摘要
目的 系统性评价利妥昔单抗(RTX)治疗抗中性粒细胞胞质抗体(ANCA)相关性血管炎(AAV)的复发率。方法 计算机检索中国知网、Embase、PubMed、Cochrane Library,检索时间为建库开始至2022年3月,查找所有关于RTX治疗AAV的随机对照试验(RCTs)。根据Cochrane协作网的风险偏倚评估工具对纳入的文献进行质量评价,使用RevMan 5.4软件进行统计学分析。结果 共纳入7篇文献,总复发率差异无统计学意义[OR=0.58,95%CI(0.27~1.22),P=0.15];不同时间复发率方面,2组12个月的复发率差异无统计学意义[OR=1.83,95%CI(0.32~10.48),P=0.50],试验组28个月的复发率低于对照组[OR=0.19,95%CI(0.09~0.41),P<0.000 1]。不同疾病类型的复发率,试验组肉芽肿性多血管炎(GPA)的复发率低于对照组[OR=0.18,95%CI(0.08~0.44),P<0.000 1];MPA的复发率差异无统计学意义[OR=0.24,95%CI(0.03~1.71),P=0.15]。对于不同ANCA类型的复发率,试验组PR3-ANCA的复发率低于对照组[OR=0.26,95%CI(0.10~0.66),P=0.005];2组MPO-ANCA的复发率差异无统计学意义[OR=0.51,95%CI(0.02~11.99),P=0.68]。结论 RTX可降低AAV的远期复发率,但最佳持续时间有待进一步研究探讨,且RTX可降低PR3-ANCA阳性的AAV复发率,在GPA中的复发率低于环磷酰胺(CTX)/硫唑嘌呤(AZA)。
Objective To systematically evaluate the recurrence rate of antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV) treated with rituximab(RTX).Methods China National Knowledge Network,Embase,PubMed and Cochrane Library were searched by computer from the beginning of the database to March 2022,and all randomized controlled trials(RCTs) on the treatment of AAV with RTX were searched.The quality of the included literatures was evaluated according to the risk bias assessment tool of the Cochrane Collaboration,and statistical analysis was performed using RevMan 5.4 software.Results A total of 7 literatures were included,and there was no significant difference in the total recurrence rate[OR=0.58,95%CI(0.27~1.22),P=0.15].In terms of recurrence rate at different time,there was no significant difference between the two groups at 12 months[OR=1.83,95%CI(0.32~10.48),P=0.50],and the recurrence rate at 28 months in the experimental group was lower than that in the control group[OR=0.19,95%CI(0.09~0.41),P<0.000 1].The recurrence rate of GPA in the experimental group was lower than that in the control group[OR=0.18,95%CI(0.08~0.44),P<0.000 1].There was no significant difference in the recurrence rate of MPA[OR=0.24,95%CI(0.03~1.71),P=0.15].For different kind of ANCA recurrence rate,experimental group PR3-ANCA the recurrence rate was lower than the control group[OR=0.26,95%CI(0.10~0.66),P=0.005].There was no significant difference in the recurrence rate of MPO-ANCA between the two groups[OR=0.51,95%CI(0.02~11.99),P=0.68].Conclusion RTX can reduce the long-term recurrence rate of AAV,but the optimal duration needs to be further investigated.RTX can reduce the recurrence rate of PR3-ANCA positive AAV,and the recurrence rate in granulomatous polyvasculitis(GPA) is lower than that of cyclophosphamide(CTX)/azathioprine(AZA).
作者
伍丽帆
胡煜琳
WU Lifan;HU Yulin(Department of Nephrology and Rheumatology,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing 402160,China)
出处
《临床合理用药杂志》
2024年第11期1-5,共5页
Chinese Journal of Clinical Rational Drug Use
