摘要
目的:探讨肾活检组织表达PLA2R对成人特发性膜性肾病免疫抑制治疗疗效的影响。方法:检索中国知网、万方、维普、中国临床注册中心、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane图书馆、Web of science、美国临床注册中心等数据库中自建立至2021年6月国内外公开发表的关于肾活检组织PLA2R表达与特发性膜性肾病免疫抑制治疗的相关文献。根据纳入和排除标准筛选文献。采用非随机对照研究的评价量表(NOS)对纳入研究质量进行评估。汇总各研究的尿蛋白总缓解率,整理为四表格整理来估算粗RR(HR)以及95%CI值。通过RevMan 5.3和Stata 16软件进行meta分析。并采用依次减少一篇文献的方法进行敏感性分析,通过Egger漏斗图检验文献发表偏倚。结果:共筛选出10篇文献。累计病例570例,其中PLA2R阳性表达组患者434例,阴性组136例。异质性检验提示存在明显的异质性(Cochrane-Q为I^(2)=85.8%,P=0.000)。通过敏感性分析确定异质源,删除异质研究后,余下研究异质性检验提示不存在异质性(Cochrane-Q为I^(2)=9%,P=0.36)。采用固定效应模型合并效应量。合并后的RR为0.72,95%CI:0.64~0.81,Z=5.51,P<0.05。Egger漏斗图显示无明显发表偏倚。结论:PLA2R表达阳性的成人特发性膜性肾病患者较PLA2R表达阴性者免疫治疗效果差。
Objective:To investigate the effect of the expression of PLA2 R in renal biopsy tissue on the immunosuppressive treatment of adult idiopathic membranous nephropathy.Methods:All available articles about PLA2 R expression in renal biopsy tissues and immunosuppression therapy of IMN which were published at home and abroad until June 2021 were pooled from CNKI,Wanfang,VIP,Chinese Clinical Registries,Chinese Biomedical Literature(CBM),PubMed,Embase,Cochrane Library,Web of Science,and American Clinical Registries database et al.Literature was screened according to inclusion and exclusion criteria.The quality of the papers were evaluated by Newcastle-Ottawa Scale(NOS).The total response rate of urinary protein in the PLA2 R positive and negative expression groups during the follow-up period was summarized in four tables to estimate crude RR(HR) and 95%CI.And then a meta analysis was conducted by the statistical softwares of RevMan 5.3 and Stata16.Sensitivity analysis was conducted by reducing one article in turn,and publication bias was tested by Egger funnel plot.Results:A total of 10 articles were screened.There were a total of 570 cases,including 434 cases in the PLA2 R positive expression group and 136 cases in the negative group.The heterogeneity test indicated that there was significant heterogeneity(Cochrane-Q:I^(2)=85.8%,P=0.000).Sensitivity analysis was used to identify heterogenous sources.After the heterogenous studies were deleted,the heterogeneity test of the remaining studies indicated that there was no heterogeneity(Cochrane-Q:I^(2)=9%,P=0.36),so Fixed effects model was used to pool effect sizes.The combined RR was 0.72,CI:0.64~0.81,Z=5.51,P<0.05.Egger funnel plot showed no obvious publication bias.Conclusion:IMN patients with positive PLA2 R expression had worse immunotherapy effect than those with negative PLA2 R expression.
作者
吴义强
张湘宁
WU Yiqiang;ZHANG Xiangning(Guangdong Medical University,Zhanjiang 523000)
出处
《中国中西医结合肾病杂志》
2022年第10期870-875,共6页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
揭阳市科技计划项目(No.2017YL012)。
