霉酚酸酯治療增生性狼瘡腎炎的系統評價_《中國循證醫學雜志》

作者：

歐三桃 ¹ , 鐘利春 ² , 杜新 ¹ ,  黃頌敏 ¹ , 劉琦 ³ , 趙安菊 ¹ , 陳澤君 ¹

1. 四川大學華西醫院腎病內科（成都 610041） 2. 瀘州醫學院消化內科（瀘州 646000） 3. 瀘州醫學院腎病內科（瀘州 646000）;

關鍵詞：

霉酚酸酯狼瘡腎炎系統評價 Meta分析

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目的　評價在糖皮質激素基礎上使用霉酚酸酯治療增生性狼瘡腎炎的有效性和安全性。
方法　計算機檢索中國生物醫學文獻光盤數據庫（1979.11～2006.2）、中國循證醫學/ Cochrane 中心數據庫（2005年）、Cochrane圖書館臨床對照試驗資料庫（2005年第4期）、MEDLINE（1966.11～2006.2）、EMbase（1975～2006.2）和SCI（1985～2006.2）等數據庫，收集霉酚酸酯治療增生性狼瘡腎炎的隨機對照試驗, 對納入研究的方法學質量進行評價。選擇臨床總有效率及完全緩解率作為近期療效指標，腎臟存活率、患者生存率及狼瘡腎炎復發率作為遠期療效指標，治療期及隨訪期發生感染、閉經、白細胞減少、腹瀉等副作用的患者比例作為安全性評價指標，提取數據并采用Cochrane 協作網推薦的RevMan 4.2.7軟件進行統計分析。
結果　共檢索到符合納入標準的隨機對照試驗9篇（512例）。對近期療效指標的Meta分析結果顯示，霉酚酸酯與環磷酰胺/硫唑嘌呤比較治療臨床療效差異無統計學意義。腎臟存活率、腎病復發率的Meta分析結果顯示，霉酚酸酯與環磷酰胺/硫唑嘌呤比較,其臨床療效差異無統計學意義。遠期療效指標和安全性評價各項指標的Meta分析提示，霉酚酸酯優于環磷酰胺/硫唑嘌呤。
結論　霉酚酸酯在改善增生性狼瘡腎炎患者的近期療效、腎臟存活率及防止腎病復發方面并不優于目前常規的環磷酰胺/硫唑嘌呤治療，但在提高患者生存率及藥物安全性方面可能優于后者。由于本系統評價納入文獻的方法學質量不夠高，加之例數有限，尚需開展多中心、大樣本隨機雙盲試驗進一步證實霉酚酸酯的療效和安全性。

引用本文： 歐三桃,鐘利春,杜新,黃頌敏,劉琦,趙安菊,陳澤君. 霉酚酸酯治療增生性狼瘡腎炎的系統評價. 中國循證醫學雜志, 2006, 06(10): 712-720. doi: 復制

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2.	劉國平, 黃九香, 林琳. 霉酚酸酯對彌漫增生型狼瘡性腎炎患者的療效觀察. 中國中西醫結合腎病雜, 2003; 4(7): 386~388.
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4.	朱彬, 周振安, 劉子棟, 等. 霉酚酸酯與環磷酰胺治療IV型狼瘡性腎炎的療效比較. 山東大學學報 (醫學版), 2003; 41(6): 692~694.
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10.	Cochrane Reviewer’s Handbook 4.2.2. The Cochrane Collaboration, 2000.
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12.	Chan TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. N Engl J Med, 2000; 343(16): 1156–1162.
13.	Chan TM, Tse KC, Tang CS, et al. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol, 2005; 16(4): 1076–1084.
14.	Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med, 2004; 350(10): 971–980.
15.	Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Eng J Med, 2005; 353(21): 2219–2228.
16.	Jiang WG,Xiao X,Fang JA. Eff icacy of Mycophenolate Mofetil in Patients with Diffuse Prol -iferative Lupus Nephritis. Chinese Journal of Integrated Traditional and Western Nephrology, 2002; 3(4): 218–221.
17.	Liu GP, Huang JX, Gui L. Clinical Study of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis.Chinese Journal of Integrated Traditional and Western Nephrology, 2003; 4(7): 386–388.
18.	Ong LM, Hooi LS, Lim TO, et al. Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis. Nephrology, 2005; 10(5): 504–510.
19.	Zhang JL, Zhang HH, Ma L, et al. A multicentric and prospective study on mycophenolate mofetil in the treatment of systemic lupus erythematosus. Chinese Journal of Rheumatology, 2002; 6(6): 406–410.
20.	Zhu B, Zhou ZA, Liu ZD, et al. Comparision of mycophenolate mofetil therapy versus cyclophosphamide treatment of proliferative lupus nephritis. Journal of Shandong Univenity (health sciences), 2003; 41(6): 692–694.

