选择性白细胞分离法联合药物治疗对溃疡性结肠炎诱导缓解和维持治疗的荟萃分析

Effect of Selective Leukocyte Apheresis Combined with Medication on Inducing and Maintaining Remission in Ulcerative Colitis:A Meta-analysis

不同研究显示选择性白细胞分离法对溃疡性结肠炎（UC）的疗效差异很大.目的：系统性评价选择性白细胞分离法联合药物治疗对UC诱导缓解和维持治疗的作用.方法：检索PubMed、EMBASE、Cochrane Central Register of Controlled Trials、Science Citation Index和中文科技期刊数据库.纳入所有比较选择性白细胞分离法联合药物治疗与传统药物治疗对UC诱导缓解和维持治疗疗效的随机对照试验（RCTs）.采用RevMan 5.0软件分析两者的诱导缓解率、维持缓解率和不良反应发生率.结果：共9项RCTs、685例患者符合人选标准,7项评估诱导缓解率,2项评估维持缓解率.选择性白细胞分离法联合药物治疗组的诱导缓解率显著高于传统药物治疗组（40.7%对29.1%,OR值为2.19,P〈0.0001）,维持缓解率亦显著高于传统药物治疗组（70.4%对25.0%,OR值为8.14,P=0.002）.选择性白细胞分离法联合药物治疗组的轻中度不良反应发生率明显低于传统药物治疗组（44.7%对65.3%,OR值为0.16,P=0.003）.结论：与传统药物治疗相比,选择性白细胞分离法联合药物治疗能明显提高UC患者的诱导缓解率和维持缓解率,并能降低不良反应发生率.

Background： The efficacy of selective leukocyte apheresis in treatment of ulcerative colitis （UC） varies greatly among different studies. Aims： To systematically review the role of selective leukocyte apheresis combined with medication on induction and maintenance of remission in UC. Methods： PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index and Chinese Biomedical Database were retrieved. All randomized controlled trials （RCTs） comparing the efficacy of selective leukocyte apheresis combined with medication and conventional medication on induction and maintenance of remission in UC were included. Statistical analysis was performed using RevMan 5.0 to evaluate the remission rates of induction and maintenance and the incidence of side effects. Results： Nine RCTs with a total of 685 participants met the inclusion criteria, seven RCTs evaluated the remission rate of induction, and 2 evaluated the remission rate of maintenance. Pooled remission rates of induction （40.7% vs. 29.1%, OR 2.19, P〈0.0001） and maintenance （70.4% vs. 25.0%, OR 8.14, P=0.002） of selective leukocyte apheresis combined with medication group were significantly higher than those of conventional medication group. The incidence of slight to moderate side effects of selective leukocyte apheresis combined with medication group was significantly lower than that of conventional medication group （44.7% vs. 65.3%, OR 0.16, P=0.003）. Conclusions： Compared with conventional medication, selective leukocyte apheresis combined with medication could significantly increase the remission rates of induction and maintenance in UC and reduce the incidence of side effects.