吗替麦考酚酯对比环磷酰胺治疗儿童紫癜性肾炎的Meta分析被引量：5

A meta-analysis of efficacy of mycophenolate mofetil and cyclophosphamide in treatment of Henoch-Sch nlein purpura nephritis in children

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摘要目的评价吗替麦考酚酯（MMF）与环磷酰胺（CTX）治疗儿童紫癜肾炎（HSPN）的疗效及安全性。方法检索CNKI、PubMed、Cochrane图书馆、中国生物医学、万方及中国维普等数据库，检索文献均从建库至2016年7月1日截止，收集关于吗替麦考酚酯与环磷酰胺治疗儿童紫癜性肾炎疗效及安全性比较的文献。2名研究人员对符合标准的文献进行质量评价，用Revman 5.3软件进行Meta分析。结果共5篇RCTs入选，纳入患儿248例。结果显示，MMF组治疗儿童紫癜性肾炎的完全缓解率[OR＝2.18，95%CI（1.25～3.81），P＝0.006]及总缓解率[OR＝2.98，95%CI（1.48～5.99），P＝0.002]均高于CTX组，差异有统计学意义。MMF组不良反应发生率[OR＝0.1，95%CI（0.05～0.19），P〈0.01]低于CTX组，差异有统计学意义；感染率[OR＝1.44，95%CI（0.39～5.32），P＝0.59〉0.05]、肝损伤率[OR＝0.64，95%CI（0.26～1.59），P＝0.34〉0.05]与CTX组比较差异未见统计学意义；但消化道不良反应发生率[OR＝0.15，95%CI（0.07～0.33），P〈0.01]、骨髓抑制率[OR＝0.15，95%CI（0.04，0.62），P＝0.008]低于CTX组，差异有统计学意义。结论与CTX比较，MMF治疗儿童HSPN疗效好，且消化道反应、骨髓抑制及性腺损害、脱发等不良反应发生率低，安全性更高。 Objective To investigate the efficacy of mycophenolate mofetil（MMF） and cyclophosphamide（CTX） in treatment of Henoch-Sch nlein purpura nephritis（HSPN）in children.Methods A search of CNKI, PubMed, the Cochrane Library, Sinomed database, Wanfang data and VIP database, etc. The literature limited range was from the establishment of database to July 1st, 2016. Collected the randomized controlled clinical trials （RCTs） on the comparison between MMF and CTX in treatment of HSPN in children.Two reviewers assessed the quality of included studies, and all the Meta-nalysis were made with Revman 5.3.Results A total of 5 RCTs were selected, and 248 children were included. Combination MMF with CTX group showed higher complete remission rate [OR=2.18, 95%CI（1.25-3.81）, P=0.006] and total remission rate [OR=2.98, 95%CI（1.48-5.99）, P=0.002], and lower reverse reactions [OR=0.1, 95%CI（0.05-0.19）, P〈0.01] than the CTX group. There were statistical differences in the chance of gastrointestinal adverse reactions[OR=0.15, 95%CI（0.07-0.33）, P〈0.01], and blood system adverse reactions [OR=0.15, 95%CI（0.04-0.62）, P=0.008] as compared with CTX group, but there were no statistical differences in reverse reactions of infection[OR=1.44, 95%CI（0.39-5.32）, P=0.59]and liver damage [OR=0.64, 95%CI（0.26-1.59）, P=0.34〉0.05].Conclusions MMF has better efficacy and higher security as compared with CTX in treatment of HSPN in children, as the incidence of adverse reactions such as gastrointestinal reaction, myelosuppression, gonadal damage and hair loss were lower.