多靶点与静脉环磷酰胺冲击诱导治疗狼疮性肾炎的Meta分析

A meta-analysis of multiple targets with cyclophosphamide in the induction treatment of lupus nephritis

目的评价激素联合霉酚酸酯（MMF）、他克莫司（FK506）多靶点治疗和激素联合静脉环磷酰胺冲击（IVc）诱导治疗狼疮性肾炎（LN）的有效性和安全性。方法电子检索PubMed、CMB、CNKI，EMbase，Cochrane图书馆临床对照试验资料库。收集比较多靶点与IVC诱导治疗LN的随机对照试验（RCT），根据纳入和排除标准筛选文献，质量评价和提取资料后，应用Rev-man5．1软件对数据进行Meta分析。结果共纳入44个国内进行的RcT合计331例患者，Meta分析结果显示多靶点组诱导治疗V＋Ⅳ型LN的完全缓解率明显高于IVC组（RR=3．94，95%CI2．10～7．38，P〈0．01），但其诱导治疗其他病理类型LN患者并没有明显优势。多靶点组胃肠道反应、肝功能异常、白细胞减少、月经失调的发生率明显低于IVC组，但新发高血压的发生率高于IVC组。另外，与IVC组相比，多靶点组患者尿蛋白减少更明显、清蛋白升高更明显，抗双链DNA转阴率也较高。结论对于我国患者，多靶点诱导治疗V＋Ⅳ型LN的疗效较IVC好，且安全性较高，但仍需更多高质量RCT进一步验证。

Objective To evaluate efficacy and safety of hormone combined mycophenolate mofetil （MMF） and taerolimus （FK506） multiple targets treatment,hormone combined intravenous cyclophosphamide pulse （IVC） in the induction treatment of lupus nephritis. Methods The RCTs of MMF plus FKS06 versus IVC in LN were searched from PubMed,EMbase,the Cochrane, CBM, and CNKI. The literature were screened according to include and exclude standards, evaluated the quality of the included stud- ies,and performed meta-analyses using Revman 5.1 software. Results It was identified 44 domestic RCTs papers including 331 pa- tients. Meta-analysis showed that multiple target therapy group had significantly superiority to IVC group in the induction treatment of V ＋IV LN （RR=3.94,95 %CI 2.10-7.38,P〈0.01） ,while with no significant advantage for other pathological types of LN patients. Gastrointestinal reaction, abnormal liver function, the incidence of leukopenia, menstrual disorders in multiple target thera py group were significantly lower than that of IVC group for LN, while the incidence of new hypertension group was significantly higher than the IVC group. Moreover,multiple target therapy group could significantly reduce urine pr0tein,increase serum albumin and had a significantly higher anti-dsDNA negative conversion rate compared with IVC group. Conclusion Multiple target therapy is more effective than IVC for V ＋ IV LN in Chinese patients and with better security. Further large-scale RCTs are needed to con- firm these results.