本文選題：環(huán)孢素　切入點(diǎn)：他克莫司　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的在全球范圍內(nèi),慢性丙肝病毒感染是肝移植術(shù)后重要的指標(biāo)之一。盡管肝移植為丙肝病毒相關(guān)的末期肝病和早期肝癌提供了最佳的治療方案。常見的移植后丙肝病毒再感染是我們主要的關(guān)注點(diǎn)。移植后丙肝病毒感染的重發(fā)生進(jìn)程會加速,5年內(nèi)移植患者再感染的發(fā)生率已上升到30%。長期移植存活率和患者生存率受到嚴(yán)重的影響。在體外,環(huán)孢素A,而非他克莫司,抑制丙肝病毒的復(fù)制。做為肝移植受者的基礎(chǔ)免疫抑制劑,他克莫司和環(huán)孢素A對HCV復(fù)發(fā)及其結(jié)局是否有不同影響移植后針對丙肝病毒復(fù)發(fā),分別使用環(huán)孢素A和他克莫司結(jié)合干擾素的抗病毒臨床治療效果報告顯示,二者的的療效報告有沖突的地方。本研究的目的通過檢索既往發(fā)表的文獻(xiàn)并進(jìn)行Meta分析,評估肝移植術(shù)后環(huán)孢素A和他克莫司對丙型肝炎病毒感染及結(jié)局的影響。 方法計算機(jī)檢索pubmed、MEDLINE、EMbase、Science Citation Index、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)、萬方數(shù)據(jù)庫、中國知網(wǎng)(CNKI)、維普網(wǎng)(VIP)、Cochrane library,檢索時間從建庫至2013年02月。英文檢索詞為FK506, TAC, tacrolimus,Cyclosprin, Cyclosprin A,CSA, hepatitis C, hep C, or HCV, LT, transplantation, transplant, graft,Interferon, IFN,pegylated-interferon, PEG-IFN, ribavirin,RBV。中文檢索詞以“他克莫司、環(huán)孢素或環(huán)孢素A、肝移植、丙型肝炎、丙肝、干擾素,聚乙二醇干擾素,利巴韋林”為檢索詞。將檢索到的文獻(xiàn)按照預(yù)定標(biāo)準(zhǔn)進(jìn)行篩選后,使用Cochrane協(xié)作網(wǎng)提供的專用RevMan4.2進(jìn)行統(tǒng)計數(shù)據(jù)分析。記數(shù)資料在隨機(jī)效應(yīng)模式下以相關(guān)風(fēng)險和95%置信區(qū)間的方式表達(dá)。 結(jié)果總計查到2764篇文獻(xiàn),17篇觀察性研究達(dá)到預(yù)先設(shè)定的篩選標(biāo)準(zhǔn)并被運(yùn)用到本次薈萃分析研究中。經(jīng)過數(shù)據(jù)分析后的結(jié)果為使用環(huán)孢素的持續(xù)病毒反應(yīng)率為42%(395/945),而使用他克莫司的持續(xù)病毒反應(yīng)率為35%(471/1364)(RR=1.18,95%CI=1.00-1.39,P=0.05)。盡管統(tǒng)計數(shù)據(jù)反映出一定的異質(zhì)性(12=45%,P=0.02),但是在隨機(jī)對照試驗中的持續(xù)病毒反應(yīng)發(fā)生率有一定的比較意義(環(huán)孢素的持續(xù)病毒反應(yīng)發(fā)生率為39%,他克莫司的持續(xù)病毒反應(yīng)發(fā)生率為35%)。使用每組患者人數(shù)在40人或以上的7個使用環(huán)孢素的研究(共計1634人),異質(zhì)性消失(12=0%,P=0.62)。 結(jié)論針對肝移植后復(fù)發(fā)丙型肝炎的治療,由于研究存在一定的異質(zhì)性,我們目前只能說環(huán)孢素較之他克莫司可能有少許的優(yōu)勢。
[Abstract]:On a global scale, Chronic hepatitis C virus infection is one of the important indicators after liver transplantation. Although liver transplantation provides the best treatment for hepatitis C virus related terminal liver disease and early liver cancer. Our main concern is that the process of reinfection of hepatitis C virus after transplantation will accelerate, and the incidence of re-infection in transplant patients has risen to 30% within 5 years. The long-term transplant survival rate and patient survival rate are seriously affected. Cyclosporine A, rather than tacrolimus, inhibits HCV replication. As a basic immunosuppressive agent for liver transplant recipients, tacrolimus and cyclosporine A have different effects on HCV recurrence and its outcome. The clinical results of antiviral therapy using cyclosporine A and tacrolimus combined with interferon showed that there was a conflict between the two reports. To evaluate the effect of cyclosporine A and tacrolimus on hepatitis C virus infection and outcome after liver transplantation. Methods computer search was conducted for pubmedum MEDLINEN EMbase Science Citation Index, Chinese Biomedical Literature Database (CBM), and Wanfang Database. The search time is from FK506, TAC, TAC, tacrolimus Cyclosprint, Cyclosprin AcanCSA, hepatitis C, hep C, or HCV, LTT, transtplanation, transplantte, graftInterferon, IFNpegylated-interferon, PEG-IFN, ribavirinRBV.Chinese keywords for "tacrolimus, liver transplantation, hepatitis C, hepatitis C", Chinese for "tacrolimus, cyclosporin or cyclosporine, liver transplantation, hepatitis C, hepatitis C", the Chinese key words: "tacrolimus, cyclosporin or cyclosporin, liver transplantation, hepatitis C, hepatitis C". Hepatitis C, interferon, pegylated interferon, ribavirin are the key words. The statistical data are analyzed by using the special RevMan4.2 provided by the Cochrane Cooperative Network. The statistical data are expressed as correlation risk and 95% confidence interval under the random effect model. Results A total of 2764 articles were found and 17 of the observational studies met the pre-set screening criteria and were used in this meta-analysis study. The results of the data analysis showed that the persistent viral response rate of cyclosporine use was 422g / 945%. The rate of persistent viral response to tacrolimus was 35% 471 / 1364% RN 1.1895 CIQ 1.00-1.39% P0. 05%. Although the statistical data showed a certain heterogeneity, the incidence of persistent viral reaction in randomized controlled trials had some comparative significance (Cyclosporine persistent virus). The incidence of response was 39 and the rate of persistent viral reaction of tacrolimus was 35. 7 patients with 40 or more patients in each group were treated with cyclosporine (1634 patients in total). Conclusion for the treatment of recurrent hepatitis C after liver transplantation, we can only say that cyclosporine may have a little advantage over tacrolimus because of the heterogeneity of the study.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.63

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

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