肾移植术后TOR-I替代CNI免疫抑制治疗的Meta分析

Meta-analysis of Immunosuppressive Therapy with Target-of-rapamycin Inhibitor Instead of Calcineurin Inhibitor after Kidney Transplantation Operation

目的:评价肾移植术后雷帕霉素靶位抑制剂(TOR-I)替代钙调蛋白抑制剂(CNI)免疫抑制治疗的疗效和安全性。方法:检索Cochrane图书馆及Medline、Embase、SCI、CBM数据库和其他相关文献,对纳入研究进行方法学质量评价和Meta分析。结果:纳入10个随机对照试验,3个A级、7个B级。Meta分析结果显示,2组急性排斥反应和肾小球滤过率差异有统计学意义:RR=1.65,95%CI[1.42,1.93]和WMD=8.04,95%CI[2.45,13.62],患者存活率和移植物存活率差异无统计学意义:RD=-0.00,95%CI[-0.02,0.02]和RD=-0.01,95%CI[-0.04,0.01]。结论:基于当前证据,TOR-I对比CNI在肾移植术后免疫抑制治疗中能提高肾小球滤过率,降低巨细胞病毒感染发生率,不影响患者存活率与移植物存活率;但增加了急性排斥反应发生率和贫血、高胆固醇血症、高甘油三酯血症发生风险。

OBJECTIVE： To evaluate the efficacy and safety of target-of-rapamycin inhibitor （TOR-I） instead of calcineurin inhibitor （CNI） for kidney transplant recipients. METHODS： Retrieved from Cochrane Library, Medline, Embase, SCI, CBM databases and relevant journals, methodological quality evaluation and Meta-analysis of included studies were conducted. RESULTS： i0 RCTs were included, 3 were grade A and 7 grade B. Results of Meta-analysis showed that there were significant differences in acute rejection and GFR between two groups： RR=l.65, 95%CI [1.42, 1.93] and WMD-=-8.04, 95%CI [2.45, 13.62]; there were no significant differences in survival rate of patients and transplants： RD = - 0.00, 95 % CI [-0.02,0.02] and RD = - 0.01, 95 % CI [-0.04, 0.01]. CONCLUSION： According to current evidence, TOR-I could increase GFR, reduce CMV infection and does not decrease survival rate of patients and transplants, compared with CNI. But it increases the incidence of acute rejection, anemia, hypercholesterolemia and hypertriglyceridemia.