang and VIP database were screened for randomized controlled clinical trials （RCTs） relating to MMF in treating LN until March 25, 2014. Qualified literatures were accessed and analyzed by RevMan 5.1 software to complete the meta-analysis. Results： A total of 168 articles were primarily searched and 7 of them were enrolled, including 699 eases. In the treatment of LN, the complete and total remis- sion rate of MMF in the study group （OR： 1.56, 95%CI 1.13-2.14） were significantly higher than those of CPA in the control group （OR：2.09, 95%CI 1.08-4.05）. There was no signifi- cant difference in partial remission rate between the two groups （OR=1.10, 95%CI 0. 80-1.51）. For drug-related adverse reactions, the in cidence of leukopenia, menstrual disorder and baldness in the MMF group was significantly lower than that respectively in the CPA group. The incidence of other adverse reactions, including infection, gastrointestinal reaction and herpes zoster, was not significantly different between the two groups. Conclusion： The curative effect of MMF for NL is superior to the CPA and the incidence of leukopenia, menstrual disorder and baldness of MMF is relatively low, which indicates better efficacy and safety.

关 键 词：吗替麦考酚酯 环磷酰胺 狼疮性肾炎 META分析 

分 类 号：R34[医药卫生—基础医学] R692