阿来佐单抗对肾移植后急性排斥反应和移植肾存活率影响的荟萃分析

Meta-analysis on the effect of Aiemtuzumab on renal graft rejection and survival

目的探讨阿来佐单抗对肾移植后急性排斥反应（AR）和移植‘肾存活率的影响。方法搜集国内外关于阿来佐单抗用于预防肾移植后AR的随机对照试验，对符合纳入标准的文献进行荟萃分析。评价疗效及差异的指标采用比值比（OR）及其95％可信区间（cI）。采用RevMan5．1软件进行统计学分析。结果共有国内外9个随机对照研究符合纳入标准。荟萃分析结果显示，阿来佐单抗具有良好的抗AR作用，术后半年阿来佐单抗组的AR发生率比对照组低55．5％（OR=0．37，95％CI为0．24～0．58，P〈0．01），术后1年阿来佐单抗组的AR发生率比对照组低51．1％（OR=0．43，95％CI为o．29～0．64，P〈O．01），术后2年阿来佐单抗组的AR发生率比对照组低28．2％（OR：0．69，95％CI为0．47～1．02，P〈0．01）。阿来佐单抗组的移植肾存活率与对照组比较，差异无统计学意义（0R=1．18，95％CI为0．76～1．85，P=0．46），阿来佐单抗组的受者存活率与对照组比较，差异无统计学意义（0R=0．94，95％CI为0．52～1．72，P：0．85）。结论阿来佐单抗对肾移植后AR具有明显的预防作用，但对术后移植肾和受者的存活率无明显影响。

Objective To study the effect of Alemtuzumab on acute rejection （AR） and graft survival after kidney transplantatiola. Method Published domestic and foreign literatures regarding the effects of Alemtuzumab used on acute rejection and graft survival were reviewed, and Meta analysis was employed to analyze the Results. Odds ratio （OR） and its 95 % confidence interval （95 % CI） were used as the parameters to evaluate the therapeutic effects. The statistical analyses were performed with RevMan 5.1 software. Result A total of 9 pertinent research articles were reviewed. Meta-analysis of pooled results indicated that Alemtuzumab prevented the recipients of kidney transplantation from acute rejection effectively with half year prevention of OR 0. 37 and 95% CI 0. 24- 0. 58 （P〈0. 01）, one year prevention of OR 0. 43 and 95% CI 0. 29-0. 64 （P〈0. 01）, and two year prevention of OR 0. 69 and 95% CI 0. 47-1.02 （P 〈 0. 01）, respectively. It was revealed that Alemtuzumab could reduce the incidence of acute rejection by 55% in half year, 51% in one year and 28% in two years, respectively. No statistically significant difference in graft survival was found between Alemtuzumab group and control group （OR = 1.18, 95% CI 0. 76-1.85, P = 0. 46）. No statistically significant difference in patients＂ survival was found between Alemtuzumab group and control group （OR = 0. 94, 95% CI 0. 52-1.72,P = 0. 85）. Conclusion Alemtuzumab may effectively prevent the recipients of kidney transplantation from acute rejection, but not obviously influence the graft and patient survival.