摘要
目的系统评价来氟米特(LEF)与环磷酰胺(CTX)治疗IgA肾病的有效性和安全性。方法电子检索The Cochrane Library、PubMed、Embase和中国知网全文数据库、中文科技期刊维普数据库检索来氟米特联合糖皮质激素与环磷酰胺联合糖皮质激素治疗IgA肾病的随机对照试验(RCT),检索文献截止时间为2013年7月,根据纳入和排除标准选择文献,进行数据提取和质量评估,使用Revman 5.1软件进行Meta分析。观察指标为:有效性指标包括:完全缓解率、有效率、24 h尿蛋白、血清白蛋白、血肌酐、安全性指标:不良反应发生率包括:白细胞减少的发生率、消化道反应发生率、肝功能异常发生率、感染发生率。结果共收集国内6个随机对照研究,纳入347例患者,结果显示,LEF与CTX对比,尿蛋白下降有统计学差异,[SMD=-0.41,95%CI(-0.65,-0.18),P=0.006],血清白蛋白升高有统计学差异[SMD=0.43,95%CI(0.20,0.67),P=0.003]。白细胞减少的发生率、消化道反应发生率更低[RR=0.11,95%CI(0.04,0.37),P=0.003]、[RR=0.23,95%CI(0.12,0.45),P=0.0001]。完全缓解率、有效率、血清肌酐、肝功能异常发生率、感染发生率无显著差异。结论对于中国患者,LEF与CTX治疗IgA肾病疗效无显著差异,LEF与CTX对比,治疗效果相似,但LEF的不良反应明显少于CTX,其安全性较好。
Objective To systematically evaluate the efficacy and the safety of leflunomide and cyclophosphamide for IgA nephropathy. Methods Databases including CNKI, CBM, EMbase, PubMed, The Cochrane Library were searched. All randomized control trials （RCTs） on leflunomide and cyclophosphamide in treating IgA nephropathy were independently collected and screened according to the inclusion and exclusion crite- ria. The data were extracted, the quality of the included studies was assessed. And then meta - analysis was conducted by using RevMan5.1 soft- ware. Results A total of 6 RCTs involving 347 patients with IgA nephropathy were included into this meta - analysis. The results of meta - analysis showed that leflunomide can significantly increase the serum albumin level[ SMD =0.43,95% CI （0.20, 0.67 ）, P = 0. 003 ] , and decrease urine protein [SMD = -0.41,95%CI（ -0.65, -0.18）, P =0.006], leucopenia rate [RR =0.11,95%CI（0.04, 0.37）, P =0.003] gastrointestinal symptoms rate[ RR =0.23,95% CI （0.12, 0.45）, P =0.0001], adverse effect rate[ RR =0.34,95% CI（0.24, 0.47）, P =0.00001 ]. There were no differences in complete remission rate, effective rate, serum creatinine, abnormal liver function, infection. Conclusion The current limited evi- dence suggests that lefluonomide combined with glucocorticoid has a similar therapeutic effect to that of cyclophosphamide combined with glucocorti- coid to Chinese Participants, but it can reduce the adverse reaction in long＇term medication. And it has a similar effect also to that of LEF with CTX, but with significantly fewer adverse events..
出处
《临床和实验医学杂志》
2014年第7期516-521,共6页
Journal of Clinical and Experimental Medicine
基金
广西卫生厅重点基金(20127261782)
