环磷酰胺联合静脉注射免疫球蛋白治疗系统性红斑狼疮的系统评价

Combining Intravenous Immunoglobulin for Patients with Systemic Lupus Erythematosus: A Meta-analysis

目的系统评价环磷酰胺联合静脉注射大剂量免疫球蛋白治疗系统性红斑狼疮的效果。方法计算机检索PubMed(1966～2010.8)、EMbase(1974～2010.8)、Cochrane图书馆(2010年第2期)、CNK(I1994～2010.8)、VIP(1989～2010.8)、CBM(1978～2010.8)和中华医学会数字化期刊(1998～2010.8),查找环磷酰胺联合静脉注射免疫球蛋白与单用环磷酰胺冲击疗法比较治疗系统性红斑狼疮的随机对照试验(RCT)。按Cochrane手册4.2.6 RCT的质量评价标准对纳入研究的方法学质量进行评价,并使用RevMan 5.0软件进行Meta分析。结果共纳入4个RCT,包括154例患者。Meta分析结果显示:与环磷酰胺冲击疗法比较,环磷酰胺联合静脉注射免疫球蛋白可降低狼疮活动指数[MD=–3.09,95%CI(–4.21,–1.97)]、感染发生率[OR=0.24,95%CI(0.11,0.54)]、缓解蛋白尿[MD=–1.09,95%CI(–2.11,–0.06)],减少疾病复发[OR=0.07,95%CI(0.01,0.37)]。但在升高补体等方面,两组无明显差别。结论现有证据表明,与环磷酰胺冲击疗法比较,环磷酰胺联合静脉注射大剂量免疫球蛋白治疗系统性红斑狼疮可能在改善患者临床症状、降低感染性疾病发生率和减少复发方面有积极作用。

Objective To assess the effects of combining intravenous immunoglobulin for systemic lupus erythematosus（SLE） by analyzing the randomized controlled trials（RCT）.Methods The electronic databases such as PubMed（1966 to Aug.2010）,EMbase（1974 to Aug.2010）,The Cochrane Library（Issue 2,2010）,CNKI（1994 to Aug.2010）,VIP（1989 to Aug.2010）,CBM（1978 to Aug.2010） and Chinese Medical Association Digital Periodicals（1998 to Aug.2010） were searched to collect RCTs of intravenous immunoglobulin for the patients with SLE.The methodology quality of the included studies was evaluated in accordance with RCTs quality evaluation standard of the Cochrane Handbook 4.2.6,and meta-analyses were performed by using RevMan 5.0 software.Results Four RCTs involving 154 participants were included.The results of meta-analyses showed that compared with cyclophosphamide pulse therapy,the combining intravenous immunoglobulin markedly reduced the SLE disease activity index（MD= –3.09,95%CI –4.21 to –1.97）,the incidence of infection（OR=0.24,95%CI 0.11 to 0.54）,the proteinuria（MD= –1.09,95%CI –2.11 to –0.06）,and the relapse of SLE（OR=0.07,95%CI 0.01 to 0.37）.But there was no significant difference in elevating of complement between two groups.Conclusion According to the results of meta-analyses,compared with cyclophosphamide pulse therapy,cyclophosphamide combining intravenous immunoglobulin may be more efficient in improving clinical symptoms,decreasing incidence rate of infectious diseases,and reducing relapse for SLE patients.