吗替麦考酚酯联合激素治疗隐源性膜性肾小球肾炎的效果和安全性的meta分析  

Meta-analysis of the clinical efficacy and safety of Mycophenolate Mofetil combined with hormone in the treatment of cryptogenic membranous glomerulonephritis

作　　者：蒋欣宇 王宇 张晓凤 程小红 JIANG Xinyu;WANG Yu;ZHANG Xiaofeng;CHENG Xiaohong(The First Clinical Medical College,Shaanxi University of Chinese Medicine,Shaanxi Province,Xianyang712046,China;Department of Nephrology,Shaanxi Hospital of Traditional Chinese Medicine,Shaanxi Province,Xi’an710003,China)

机构地区：[1]陕西中医药大学第一临床医学院,陕西咸阳712046 [2]陕西省中医医院肾病科,陕西西安710003

出　　处：《中国医药导报》2022年第12期70-74,共5页China Medical Herald

基　　金：国家重点研发计划课题(2019YFC1709404)。

摘　　要：目的系统评价吗替麦考酚酯联合激素治疗隐源性膜性肾小球肾炎的效果和安全性。方法计算机检索中国知网、万方数据库、维普网、SinoMed、PubMed、EMbase、The Cochrane Library数据库中吗替麦考酚酯与激素联合治疗隐源性膜性肾小球肾炎的相关文献,检索时限为建库至2021年3月。由两名研究者单独筛选文献、提取资料,采用R 4.0.3进行meta分析。结果共纳入12篇文献,包括789例患者。联合组治疗6个月的完全缓解率(OR=2.27,95%CI:1.49~3.45,P<0.05)、总缓解率(OR=1.90,95%CI:1.26~2.85,P<0.05)均高于对照组;治疗12个月完全缓解率(OR=1.86,95%CI:1.14~3.03,P<0.05)、总缓解率(OR=1.95,95%CI:1.20~3.14,P<0.05)均高于对照组。联合组不良反应发生率与对照组比较,差异无统计学意义(OR=0.57,95%CI:0.31~1.05,P>0.05)。联合组治疗6个月时的白蛋白(SMD=-0.25,95%CI:-1.00~0.51,P>0.05)、血肌酐(SMD=-0.01,95%CI:-0.23~0.25,P>0.05)、24 h尿蛋白(SMD=0.09,95%CI:-0.08~0.26,P>0.05)与对照组比较,差异无统计学意义。联合组治疗12个月的白蛋白(SMD=0.15,95%CI:-0.08~0.38,P>0.05)、血肌酐(SMD=-0.02,95%CI:-0.21~0.26,P>0.05)、24 h尿蛋白(SMD=-0.19,95%CI:-0.42~-0.04,P>0.05)与对照组比较,差异无统计学意义。不良反应发生率Begg检验及Egger检验P>0.05,无发表偏倚。结论吗替麦考酚酯联合激素治疗隐源性膜性肾小球肾炎效果较好,值得临床上进一步研究和证实。Objective To systematically evaluate the efficacy and safety of Mycophenolate Mofetil combined with hormone in the treatment of cryptogenic membranous glomerulonephritis.Methods The literatures related to Mycophenolate Mofetil combined with hormone in the treatment of cryptogenic membranous glomerulonephritis were searched from CNKI,Wanfang Data,VIP,SinoMed,PubMed,Embase,and The Cochrane Library,the retrieval period was from the inception to March 2021.Literatures were screened and data were extracted by two researchers,and meta-analysis was performed using R 4.0.3.Results A total of 12 literatures were included,including 789 patients.The complete response rate(OR=2.27,95%CI:1.49-3.45,P<0.05)and total response rate(OR=1.90,95%CI:1.26-2.85,P<0.05)in the combined group were higher than those in the control group at six months,and the complete response rate(OR=1.86,95%CI:1.14-3.03,P<0.05)and total response rate(OR=1.95,95%CI:1.20-3.14,P<0.05)were higher than those in control group at 12 months.There was no significant difference in the incidence of adverse reactions between the combined group and the control group(OR=0.57,95%CI:0.31-1.05,P>0.05).Albumin(SMD=-0.25,95%CI:-1.00-0.51,P>0.05),serum creatinine(SMD=-0.01,95%CI:-0.23-0.25,P>0.05),24 h urinary protein(SMD=0.09,95%CI:-0.08-0.26,P>0.05)in the combined group at six months compared with the control group,the difference was not statistically significant.Albumin(SMD=0.15,95%CI:-0.08-0.38,P>0.05),serum creatinine(SMD=-0.02,95%CI:-0.21-0.26,P>0.05),and 24h urine protein(SMD=-0.19,95%CI:-0.42--0.04,P>0.05)in the combined group at 12 months compared with the control group,the difference was not statistically significant.The incidence of adverse reactions was P>0.05 by Egger and Begg test,and there was no publication bias.Conclusion The effect of Mycophenolate Mofetil combined with hormone in the treatment of cryptogenic membranous glomerulonephritis is better,which is worthy of further study and confirmation in clinic.

关 键 词：隐源性膜性肾小球肾炎 吗替麦考酚酯 糖皮质激素 META分析 

分 类 号：R692[医药卫生—泌尿科学]