摘要
目的评价长期使用不同免疫抑制剂联合糖皮质激素治疗狼疮肾炎(LN)的有效性和安全性。方法检索PubMed、The Cochrane Library、Web of Science、中国知网、万方数据库和中国生物医学文献数据库,检索时限为建库至2018年2月,收集不同免疫制剂药物联合糖皮质激素治疗LN的随机对照试验(RCT),采用WinBugs 1.4.3和Stata 12.0软件进行统计分析。结果纳入50个RCT,共4202例患者。治疗LN降低尿蛋白有效性上,Meta分析结果显示,来氟米特、环磷酰胺+来氟米特、霉酚酸酯、来氟米特+霉酚酸酯、环磷酰胺+霉酚酸酯、他克莫司+霉酚酸酯的效果优于环磷酰胺(P<0.05),环磷酰胺+来氟米特的效果优于来氟米特(P<0.05);网状Meta分析结果显示,环磷酰胺+霉酚酸酯、来氟米特、来氟米特+霉酚酸酯和霉酚酸酯的效果优于他克莫司[SMD(95%CI)分别为-1.23(-2.40,-0.04)、-1.11(-2.00,-0.22)、-1.44(-2.79,-0.08)、-1.17(-2.04,-0.29)],霉酚酸酯的效果优于环磷酰胺[SMD(95%CI)为-0.40(-0.78,-0.01)];累积排序概率曲线图排序结果显示,环磷酰胺+来氟米特、来氟米特+霉酚酸酯和环磷酰胺+霉酚酸酯的累积排序概率图下面积分别为75.3%、72.7%、63.4%。治疗LN降低血清肌酐有效性上,Meta分析结果显示,环磷酰胺+来氟米特、霉酚酸酯、环磷酰胺+霉酚酸酯的效果优于环磷酰胺(P<0.05);网状Meta分析结果显示,霉酚酸酯的效果优于环磷酰胺[SMD(95%CI)为-0.37(-0.65,-0.09)];累积排序概率曲线图排序结果显示,环磷酰胺+来氟米特、霉酚酸酯和环磷酰胺+霉酚酸酯的SUCRA分别为75.9%、65.1%、63.7%。结论环磷酰胺+来氟米特和环磷酰胺+霉酚酸酯等多靶点治疗LN的效果优于其他药物。
Objective To evaluate the efficacy and safety of long-term using different immunosuppressants combined with glucocorticoids in the treatment of systemic lupus erythematosus nephritis(LN).Methods The databases were retrieved in an orderly manner from the dates of their establishment to February,2018,including PubMed,The Cochrane Library,Web of Science,CNKI,Wanfang datebase and China Biology Medicine Disc database,to collect randomized controlled trials(RCT)of different immunosuppressants combined with glucocorticoids for LN.Then a network Meta-analysis was conducted using WinBugs 1.4.3 and Stata 12.0 softwares.Results A total of 50 RCTs involving 4202 patients were included.The Meta-analysis showed that,in the treatment of LN in reducing proteinuria,leflunomide,cyclophosphamide+leflunomide,mycophenolate mofetil,leflunomide+mycophenolate mofetil,cyclophosphamide+Mycophenolate mofetil,tacrolimus+mycophenolate mofetil were superior to cyclophosphamide(P<0.05),and cyclophosphamide+leflunomide was superior to leflunomide(P<0.05).The network Meta-analysis also showed that cyclophosphamide+mycophenolate mofetil,leflunomide,leflunomide+mycophenolate mofetil and mycophenolate mofetil were superior to tacrolimus[SMD(95%CI)respectively:-1.23(-2.40,-0.04),-1.11(-2.00,-0.22),-1.44(-2.79,-0.08),-1.17(-2.04,-0.29)],and mycophenolate mofetil was superior to cyclophosphamide[SMD(95%CI):-0.40(-0.78,-0.01)].The SUCRA of cyclophosphamide+leflunomide,leflunomide+mycophenolate mofetil and cyclophosphamide+mycophenolate mofetil were respectively 75.3%,72.7%and 63.4%.In the treatment of LN in reducing serum creatinine,the Meta-analysis showed that cyclophosphamide+leflunomide,mycophenolate mofetil and cyclophosphamide+mycophenolate mofetil were superior to cyclophosphamide(P<0.05),and mycophenolate mofetil was superior to cyclophosphamide[SMD(95%CI):-0.37(-0.65,-0.09)].The SUCRA of cyclophosphamide+leflunomide,mycophenolate mofetil and cyclophosphamide+mycophenolate mofetil were respectively 75.9%,65.1%and 63.7%.Conclusion The effects of cyclophosphamide+leflunomide and cyclophosphamide+mycophenolatemofetil on LN were superior to other drugs.
作者
王瑞娟
马兴铭
周立
芦永斌
Wang Rui-juan;Ma Xing-ming;Zhou Li;Lu Yong-bin(School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China;Neonatology Department,Lanzhou Maternal and Child Health Care Hospital,Lanzhou 730030,China;Department of Science and Technology,The First Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《兰州大学学报（医学版）》
CAS
2018年第6期1-8,共8页
Journal of Lanzhou University（Medical Sciences）
作者简介
通信联系人:马兴铭,男,教授,博士,研究方向为结核病免疫病理损伤分子机制与免疫治疗,e-mail:maxm@lzu.edu.cn
