本文選題：環(huán)磷酰胺　切入點：潑尼松　出處：《天津醫(yī)藥》2015年05期 　論文類型：期刊論文

【摘要】：目的系統(tǒng)評價激素聯(lián)合嗎替麥考酚酯與環(huán)磷酰胺對成人難治性腎病綜合征的有效性及不良反應(yīng)。方法電子檢索Embase、Pubmed、Cochrane library、中國知網(wǎng)、萬方和維普中文科技期刊數(shù)據(jù)庫,檢索時間范圍為建庫至2014年3月,納入涉及激素聯(lián)合嗎替麥考酚酯與環(huán)磷酰胺對比治療成人難治性腎病綜合征的隨機對照試驗(RCT),根據(jù)納入標準和排除標準篩選文獻,經(jīng)質(zhì)量評價及提取數(shù)據(jù)后,使用Rev Man5.2軟件對經(jīng)治療后的成人難治性腎病綜合征的完全緩解率、有效率、血清白蛋白、相關(guān)不良反應(yīng)等指標進行數(shù)據(jù)統(tǒng)計分析。結(jié)果共納入RCT 9篇,467例患者,其中嗎替麥考酚酯組235例,環(huán)磷酰胺組232例。Meta分析結(jié)果顯示嗎替麥考酚酯組完全緩解率(RR=1.45,95%CI為1.17~1.81,P=0.000 7)、有效率(RR=1.23,95%CI為1.11~1.36,P0.000 1)、血清白蛋白(WMD=2.73,95%CI為1.42~4.04,P0.000 1)高于環(huán)磷酰胺組,24 h尿蛋白定量(SMD=-0.63,95%CI為-1.16~-0.10,P=0.02)低于環(huán)磷酰胺組,血清膽固醇水平(SMD=0.31,95%CI為-0.23~0.84),P=0.26)與環(huán)磷酰胺組差異無統(tǒng)計學(xué)意義。嗎替麥考酚酯組肝功能損害(RR=0.13,95%CI為0.06~0.28)、白細胞下降(RR=0.10,95%CI為0.04~0.23)、胃腸道反應(yīng)(RR=0.21,95%CI為0.11~0.39)和脫發(fā)(RR=0.08,95%CI為0.02~0.29)的發(fā)生率均低于環(huán)磷酰胺組(均P0.05);2組上呼吸道感染(RR=0.68,95%CI為0.41~1.14)和肺部感染(RR=0.58,95%CI為0.31~1.08)的發(fā)生率差異無統(tǒng)計學(xué)意義。結(jié)論嗎替麥考酚酯治療成人難治性腎病綜合征的有效性和安全性優(yōu)于環(huán)磷酰胺。
[Abstract]:Objective to systematically evaluate the efficacy and adverse reactions of steroids combined with metocophenolate mofetil and cyclophosphamide in the treatment of intractable nephrotic syndrome in adults. Methods the databases of Embase Pubmedmedmeda Cochrane library, Chinese Journal of Science and Technology of China, Wanfang and Weipu were searched electronically. The search time ranged from the establishment of the bank to March 2014, and included in the randomized controlled trial (RCTT) involving the combination of hormones and cytophosphamide in the treatment of intractable nephrotic syndrome in adults. The literature was screened according to the inclusion criteria and exclusion criteria. After quality evaluation and data extraction, the complete remission rate, effective rate, serum albumin and serum albumin were obtained by using Rev Man5.2 software in the treatment of refractory nephrotic syndrome in adults. The data of related adverse reactions were statistically analyzed. Results totally 467 patients with RCT were included in the study. Meta-analysis of 232 cases in cyclophosphamide group showed that the complete remission rate (RR1.455-95 CI = 1.17 ~ 1.81), the effective rate (RRX 1.23995 CI = 1.111.36) and the serum albumin (WMD2.739 / 95 CI = 1.42 鹵4.04 / P0.000) were higher than those in cyclophosphamide group (CI = -1.16 ~ -0.39 ~ (95) CI = -1.16 ~ -0.10 P ~ (0.02)) and higher than that in cyclophosphamide group (P = -1.16 ~ -0.39 ~ 95 CI = -1.16 ~ -0.10 P ~ (0.02)). There was no significant difference between the serum cholesterol level and the cyclophosphamide group. The incidence of liver dysfunction in the Mutimefen group was 0.06 鹵0.28, RR0.1095 CI was 0.040.23, the incidence of gastrointestinal reaction was 0.21 / 95 CI was 0.110.39) and the incidence of alopecia was 0.0895CI was 0.020.29). There was no significant difference between the two groups in the incidence of upper respiratory tract infection (RRN 0.6895 CI = 0.41 鹵1.14) and pulmonary infection (RRX 0.5895 CI = 0.31V 1.08). Conclusion the efficacy and safety of mycophenolate mofetil in the treatment of refractory nephrotic syndrome in adults is better than that of cyclophosphamide.
【作者單位】： 廣西醫(yī)科大學(xué)第一附屬醫(yī)院腎內(nèi)科;
【分類號】：R692.3

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