AIM: To investigate the efficacy and safety of combined antiviral and immunosuppressant therapy in adult hepatitis B virus-associated glomerulonephritis (HBVGN) patients. METHODS: A computerized literature search was ...AIM: To investigate the efficacy and safety of combined antiviral and immunosuppressant therapy in adult hepatitis B virus-associated glomerulonephritis (HBVGN) patients. METHODS: A computerized literature search was carried out in the PubMed database, Embase, the Cochrane Library, Chinese BioMedical Literature on disc, Chinese Medical Current Contents, Chinese National Knowledge Infrastructure, Wanfang and VIP (Chinese Technological Journal of Database) to collect articles between June 1980 and December 2010 on therapy with immunosuppressants, e.g., glucorticosteroids, mycophenolate mofetil and leflunomide, combined with antivirals, e.g., interferon, lamivudine, entecavir and adefovir dipivoxil, in adult HBV-GN patients. The primary outcomes were remission of proteinuria, clearanceof HBV e-antigen, and elevation of serum albumin. The secondary outcomes were blood levels of alanine aminotransferase, serum creatinine, and HBV-DNA titer. Meta-analysis was performed using Review Manager 5.1. Fixed or random effect models were employed to combine the results after a heterogeneity test. The effects of the combined therapy were analyzed for different doses of glucorticosteroid and different types of HBV-GN. RESULTS: Twelve clinical trials with 317 patients were included. A significantly higher incidence of HBV-GN was found in male patients (relative risk = 2.40, 95% CI: 1.98-2.93). Combined therapy reduced the proteinuria significantly with a mean difference of 4.19 (95% CI: 3.86-4.53) and increased the serum albumin concentration significantly with a mean difference of -11.95 (95% CI: -12.97-10.93) without significant alterations of liver function (mean difference: 4.62, 95% CI: -2.55-11.79) and renal function (mean difference: 10.29, 95% CI: 0.14-20.45). No signif icant activation of HBV-DNA replication occurred (mean difference: 0.12, 95% CI: -0.37-0.62). There was no significant difference between the high dose glucorticosteroid group and the low dose glucorticosteroid group in terms of proteinuria remission (P = 0展开更多
目的:探讨小剂量他克莫司(FK-506)治疗难治性全身型重症肌无力(MG)的疗效和安全性.方法:临床确诊的难治性全身型MG 5例,均为OssermanⅡB或美国MG基金会(Myasthenia Gravis Foundation of America,MGFA)ⅢB型,予FK-506 3 mg·d-1治...目的:探讨小剂量他克莫司(FK-506)治疗难治性全身型重症肌无力(MG)的疗效和安全性.方法:临床确诊的难治性全身型MG 5例,均为OssermanⅡB或美国MG基金会(Myasthenia Gravis Foundation of America,MGFA)ⅢB型,予FK-506 3 mg·d-1治疗20周.分别在治疗前和治疗后第4、8、12、16、20周进行临床和安全性评估,服用8～12周后进行FK-506血浓度测定.结果:所有病人均完成了20周的临床治疗,除1例在用药第2周出现一过性丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)轻度增高外,其余病人均无明显不良反应.5例病人治疗20周后的Osserman评级、MGFA量表、日常生活量表(activities of dailyliving,ADL)和徒手肌力量表(manual muscle test,MMT)评分均较治疗前有改善,Osserman评级均减少2级,MGFA改善程度为38.1%～88.8%,ADL为48.4%～100%,MMT为54.5%～91.3%,合并用药也较治疗前有不同程度减少.结论:我们在国内应用小剂量FK-506治疗难治性全身型MG,初步临床研究结果表明安全有效.展开更多
基金Supported by National Natural Science Foundation, No. 81072914Major Project Foundation of National Science and Technology, No. 2010ZX9102-204Traditional Chinese Medicine Research Grant for Military Organization, No. 10ZYZ255
文摘AIM: To investigate the efficacy and safety of combined antiviral and immunosuppressant therapy in adult hepatitis B virus-associated glomerulonephritis (HBVGN) patients. METHODS: A computerized literature search was carried out in the PubMed database, Embase, the Cochrane Library, Chinese BioMedical Literature on disc, Chinese Medical Current Contents, Chinese National Knowledge Infrastructure, Wanfang and VIP (Chinese Technological Journal of Database) to collect articles between June 1980 and December 2010 on therapy with immunosuppressants, e.g., glucorticosteroids, mycophenolate mofetil and leflunomide, combined with antivirals, e.g., interferon, lamivudine, entecavir and adefovir dipivoxil, in adult HBV-GN patients. The primary outcomes were remission of proteinuria, clearanceof HBV e-antigen, and elevation of serum albumin. The secondary outcomes were blood levels of alanine aminotransferase, serum creatinine, and HBV-DNA titer. Meta-analysis was performed using Review Manager 5.1. Fixed or random effect models were employed to combine the results after a heterogeneity test. The effects of the combined therapy were analyzed for different doses of glucorticosteroid and different types of HBV-GN. RESULTS: Twelve clinical trials with 317 patients were included. A significantly higher incidence of HBV-GN was found in male patients (relative risk = 2.40, 95% CI: 1.98-2.93). Combined therapy reduced the proteinuria significantly with a mean difference of 4.19 (95% CI: 3.86-4.53) and increased the serum albumin concentration significantly with a mean difference of -11.95 (95% CI: -12.97-10.93) without significant alterations of liver function (mean difference: 4.62, 95% CI: -2.55-11.79) and renal function (mean difference: 10.29, 95% CI: 0.14-20.45). No signif icant activation of HBV-DNA replication occurred (mean difference: 0.12, 95% CI: -0.37-0.62). There was no significant difference between the high dose glucorticosteroid group and the low dose glucorticosteroid group in terms of proteinuria remission (P = 0
文摘目的:探讨小剂量他克莫司(FK-506)治疗难治性全身型重症肌无力(MG)的疗效和安全性.方法:临床确诊的难治性全身型MG 5例,均为OssermanⅡB或美国MG基金会(Myasthenia Gravis Foundation of America,MGFA)ⅢB型,予FK-506 3 mg·d-1治疗20周.分别在治疗前和治疗后第4、8、12、16、20周进行临床和安全性评估,服用8～12周后进行FK-506血浓度测定.结果:所有病人均完成了20周的临床治疗,除1例在用药第2周出现一过性丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)轻度增高外,其余病人均无明显不良反应.5例病人治疗20周后的Osserman评级、MGFA量表、日常生活量表(activities of dailyliving,ADL)和徒手肌力量表(manual muscle test,MMT)评分均较治疗前有改善,Osserman评级均减少2级,MGFA改善程度为38.1%～88.8%,ADL为48.4%～100%,MMT为54.5%～91.3%,合并用药也较治疗前有不同程度减少.结论:我们在国内应用小剂量FK-506治疗难治性全身型MG,初步临床研究结果表明安全有效.
