【摘要】：目的系統(tǒng)評(píng)價(jià)神經(jīng)鈣調(diào)蛋白抑制劑(CNI)、環(huán)磷酰胺(CTX)治療兒童激素耐藥型腎病綜合征療效的差異。方法檢索Pubmed數(shù)據(jù)庫(kù)和CNKI、萬(wàn)方數(shù)據(jù)庫(kù)、維普數(shù)據(jù)庫(kù)中有關(guān)CNI(環(huán)孢素A或者他克莫司)、CTX治療兒童激素耐藥型腎病綜合征療效差異的隨機(jī)對(duì)照研究。由兩位獨(dú)立的研究者對(duì)入選的文獻(xiàn)按納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)進(jìn)行篩選,并評(píng)價(jià)文獻(xiàn)質(zhì)量。提取納入文獻(xiàn)中兒童激素耐藥型腎病綜合征患者的治療方案、治療6個(gè)月時(shí)的有效(完全緩解+部分緩解)率和完全緩解率。其中采用CNI治療者為CNI組,CTX治療者為CTX組。采用Reviewer Manager5.2軟件比較CNI、CTX組治療6個(gè)月時(shí)的有效率、完全緩解率。對(duì)納入研究的文獻(xiàn)數(shù)據(jù)進(jìn)行異質(zhì)性檢驗(yàn),I~240%表示各研究之間無(wú)顯著異質(zhì)性。結(jié)果共檢索到67篇文獻(xiàn),根據(jù)納入和排除標(biāo)準(zhǔn)最終11篇文獻(xiàn)納入本研究,共912例患者,其中CNI組497例、CTX組415例。隨訪6個(gè)月時(shí),CNI組56例、CTX組49例失訪。治療6個(gè)月時(shí)CNI組、CTX組有效率分別為81.2%(358/441)、41.3%(151/366),CNI組有效率高于CTX組(RR為2.13,95%CI為1.64~2.78,I~2=32%,P0.05);治療6個(gè)月時(shí)CNI組、CTX組完全緩解率分別為45.1%(199/441)、13.1%(48/366),CNI組完全緩解率高于CTX組(RR為2.63,95%CI為1.47~3.80,I~2=17%,P0.05)。結(jié)論 CNI治療兒童激素耐藥型腎病綜合征的療效優(yōu)于CTX。
[Abstract]:Objective to evaluate the efficacy of neurocalmodulin inhibitor (CNI), cyclophosphamide (CTX) in the treatment of steroid-resistant nephrotic syndrome in children. Methods A randomized controlled study was conducted to search Pubmed database, CNKI, Wanfang database and Wiper database about the difference of the efficacy of CNI (cyclosporine A or tacrolimus) in the treatment of steroid-resistant nephrotic syndrome in children. The selected literature was screened by two independent researchers according to inclusion criteria and exclusion criteria, and the quality of the literature was evaluated. The effective (complete remission) rate and complete remission rate at 6 months after treatment of steroid-resistant nephrotic syndrome in children were extracted and included in the literature. The patients treated with CNI were CNI group and CTX group. Reviewer Manager5.2 software was used to compare the effective rate and complete remission rate of CNI,CTX group at 6 months. The heterogeneity test of the literature data included in the study indicated that there was no significant heterogeneity among the studies. Results A total of 67 articles were retrieved. According to the inclusion and exclusion criteria, 11 articles were included in this study. A total of 912 patients were included in the study, including 497 cases in CNI group and 415 cases in CTX group. At 6 months follow-up, there were 56 cases in CNI group and 49 cases in CTX group. At 6 months after treatment, the effective rate of CNI group was 81.2% (358 / 441) and 41.3% (151366) respectively. The effective rate of CNI group was higher than that of CTX group (RR = 2.13395 CI = 1.64 鹵2.78CI = 1.64 鹵2.78CI = 1.64), and the complete remission rate of CNI group was 45.1% (199441) 13.1% (48 / 366) compared with CTX group (RR = 2.6395CI = 1.473.80I-1 / 217P 0.05) at 6 months after treatment, the complete remission rate of CNI group was higher than that of CTX group (RR = 2.6395CI = 1.473.80I217P 0.05). Conclusion CNI is superior to CTX. in the treatment of steroid-resistant nephrotic syndrome in children.
【作者單位】： 中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院北京協(xié)和醫(yī)院;
【分類號(hào)】：R726.9
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本文編號(hào)：2221821