摘要
目的评价霉酚酸酯(MMF)治疗IgA肾病(IgAN)的疗效与安全性。方法检索Cochrane图书馆、PubMed、EMBASE、万方数据库、中国期刊全文数据库(CNKI)和中国维普数据库(VIP),检索区间为建库起至2018年3月31日。收集所有关于MMF治疗IgAN的随机对照试验(RCT),并由3名作者独立完成数据提取及采用Cochrane风险偏倚评估工具完成文献质量评价。采用Stata 12.0统计学软件进行Meta分析。结果·共纳入9篇文献,均为随机对照试验,2篇A级研究,6篇B级研究,1篇C级研究。系统评价结果显示:(1)与安慰剂联合血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)或单用ACEI/ARB组相比,MMF联合ACEI/ARB治疗组血肌酐增高和终末期肾病(ESRD)发生率无明显改变,但两组蛋白尿部分缓解率的差异有统计学意义(OR=2.59,95%CI为1.01~6.65,P=O.049)。(2)与单用糖皮质激素(GC)治疗组相比,单用MMF或MMF联合GC治疗组蛋白尿缓解率亦无明显改变。(3)与来氟米特(LEF)及环磷酰胺(CTX组相比,MMF治疗组蛋白尿缓解率亦无明显改变,但血肌酐增高发生率低于CTX组(OR=O.21,95%CI为0.04~1.07,P=O.043)。(4)MMF治疗组患者均有不同程度的不良反应发生,但多表现轻微,均在MMF减量或停药后逐渐恢复。结论单用MMF治疗IgAN的疗效优于ACEUARB,但较GC无显著优势。MMF联合GC与单用GC相比,MMF可替代部分GC作用,减少GC用量。与其他免疫抑制剂相比,MMF的近期疗效不优于LEF及CTX,但较CTX有较好的远期疗效及更少的不良反应。MMF治疗中出现的不良反应多表现轻微,减量或停药后逐渐消失。MMF是治疗IgAN的安全有效的药物。
Objective To evaluate the efficacy and safety of mycophenolate mofetil (MMF)in treatment of IgA nephropathy.Methods The Cochrane library,PubMed,EMBASE,Wanfang Data Knowledge Service Platform,CNKI and VIP were searched from the time when the databases were established to March 31,2018.Reports on randomized controlled trials (RCTs)on treating IgAN with MMF were collected.Data were extracted and assessed independently by three reviewers and the methodological quality of included RCTs was assessed by the Cochrane collaboration's tool for assessing risk of bias.The Meta analysis of homogeneous RCTs was managed by using Stata 12.0. Results Nine RCTs,of which two RCTs were assessed as A-level studies scoring from 4 to 7 points, six RCTs were assessed as B-level studies scoring from 2 to 3 points,and one RCT was assessed as C-level study with scores less than 2 points,were enrolled in the study.Important outcomes of this systematic review were described as follows:(1)Compared to placebo plus ACEI/ARB or ACEI/ARB monotherapy,MMF plus ACEI/ARB did not reduce the incidence of increased serum creatinine and ESRD,but increased the partial remission rate of urinary protein (0R=2.59,95% CI 1.01-6.65,P=0.049.(2)No significant difference was detected in the efficacy of reducing urinary protein for MMF monotherapy or MMF plus glucocorticoid (GC)compared to GC monotherapy.(3)MMF showed no significant difference in the efficacy of reducing urinary protein compared to LEF or CTX,but lower incidence rate of serum creatinine increasing than that of CTX group (OR=0.21,95%CI 0.04-1.07,P=0.043.(4)Different levels of adverse reactions occurred in each treatment group with MMF,but most symptoms were mild,and recovered gradually after reducing or withdrawing MMF.Conclusions MMF monotherapy shows a superiority in curing IgAN compared to ACEI/ARB,but no significant superiority compared to GC.MMF can replace a part of the effect of GC when used in combination with GC and can reduce the dosage of GC compared to GC monotherapy.Additionally,MMF di
作者
王琴
张建江
窦文杰
张莉
甄淑娟
Wang Qin;Zhang Jianjiang;Dou Wenjie;Zhang Li;Zhen Shujuan(Department of Pediatrics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Clinical Center of Pediatric Nephrology of Henan Province,Zhengzhou 450052,China)
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2018年第12期900-908,共9页
Chinese Journal of Nephrology
基金
河南省医学科技攻关计划省部共建项目(201601007)
河南省医学科技攻关项目(201503070).
