霉酚酸酯治疗特发性膜性肾病的荟萃分析

Mycophenolate mofetii treatment for idiopathic membranous nephropathy： a meta-analysis

目的评价霉酚酸酯治疗特发性膜性肾病的临床疗效和不良反应。方法检索了PubMed—Medline、EMBASE和Cochrane Library电子数据库的霉酚酸酯治疗特发性膜性肾病的随机对照试验或临床对照试验。疗效使用优势比（OR）进行计算评估；不良反应用相对危险度（RR）进行计算评估。结果3个随机对照试验和1个临床对照试验，共计141例被纳入本次研究。3个随机对照试验分别比较了霉酚酸酯与环磷酰胺、非免疫抑制剂的保守治疗和苯丁酸氮芥的疗效。1个临床对照试验比较了霉酚酸酯与环磷酰胺的疗效。与对照组相比，霉酚酸酯治疗特发性膜性肾病的临床完全缓解、部分缓解和总缓解率的OR（95％CI）分别为0．74（0．32～1．75）、0．56（0．28～1．11）和0．46（0．23～0．92）。表明霉酚酸酯治疗特发性膜性肾病的临床完全缓解、部分缓解率与对照组相当（P〉0．05），而总缓解率明显低于对照组（P〈0．05）。霉酚酸酯与其他免疫抑制剂在感染、胃肠道症状和贫血等不良反应差异无统计学意义，但霉酚酸酯可以降低自细胞减少症的发生率，其月R（95％CI）为0．06（0．01～0．41）。结论不推荐霉酚酸酯作为特发性膜性肾病的首选用药。

Objective To evaluate the efficacy and side effects of mycophenolate mofetil （MMF） in the treatment of idiopathic membranous nephropathy （IMN）. Methods Randomized controlled trials （RCTs） and clinical controlled trials （CCTs）were used for the meta-analysis. Electronic and manual retrieval from Pubmed-Medline, EMBASE and Cochrane Library Database were performed to identify RCTs or CCTs in which MMF was compared with other regimes in treating IMN. Efficacy and side effects data were extracted and summarized with fixed effect model odds ratio （OR） or risk ratio （OR）. Results Three RCTs and one CCT with 141 patients were enrolled in the study. In 3 RCTs, MMF was compared with cyclophosphamide （CTX）, conservative treatment （non-immunosuppressive）and chlorambucil respectively. In the CCT, MMF was compared with cyclophosphamide. Compared with control groups, MMF did not significantly increase the complete remission （OR=0.74, 95%CI=0.32-1.75） and partial remission （0R=0.56, 95%CI=0.28- 1.11）. The overall response rate of MMF therapy was significantly lower than that of control groups （OR=0.46, 95%CI=0.23-0.92）. There was no significant difference in infection, gastrointestinal symptoms or anemia among the patients receiving MMF and the patients receiving other immunosuppressive agents, but MMF reduced the incidence of leucopenia obviously （OR=0.06, 95% CI=0.01-0.41）. Conclusion Mycophenolate mofetil should not be recommended as the firstline therapy for IMN.