CAJ | 학술논문

目的：客观评价钙调神经磷酸酶抑制剂他克莫司、环孢素 A 与环磷酰胺(cyclophos-phamide,CTX)比较治疗特发性膜性肾病(idiopathic membranous nepropathy,IMN)患者的疗效及安全性。方法采用Cochrane系统综述方法,检索年限截至2014年10月,检索范围包括中国期刊全文数据库、维普数据、万方数据、PubMed、MEDLINE、Cochrane Library 等数据库,同时进行手工检索,采用 RevMan 5.0软件对符合纳入标准的同质资料进行 Meta 分析。结果共检索出符合纳入标准的随机对照试验(randomized controlled trials,RCT)12篇。Meta 分析显示,他克莫司组总缓解率和完全缓解率均优于 CTX 组(P<0.05)；他克莫司组肝功能损害、白细胞减少及感染发生率低于CTX组(P<0.05)；2组患者血糖代谢异常、胃肠道症状等不良反应发生率均无统计学差异(P>0.05)。环孢素 A组与CTX组比较,总缓解率、完全缓解率差异均无统计学意义(P>0.05),但环孢素 A组肝功能损害、白细胞减少、胃肠道症状发生率低于 CTX组(P<0.05)。结论钙调神经磷酸酶抑制剂能明显增加 IMN患者的总缓解率和完全缓解率,且他克莫司的疗效优于CTX,环孢素 A与CTX的疗效相当,不良反应发生率更少。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：객관평개개조신경린산매억제제타극막사、배포소 A 여배린선알(cyclophos-phamide,CTX)비교치료특발성막성신병(idiopathic membranous nepropathy,IMN)환자적료효급안전성。방법채용Cochrane계통종술방법,검색년한절지2014년10월,검색범위포괄중국기간전문수거고、유보수거、만방수거、PubMed、MEDLINE、Cochrane Library 등수거고,동시진행수공검색,채용 RevMan 5.0연건대부합납입표준적동질자료진행 Meta 분석。결과공검색출부합납입표준적수궤대조시험(randomized controlled trials,RCT)12편。Meta 분석현시,타극막사조총완해솔화완전완해솔균우우 CTX 조(P<0.05)；타극막사조간공능손해、백세포감소급감염발생솔저우CTX조(P<0.05)；2조환자혈당대사이상、위장도증상등불량반응발생솔균무통계학차이(P>0.05)。배포소 A조여CTX조비교,총완해솔、완전완해솔차이균무통계학의의(P>0.05),단배포소 A조간공능손해、백세포감소、위장도증상발생솔저우 CTX조(P<0.05)。결론개조신경린산매억제제능명현증가 IMN환자적총완해솔화완전완해솔,차타극막사적료효우우CTX,배포소 A여CTX적료효상당,불량반응발생솔경소。단가고적결론잉수요대양본、다중심、설계량호적 RCT 적진일보험증。
Objective To objectively evaluate the efficacy and safety of calcineurin inhibitors, including tacrolimus and cyclosporine A (CsA),vs.cyclophosphamide (CTX)in treating idiopathic membranous nephropathy (IMN).Methods By methods of Cochrane systematic review,databases in-cluding Chinese Journal full-text Database,Weipu Database,Wanfang Database,PubMed,MED-LINE,and Cochrane Library were searched till October of 2014,and manual retrieval was employed meanwhile.Homogeneous data that met the inclusion criteria were analyzed by RevMan 5.0 software. Results Twelve randomized controlled trials (RCT)meeting the inclusion criteria were enrolled.The total remission rate and complete remission rate were higher (P<0.05),and the incidence rate of he-patic dysfunction,leukocytopenia and infection was lower in tacrolimus group than in CTX group (P<0.05),but there was no statistically significant difference in the incidence rate of glucose intolerance and gastrointestinal syndrome between the two groups (P>0.05 ).Between CsA group and CTX group,no statistically significant difference was found regarding to the total remission rate and com-plete remission rate (P>0.05),while the incidence rate of hepatic dysfunction,leukocytopenia,and gastrointestinal syndrome was lower in CsA group than in CTX group (P<0.05).Conclusions Calci-neurin inhibitor can significantly increase the total remission rate and complete remission rate in IMN patients,tacrolimus is more effective than CTX,and CsA has similar effectiveness with CTX.Moreo-ver,calcineurin inhibitor has less incidence rate of adverse effects than CTX.However,large scale, multicentered,well-designed randomized controlled trials should be adopted to further confirm the conclusions.