本文選題：腎移植 + 程序性活檢　； 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：目的：通過meta分析及系統(tǒng)性評價的方法為程序性活檢在腎移植患者中的應(yīng)用價值提供循證醫(yī)學(xué)依據(jù)。 方法：采用電子檢索進行文獻初檢,電子檢索數(shù)據(jù)庫有Medline、Embase數(shù)據(jù)庫和Cochrane圖書館。納入涉及程序性活檢在腎移植患者中應(yīng)用的隨機對照試驗(RCT),數(shù)據(jù)由兩名作者獨立提取,納入研究的偏倚風(fēng)險采用Cochrane協(xié)作網(wǎng)推薦的偏倚風(fēng)險評估工具進行評估,使用Cochrane協(xié)作網(wǎng)提供的專用RevMan5.0軟件進行統(tǒng)計數(shù)據(jù)分析。 結(jié)果：納入5篇關(guān)于程序性活檢在腎移植患者中的應(yīng)用的前瞻性病例對照研究。對程序性活檢對腎移植患者移植腎存活率、腎功能、急性排斥反應(yīng)的發(fā)生率的影響進行了meta分析,并從文獻中提取亞臨床排異、腎間質(zhì)纖維化／小管萎縮、CNI中毒、BK病毒相關(guān)性腎病、程序性活檢的不良反應(yīng)及患者對程序性活檢的順應(yīng)性等的發(fā)病學(xué)資料進行合并分析。Meta分析的結(jié)果提示：1.亞臨床病理異常的發(fā)現(xiàn)與治療可以提高移植腎長期存活率,降低移植腎丟失率,RR為0.40,95%CI(0.25,0.65),P0.001。2.亞臨床病理異常的發(fā)現(xiàn)與治療可以降低血肌酐WMD為-38.21,95%CI(-54.83,-21,60),p0.00001。3.在以他克莫司為主要維持性免疫抑制劑方案的一類受者中,亞臨床病理異常的發(fā)現(xiàn)與治療并不能明顯提高患者腎小球濾過率／肌酐清除率。而對于那些文獻中交代維持性免疫抑制劑以他克莫司或環(huán)孢素A為主的患者中,程序性活檢組可以提高腎小球濾過率,SMD為0.78,95%CI(0.51,1.05)。4.亞臨床病理異常的發(fā)現(xiàn)與治療對急性排斥反應(yīng)發(fā)生率并沒有明顯影響。從納入的5篇文獻中提取相關(guān)發(fā)病學(xué)資料匯總的結(jié)果：亞臨床排異的發(fā)生率為3%-56%。程序性活檢對CNI中毒的發(fā)現(xiàn)率,為0-29%。移植后BK病毒相關(guān)性腎病的發(fā)生率在2.0%-4.7%。程序性活檢的不良反應(yīng)發(fā)生率1.1%-10%。沒有因不良反應(yīng)而發(fā)生移植腎丟失或死亡的報道。 結(jié)論：通過程序性活檢發(fā)現(xiàn)并治療亞臨床排異可以提高移植腎存活率。程序性活檢可能提高長期腎功能,尤其在以環(huán)孢素為主要基礎(chǔ)免疫抑制劑的病人中。程序性活檢并不能顯著減少臨床急性排斥反應(yīng)的發(fā)生率。程序性活檢嚴(yán)重不良反應(yīng)發(fā)生率較低,可以認為是一個比較安全的臨床措施。
[Abstract]:Objective: to provide evidence-based medical evidence for the application of procedural biopsy in renal transplantation by meta analysis and systematic evaluation. Methods: electronic retrieval was used to check the literature. There were Medline Embase database and Cochrane library. A randomized controlled trial involving the use of procedural biopsies in renal transplant patients was included. The data were extracted independently by two authors, and the bias risks in the study were assessed using the bias risk assessment tool recommended by the Cochrane Collaborative Network. The special RevMan5.0 software provided by Cochrane cooperation network is used for statistical data analysis. Results: five prospective case-control studies were included on the application of procedural biopsy in renal transplant patients. The effects of routine biopsy on the survival rate, renal function and incidence of acute rejection in renal transplantation patients were analyzed by meta, and subclinical rejection was extracted from the literature. The pathogenetic data of renal interstitial fibrosis / tubule atrophy caused by CNI poisoning and BK virus associated nephropathy, the adverse reactions of programmed biopsy and the compliance of patients with programmed biopsy were analyzed. The results of meta-analysis suggested that: 1. The detection and treatment of subclinical pathological abnormalities can improve the long-term survival rate and reduce the rate of renal allograft loss. The RR is 0.4095% ~ 0.25% ~ 0.65% ~ 0.65% P 0.001.2. The detection and treatment of subclinical pathological abnormalities can reduce the WMD of serum creatinine to -38.21 and 95. In a group of recipients with tacrolimus as the main maintenance immunosuppressant regimen, the detection and treatment of subclinical pathological abnormalities did not significantly improve the glomerular filtration rate / creatinine clearance rate. In those patients whose maintainable immunosuppressants were tacrolimus or cyclosporine A, the SMD of glomerular filtration rate was increased in the programmed biopsy group. The detection and treatment of subclinical pathological abnormalities had no significant effect on the incidence of acute rejection. A summary of relevant pathogenetic data was extracted from the 5 articles included: the incidence of subclinical rejection was 3-56. The detection rate of CNI poisoning by programmed biopsy ranged from 0 to 29. The incidence of BK virus associated nephropathy after transplantation ranged from 2.0 to 4.7. The incidence of adverse reactions in procedural biopsy was 1.1-10. No kidney graft loss or death was reported as a result of adverse reactions. Conclusion: subclinical rejection can be improved by routine biopsy. Procedural biopsies may improve long-term renal function, especially in patients with cyclosporine as the primary immunosuppressant. Procedural biopsy does not significantly reduce the incidence of clinical acute rejection. The incidence of severe adverse reactions in procedural biopsy is relatively low, which can be considered as a safe clinical measure.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R699.2

【參考文獻】

相關(guān)期刊論文 前1條

1 Walter Guillermo Douthat;Carlos Raul Chiurchiu;Pablo Ulises Massari;;New options for the management of hyperparathyroidism after renal transplantation[J];World Journal of Transplantation;2012年03期

，

本文編號：1872420