不同免疫抑制方案治疗肝移植患者疗效Meta分析

Efficacy of Different Therapies for Immunosuppression after Liver Transplantation: A Meta-analysis

目的:评价不同免疫抑制方案中他克莫司(FK506)二联用药和环孢素A(CsA)三联用药治疗肝移植术患者的疗效差异。方法:通过计算机检索,全面收集有关FK506和CsA用于肝移植患者术后治疗排斥反应的随机对照试验(RCT),筛选FK506二联用药对比CsA三联用药的RCT,用RevMan5.0软件进行分析。结果:共纳入7篇RCTs,3篇为高质量文献,4篇为中等质量文献。Meta分析结果显示,FK506二联用药对比CsA三联用药,患者存活率(RR=1.06,95%CI为0.77～1.45,P=0.72)、移植物存活率(RR=0.99,95%CI为0.76～1.29,P=0.92)、感染发生率(RR=0.98,95%CI为0.60～1.58,P=0.93)和神经毒性发生率(RR=0.59,95%CI为0.32～1.07,P=0.08)差异无统计学意义;CsA三联用药的急性排斥反应(RR=1.57,95%CI为1.23～2.01,P=0.0003)发生率低于FK506二联用药,差异具有统计学意义。结论:与CsA三联用药相比,FK506二联用药在患者/移植物存活率、感染结果指标中疗效无差异,但能增加急性排斥反应发生率。CsA能增加神经毒性反应的发生率,对于患有神经系统疾病的患者推荐使用FK506。

OBJECTIVE： To evaluate the safety and efficacy of FK506-based dual therapy and CsA-based triple therapy for immunosuppression after liver transplantation. METHODS： The literature about the randomized controlled trials （RCT） on FK506 and CsA for immunosuppression after liver transplantation was retrieved for analysis using RevMan 5.0 software. RESULTS： A total of 7 RCTs were included; 3 were considered as high quality of RCT, 4 as moderate quality. The results of Meta-analysis of FK506-based dual therapy indicated the patients＇ survival rate （RR=1.06, 95% CI=0.77-1.45, P=0.72）, grafts＇ survival rate （RR = 0.99, 95 % CI = 0.76 - 1.29, P= 0.92 ）, infection rate （RR = 0.98, 95 % CI = 0.60 - 1.58, P = 0.93 ） and incidence of neurotoxicity （RR=0.59, 95%CI=0.32-l.07,P=0.08）was not significantly different. The incidence of acute rejection in CsA group was lower than in FK506 group （RR=1.57, 95%CI=1.23-2.01,P=0.000 3）. CONCLUSION： The curative efficacy of FK506 group is not different from that of CsA group in respect of rate of patient/graft, infection but increase the incidence of acute rejection. Because CsA can increase incidence of neurotoxicity, it is suggestion to treat patients of nervous systerm disease with FK506.