抗TNF-α制剂降阶梯治疗克罗恩病的疗效与安全性的Meta分析  

Efficacy and safety of anti-TNF-αagents in the top-down treatment of Crohn’s disease:a Meta-analysis

作　　者：李青霞 刘立新[1,2] 郭晓红[1,2] LI Qingxia;LIU Lixin;GUO Xiaohong(Department of Gastroenterology,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Scientific Research Experimental Center,First Hospital of Shanxi Medical University)

机构地区：[1]山西医科大学第一医院消化科,太原030001 [2]山西医科大学第一医院科研实验中心

出　　处：《山西医科大学学报》2020年第12期1383-1388,共6页Journal of Shanxi Medical University

基　　金：山西医科大学第一医院博士启动基金项目(YB1402)。

摘　　要：目的系统评价抗TNF-α制剂降阶梯治疗克罗恩病(Crohn’s disease,CD)的疗效与安全性。方法检索PubMed、Cochrane Library、Embase、中国知网、万方和维普数据库,纳入早期使用抗TNF-α制剂降阶梯治疗CD的随机对照试验(RCT)或队列研究。应用RevMan 5.3软件进行Meta分析。结果共纳入11篇文献(10项研究),包括3223例CD患者。Meta分析显示,降阶梯治疗组临床缓解率、黏膜愈合率、深度缓解率优于对照组(RR=1.40,95%CI 1.22-1.62,P<0.00001;RR=1.79,95%CI 1.31-2.45,P=0.0003;RR=1.69,95%CI 1.16-2.48,P=0.007);复发率低于对照组(RR=0.64,95%CI 0.44-0.94,P=0.02)。手术率和不良反应发生率差异无统计学意义(RR=0.69,95%CI 0.38-1.27,P=0.24;RR=0.96,95%CI 0.78-1.19,P=0.72)。结论早期使用抗TNF-α制剂降阶梯治疗CD对部分患者疗效好且安全。Objective To systematically evaluate the efficacy and the safety of anti-TNF-αagents in the top-down treatment of Crohn’s disease(CD).Methods PubMed,Cochrane Library,Embase,CNKI,Wangfang,VIP data were retrieved to collect randomized controlled trials(RCTs)or cohort studies about early use of anti-TNF-αagents for the top-down treatment of CD were included.Meta-analysis was conducted using RevMan 5.3 software.Results A total of 11 articles(10 studies)involving 3223 patients with CD were included.Meta-analysis showed that the clinical remission rate,the mucosal healing rate,and the deep remission rate in top-down group were higher than those in control group(RR=1.40,95%CI 1.22-1.62,P<0.00001;RR=1.79,95%CI 1.31-2.45,P=0.0003;RR=1.69,95%CI 1.16-2.48,P=0.007),and the relapse rate was lower than that in control group(RR=0.64,95%CI 0.44-0.94,P=0.02).There was no statistical difference in surgical rate and adverse events(RR=0.69,95%CI 0.38-1.27,P=0.24;RR=0.96,95%CI 0.78-1.19,P=0.72).Conclusion Early use of anti-TNF-αagents for the top-down treatment of CD is safe and effective to some patients.

关 键 词：克罗恩病 抗TNF-α制剂 降阶梯 META分析 

分 类 号：R574[医药卫生—消化系统]