發(fā)布時間：2018-05-23 08:02

  本文選題：他克莫司 + 難治性腎病��； 參考：《新疆醫(yī)科大學》2014年碩士論文

【摘要】：目的：系統評價他克莫司聯合激素治療難治性腎病的有效性和安全性。方法：計算機檢索中國生物醫(yī)學文獻數據庫（CBM）、中國知網（CNKI）、維普、萬方數據庫、MEDLINE、PubMed、The Cochrane Library、EMBASE、Up To Date，時限為1984年他克莫司首次發(fā)現至2014年6月，同時手工檢索相關雜志及研究資料，查找他克莫司聯合激素治療難治性腎病的隨機對照試驗或半隨機對照試驗，并且根據患者的年齡將研究對象分為成人和兒童兩部分，分別進行評價，由兩名評價員獨立篩選文獻、提取資料、評價質量并交叉核對，采用RevMan5.2軟件進行Meta分析。結果：成人部分共有11篇文獻納入本研究，高質量文獻2篇，對593例成人患者進行了Meta分析，結果顯示總緩解率：他克莫司聯合激素組高于對照組，不良反應：他克莫司聯合激素組與對照組相比，具有相似的胃腸道不良反應、血糖耐受，但總體不良反應發(fā)生率的比較有統計學意義，低于對照組；兒童部分共有6篇文獻納入本研究，高質量文獻2篇，對354例兒童患者進行了Meta分析，，結果顯示總緩解率：他克莫司聯合激素組優(yōu)于單用他克莫司組，優(yōu)于環(huán)磷酰胺聯合激素組，不良反應：他克莫司聯合激素組總體不良反應發(fā)生率低于對照組，嚴重不良反應發(fā)生率低于對照組，胃腸道不良反應的發(fā)生率與對照組無統計學意義。結論：他克莫司聯合激素治療難治性腎病對于成人和兒童患者均可提高總緩解率，降低總體不良反應發(fā)生率，但兩者臨床病理分型有所不同，兒童以微小病變型腎病多見，成人以膜性腎病多見。基于研究的局限性，仍需高質量的臨床隨機對照試驗進一步論證。
[Abstract]:Objective: to evaluate the efficacy and safety of tacrolimus combined with hormone in the treatment of refractory nephropathy. Methods: the Chinese biomedical literature database was searched by computer. CNKI, Weip, Wanfang were searched by computer. The Cochrane Library EMBASEN up to date was first found in 1984 to June 2014, and the relevant journals and research materials were searched manually. A randomized controlled trial or a semi-randomized controlled trial of tacrolimus combined with hormone in the treatment of refractory nephropathy was found, and the subjects were divided into two groups, adults and children, according to the age of the patients. Two evaluators independently sifted the literature, extracted the data, evaluated the quality and cross-checked, and used RevMan5.2 software to carry out Meta analysis. Results: a total of 11 articles were included in this study in adults and 2 articles in high quality. Meta analysis was performed on 593 adult patients. The results showed that the total remission rate was higher in tacrolimus combined hormone group than in control group. Adverse reactions: compared with the control group, tacrolimus combined with hormone group had similar gastrointestinal adverse reactions and glucose tolerance, but the incidence of overall adverse reactions was significantly lower than that of the control group. A total of 6 articles were included in this study in the children's section, and 2 articles of high quality were included in the study. Meta analysis was performed in 354 children. The results showed that tacrolimus combined with steroid group was better than tacrolimus group alone. The overall adverse reaction rate of tacrolimus combined hormone group was lower than that of control group, and the incidence of severe adverse reaction was lower than that of control group. There was no significant difference between the incidence of gastrointestinal adverse reactions and the control group. Conclusion: tacrolimus combined with steroid therapy for refractory nephropathy can increase the total remission rate and decrease the overall adverse reaction rate in both adults and children. Membranous nephropathy is more common in adults. Due to the limitations of the study, high-quality randomized controlled trials are still needed.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692

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本文編號：1923925