摘要
目的系统评价霉酚酸酯治疗过敏性紫癜肾炎的疗效和安全性。方法计算机检索PubMed、EMbase、CENTRAL、VIP、CNKI、CBM和WanFang Data数据库,全面收集霉酚酸酯治疗过敏性紫癜肾炎的随机对照试验(RCT),检索时限均为从建库至2013年12月。由2位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果共纳入10个RCT,426例患者,其中试验组231例,对照组195例。试验组均采用激素加霉酚酸酯治疗,对照组采用激素加环磷酰胺、来氟米特、硫唑嘌呤或者单用激素治疗。Meta分析结果显示:与环磷酰胺比较,6个月时霉酚酸酯治疗过敏性紫癜肾炎疗效与其无明显差异[OR=1.36,95%CI(0.67,2.73),P=0.85],但在治疗12个月时其疗效优于环磷酰胺[OR=6.58,95%CI(2.45,17.70),P=0.002]。与硫唑嘌呤比较,霉酚酸酯治疗过敏性紫癜肾炎仍有优势,但与来氟米特组和单用激素组比较无明显差异。在不良反应方面,霉酚酸酯组不良反应发生率小于环磷酰胺组[OR=0.25,95%CI(0.13,0.45),P<0.00001]和单用激素组[OR=0.26,95%CI(0.09,0.79),P=0.02],而与来氟米特组差异无统计学意义。结论现有证据显示,霉酚酸酯治疗过敏性紫癜肾炎疗效方面优于环磷酰胺;在安全性方面,霉酚酸酯较环磷酰胺和单用激素不良反应发生少。
Objective To systematically review the efficacy and safety of mycophenolate mofetil （MMF） for Henoch-Schonlein purpura nephritis （HSPN）. Methods Databases such as PubMed, EMbase, CENTRAL, VIP, CNKI, CBM and WanFang Data were electronically searched for comprehensively collecting the randomized controlled trials （RCTs） on the efficacy and safety of MMF for HSPN from inception to December, 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 10 RCTs involving 426 patients （231 in the trial group and 195 in the control group） were included. The trial group was treated with MMF and corticosteroids, and the control group was treated with corticosteroids monotherapy or combined with cyclophosphamide （CTX）, leflunomide （LEF）, or azathioprine （AZA）. The results of meta-analysis showed that, as for efficacy, no significant difference was found between the two groups after six-mouth treatment （OR=1.36, 95%CI 0.67 to 2.73, P=0.85）, while after twelve-mouth treatment, MMF was superior to CTX with a significant difference （OR=6.58, 95%CI 2.45 to 17.33, P=0.002）. In addition, the efficacy of MMF was still superior to the azathioprine group, but not better than either LEF or prednisone monotherapy. Lower incidence of side effects were found in the MMF group, compared with the CTX group （OR=0.25, 95%CI 0.13 to 0.45, P〈0.000 01） and the prednisone monotherapy group （OR=0.26, 95%CI, 0.09 to 0.79, P=0.02）, while there was no significant difference between the MMF group and the LEF group in side effects. Conclusion Based on the current evidence, the efficacy of MMF for HSPN is better than CTX, and its side effects are less than those of CTX and prednisone.
出处
《中国循证医学杂志》
CSCD
2014年第2期184-190,共7页
Chinese Journal of Evidence-based Medicine
关键词
霉酚酸酯
环磷酰胺
过敏性紫癜'肾炎
系统评价
Meta分析
随机对照试验
Mycophenolate mofetil
Cyclophosphamide
Henoch-Schonlein purpura nephritis
Systematic review
Meta-analysis
Randomized controlled trial