1. 蔣文功, 肖笑, 方敬愛. 霉酚酸酯治療彌漫增生性狼瘡腎炎的臨床觀察. 中國中西醫結合腎病雜志, 2002; 3(4): 218–221.
2. 劉國平, 黃九香, 林琳. 霉酚酸酯對彌漫增生型狼瘡性腎炎患者的療效觀察. 中國中西醫結合腎病雜, 2003; 4(7): 386~388.
3. 張江林, 張火亙, 馬麗等. 嗎替麥考酚酯治療系統性紅斑狼瘡的多中心前瞻性研究. 中華風濕病學雜志, 2002; 6(6): 406~410.
4. 朱彬, 周振安, 劉子棟, 等. 霉酚酸酯與環磷酰胺治療IV型狼瘡性腎炎的療效比較. 山東大學學報 (醫學版), 2003; 41(6): 692~694.
5. Boumpas DT, Austin HA III, Vaughn EM, et al. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis.Lancet, 1992; 340: 741–745.
6. Dooley MA, Cosio FG, Nachman PH, et al. Mycophenolate mofetil therapy in lupus nephritis: clinical observations. J Am Soc Nephml, 1999;10(4): 833–839.
7. Tan EM, Cohen AS, Fries JF, et al. The1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum, 1982; 25: 1271–1277.
8. Egger M, Smith GD, Altman DG. Systematic Reviews in Heath Care. London: Tavistock Square, Second edition, 2001. 73-78.
9. Jadad AR ,Moore A ,Carrol D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary. Control Clin Trials, 1996 ; 17: 1–12.
10. Cochrane Reviewer’s Handbook 4.2.2. The Cochrane Collaboration, 2000.
11. Schulz KF, Chalmers I, Hayes RJ. Empirical evidence of bias .JAMA, 1995; 273: 408–412.
12. Chan TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. N Engl J Med, 2000; 343(16): 1156–1162.
13. Chan TM, Tse KC, Tang CS, et al. Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol, 2005; 16(4): 1076–1084.
14. Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med, 2004; 350(10): 971–980.
15. Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Eng J Med, 2005; 353(21): 2219–2228.
16. Jiang WG,Xiao X,Fang JA. Eff icacy of Mycophenolate Mofetil in Patients with Diffuse Prol -iferative Lupus Nephritis. Chinese Journal of Integrated Traditional and Western Nephrology, 2002; 3(4): 218–221.
17. Liu GP, Huang JX, Gui L. Clinical Study of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis.Chinese Journal of Integrated Traditional and Western Nephrology, 2003; 4(7): 386–388.
18. Ong LM, Hooi LS, Lim TO, et al. Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis. Nephrology, 2005; 10(5): 504–510.
19. Zhang JL, Zhang HH, Ma L, et al. A multicentric and prospective study on mycophenolate mofetil in the treatment of systemic lupus erythematosus. Chinese Journal of Rheumatology, 2002; 6(6): 406–410.
20. Zhu B, Zhou ZA, Liu ZD, et al. Comparision of mycophenolate mofetil therapy versus cyclophosphamide treatment of proliferative lupus nephritis. Journal of Shandong Univenity (health sciences), 2003; 41(6): 692–694.

《中國循證醫學雜志》

霉酚酸酯治療增生性狼瘡腎炎的系統評價

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《中國循證醫學雜志》

霉酚酸酯治療增生性狼瘡腎炎的系統評價

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