CAJ | 학술논문

目的系统评价钙神经调节蛋白抑制剂环孢素A和他克莫司治疗狼疮性肾炎的临床治疗作用.方法采用Cochrane系统综述方法,检索时间截至2010年5月,检索范围包括www.guideline.gov,www.nice.org.uk,mdm.ca/cpgsnew/cpgs/index.asp,www.show.scot.nbs.uk,www.nzgg.org nz,www.eguidelines.c o.uk,www.-n.net,Cochrane图书馆、EMBASE、MEDLINE、万方数据库,中国期刊全文数据库,重庆维普中文科技期刊数据库,同时手工检索了相关杂志、专业资料和网络信息,对同质资料进行研究.采用Cochrane协作网提供的RevMan4.2软件进行Meta分析.结果共检索出符合纳入标准的共7篇随机对照试验(RCT),其中环孢素A与环磷酰胺(CTX)治疗对照的RCT4篇,他克莫司与CTX治疗对照的RCT3篇.无论是环孢素A治疗组还是他克莫司治疗组,24 h尿蛋白量均有明显下降.与CTX治疗组比较,他克莫司治疗组24 h尿蛋白下降量差异有统计学意义(Z=2.8,P=0.005),但环孢素A治疗组差异无统计学意义(Z=1.08,P=0.28).他克莫司治疗组完全缓解率大于CTX治疗组(Z=3.64,P=0.0003),不完全缓解率两组差异无统计学意义(Z=0.53,P=0.6),总有效率他克莫司治疗组优于CTX治疗组(Z=2.2,P=0.03).结论钙神经调节蛋白抑制剂能明显降低狼疮性肾炎患者24 h蛋白尿,且他克莫司的疗效优于CTX,但可靠的结论仍需要大样本、多中心、设计良好的RCT的进一步验证.
목적 계통평개개신경조절단백억제제배포소A화타극막사치료랑창성신염적림상치료작용.방법 채용Cochrane계통종술방법,검색시간절지2010년5월,검색범위포괄www.guideline.gov,www.nice.org.uk,mdm.ca/cpgsnew/cpgs/index.asp,www.show.scot.nbs.uk,www.nzgg.org nz,www.eguidelines.c o.uk,www.-n.net,Cochrane도서관、EMBASE、MEDLINE、만방수거고,중국기간전문수거고,중경유보중문과기기간수거고,동시수공검색료상관잡지、전업자료화망락신식,대동질자료진행연구.채용Cochrane협작망제공적RevMan4.2연건진행Meta분석.결과 공검색출부합납입표준적공7편수궤대조시험(RCT),기중배포소A여배린선알(CTX)치료대조적RCT4편,타극막사여CTX치료대조적RCT3편.무론시배포소A치료조환시타극막사치료조,24 h뇨단백량균유명현하강.여CTX치료조비교,타극막사치료조24 h뇨단백하강량차이유통계학의의(Z=2.8,P=0.005),단배포소A치료조차이무통계학의의(Z=1.08,P=0.28).타극막사치료조완전완해솔대우CTX치료조(Z=3.64,P=0.0003),불완전완해솔량조차이무통계학의의(Z=0.53,P=0.6),총유효솔타극막사치료조우우CTX치료조(Z=2.2,P=0.03).결론 개신경조절단백억제제능명현강저랑창성신염환자24 h단백뇨,차타극막사적료효우우CTX,단가고적결론 잉수요대양본、다중심、설계량호적RCT적진일보험증.
Objective To systematically evaluate the clinical effects of cyclosporine A(CsA)and tacrolimus,which are calcineurin inhibitors,on lupus nephritis.Method In this study,the clinical trials on treatment of lupus nephritis with cyclosporine A and tacrolimus published until May 2010 were searched at www.guideline.gov, www.nice.org.uk, mdm.ca/cpgsnew/cpgs/index.asp, www.show.scot.nhs.uk,www.nzgg.org.nz,www.eguid elines.co.uk,www.gin.net, Cochrane library, EMBASE, MEDLINE,Wanfang database,Chinese Journal full-text Database,Chongqing Weipu Database by using the methods of Cochrane systematic review.At the same time the information from related journals,professional data and network were hand-searched.The homogeneous evaluation was performed by meta-analysis.Statistical analysis of clinical data was performed by using RevMan 4.2 software provided by the Cochrane Collaboration.Result A total of 214 reports were found,while only 7 randomized controlled trials met the inclusion criteria,4 of them were on the treatment with CsA(treatment group)and cyclosporine(CTX)group(control group),and 3 of them were the on treatment with FK506(treatment group)and CTX group(control group).There were 148 reports in the treatment of CsA and CTX group,while 185 reports in the treatment of FK506 and CTX group.Both CsA and tacrolimus group could decrease daily urinary protein.Tacrolimus group was good at reducing daily urinary protein as compared with CTX group,and the difference was statistically significant (Z = 2.8 ,P = 0.005),but there was no significant difference between CsA and CTX groups(Z = 1.08 ,P =0.28).Tacrolimus group was good at complete remission as compared with CTX group(Z = 3.64,P =0.0003),partial remission was similar in both groups(Z = 0.53,P = 0.6),and tacrolimus group was good at total remission(Z =2.2,P =0.03).There was no significant difference between CsA and CTX group in side effect within a short period,while FK506 had less side-effect than CTX group.Conclusion Compared with the treatment with CTX,tacrolimus was good at reducing daily urinary protein.CsA and CTX were similar in reducing daily urinary protein in the treatment of lupus nephritis.Tacrolimus resulted in better total remission than CTX and had less side effect.CsA and CTX groups were similar in side effect.On the whole,calcineurin inhibitor could significantly decrease daily urinary protein,and tacrolimus was better in treatment and had less side- effect than CTX.However,large scale,multicenter,well-designed clinical trials should be adopted to further confirm the conclusions.