环孢霉素治疗增殖性狼疮性肾炎的系统评价

Systematic Review on Cyclosporine in Treating Proliferative Lupus Nephritis

目的评价环孢霉素(CsA)治疗增殖性狼疮性肾炎(PLN)的疗效和安全性。方法运用Cochrane图书馆(2010年第1期)的临床对照试验中心资料库(CENIRAL)、PubMed、EMBASE、中国生物医学文献数据库(CBMd isc)、中国期刊全文数据库(CNKI)和中国维普数据库(VIP),检索时间截止至2010年2月28日,由3名系统评价员进行资料提取和质量评价,对同质资料进行Meta分析。结果共纳入7个研究361名患者,均为完全随机对照试验(RCT)。CsA与环磷酰胺(CTX)比较,其24 h尿蛋白量、抗双链DNA抗体(Anti-ds DNA)、血清总补体(CH50)、生长速度、生长速度标准差和C3(mg/dl)的差异有统计学意义,而其余指标间差异均无统计学意义;CsA与硫唑嘌呤(AZA)比较,其内生肌酐清除率(6、24、48个月)、关节痛和胃肠道不适的发生率间差异均有统计学意义,余临床指标间差异无统计学意义;CsA与醋酸泼尼松(Pred)比较,其24 h尿蛋白量间差异有统计学意义,余临床指标间差异无统计学意义。结论现有研究结果显示:CsA与CTX或Pred比较,可减轻PLN患儿的临床症状,但不能改善其血清学指标,可以起到激素节余的作用;CsA与AZA比较,副作用发生率较高,二者对临床的改善作用相同;有关患儿的疗效有待进一步的RCT研究予以明确。

Objective To assess the therapeutic effect and safety of cyclosprine in the treatment of proliferative lupus nephritis. Methods The CENIRAL of Cochrane library, PuBmed, EMBASE, CBMdisc, CNKI, VIP that is to the 28th February 2010 were searched. Three reviewers assessed the quality of including studies, extracted data and Meta - analyzed the homogenous studies. Results Seven studies involving 361 participants were included, and all studies were randomized control trials （RCT）. There were statistical difference in proteinuria （24 h） , Anti -ds DNA, CH50, height velocity, height SDS and C3 （mg/dl） between cyclosporine and CTX, but no statistical difference in other indicators; There were statistical difference in CCr （6, 24, 48 months） , arthralgias and gastrointestinal disorders between cyclosporine A and AZA, but no statistical difference in other indicators. There were statistical difference in proteinuria （24 h） between cyclosporine and pred, but no statistical difference in other indicators. Conclusion Available evidence show： comparing with CTX or Pred, CsA can improve the clinical symptom and spare steroid, but cannot control serological activity; Comparing with AZA, CsA has more side effects, while the improving effect was similar; Larger scale clinical trials are needed to evaluate its effectiveness.