环孢素联合糖皮质激素对比环磷酰胺联合糖皮质激素治疗膜性肾病有效性与安全性的Meta分析  

Efficacy and Safety of Ciclosporin Combined with Glucocorticoid versus Cyclophosphamide Combined with Glucocorticoid in the Treatment of Membranous Nephropathy:a Meta-analysis

作　　者：陆晓华[1,2,3] 郑亚莉[1,2,3] 高永财[1,2,3] 保莉 王慧 曹丽[1,2,3] 田大成 LU Xiaohua;ZHENG Yali;GAO Yongcai;BAO Li;WANG Hui;CAO Li;TIAN Dacheng(Ningxia Hui Autonomous Region People’s Hospital,Yinchuan 750002,China;The First Affiliated Hospital of Northwest University for Nationalities,Yinchuan 750002,China;The Affiliated Autonomous Region People’ s Hospital of Ningxia Medical University,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院,银川750002 [2]西北民族大学第一附属医院,银川750002 [3]宁夏医科大学附属自治区人民医院,银川750002

出　　处：《中国药房》2019年第10期1407-1411,共5页China Pharmacy

基　　金：国家自然科学基金资助项目(No.81860136;81460-161);宁夏回族自治区重点研发计划重大(重点)项目(No.2018BFG02-010);宁夏回族自治区重点研发计划一般项目(No.2018BEG03053);宁夏自然科学基金资助项目(No.NZ17186)

摘　　要：目的:系统评价环孢素联合糖皮质激素对比环磷酰胺联合糖皮质激素治疗膜性肾病的有效性与安全性。方法:计算机检索Embase、Medline、中国知网、维普中文科技期刊数据库、万方数据库,收集环孢素联合糖皮质激素(试验组)对比环磷酰胺联合糖皮质激素(对照组)治疗膜性肾病的随机对照试验(RCT),筛选文献、提取资料并采用Jadad量表评价文献质量后,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入6项RCT,共计312例患者。Meta分析结果显示,试验组患者治疗3个月后缓解率[OR=3.42,95%CI(2.05,5.71),P<0.000 01]、复发率[OR=3.12,95%CI(1.45,6.70),P=0.004]、治疗12个月后白细胞计数[MD=1.77,95%CI(0.96,2.58),P<0.000 1]均显著高于对照组;两组患者治疗6个月后缓解率[OR=2.06,95%CI(0.80,5.30),P=0.13]、治疗12个月后缓解率[OR=1.30,95%CI(0.68,2.48),P=0.42]、治疗3个月后血肌酐水平[MD=-1.55,95%CI(-6.72,3.62),P=0.56]、治疗6个月后血肌酐水平[MD=-1.21,95%CI(-5.96,3.54),P=0.62]、治疗12个月后胆固醇水平[MD=-0.77,95%CI(-1.81,0.28),P=0.15]、治疗12个月后丙氨酸转氨酶[MD=-0.40,95%CI(-4.38,3.58),P=0.98]比较,差异均无统计学意义。RCT报道了5项不良反应发生情况,但结果不一。结论:环孢素联合糖皮质激素治疗膜性肾病的远期有效性与环磷酰胺联合糖皮质激素相当,环孢素联合糖皮质激素起效更快,但复发率较高。OBJECTIVE:To systematically evaluate the efficacy and safety of cyclosporin combined with glucocorticoid versus cyclophosphamide combined with glucocorticoid in the treatment of membranous nephropathy(MN).METHODS:Retrieved from Embase,Medline,CNKI,VIP and Wanfang database,RCTs about cyclosporin combined with glucocorticoid(trial group)versus cyclophosphamide combined with glucocorticoid(control group)in the treatment of MN were collected.Meta-analysis was conducted by using Rev Man 5.3 statistical software after literature screening,data extraction and quality evaluation with Jadad scale.RESULTS:Totally 6 RCTs were included,involving 312 patients in total.Results of Meta-analysis showed that remission rate 3 months after treatment[OR=3.42,95% CI(2.05,5.71),P<0.000 01]and relapse rate[OR=3.12,95% CI(1.45,6.70),P=0.004],leukocyte count 12 months after treatment[MD=1.77,95% CI(0.96,2.58),P<0.000 1]in trial group were significantly higher than control group.There was no statistical significance in remission rate 6 months after treatment[OR=2.06,95% CI(0.80,5.30),P=0.13]and remission rate 12 months after treatment[OR=1.30,95% CI(0.68,2.48),P=0.42],blood creatinine level 3 months after treatment[MD=-1.55,95% CI(-6.72,3.62),P=0.56]and blood creatinine level 6 months after treatment[MD=-1.21,95% CI(-5.96,3.54),P=0.62],cholesterol level 12 months after treatment[MD=-0.77,95% CI(-1.81,0.28),P=0.15]or ALT level[MD=-0.40,95% CI(-4.38,3.58),P=0.98]between 2 groups.ADR were reported in 5 RCTs,but their results were different.CONCLUSIONS:Long-term efficacy of cyclosporine combined with corticosteroid is similar to that of cyclophosphamide combined with corticosteroid in the treatment of MN.Cyclosporin combined with glucocorticoid has a faster effect,but a higher relapse rate.

关 键 词：环孢素 环磷酰胺 糖皮质激素 膜性肾病 疗效 安全性 META分析 

分 类 号：R692[医药卫生—泌尿科学]