吗替麦考酚酯对比环磷酰胺治疗狼疮性肾炎的有效性和安全性的系统评价

Effectiveness and Safety of Mycophenolate Mofetil versus Cyclophosphamidemofetil in the Treatment of Lupus Nephritis:A Systematic Evaluation

目的:系统评价吗替麦考酚酯(MMF)对比环磷酰胺(CYC)治疗狼疮性肾炎(LN)的有效性和安全性,以为临床提供循证参考。方法:计算机检索PubMed、Medline、Cochrane图书馆、EMBase、中国期刊全文数据库(CNKI)、维普中文科技期刊数据库、万方数据库中有关MMF治疗LN的随机对照试验(RCT),采用Rev Man 5.0统计软件进行Meta分析。结果:共纳入9项RCT,合计846例患者。Meta分析显示,MMF组患者的缓解率[OR=1.72,95%CI(1.12,2.62),P=0.01]和完全缓解率[OR=1.66,95%CI(1.12,2.46),P=0.01]显著高于CYC组;两组患者死亡率比较,差异无统计学意义[OR=0.72,95%CI(0.38,1.35),P=0.30];MMF组月经不调发生率显著低于CYC组[OR=0.36,95%CI(0.17,0.74),P=0.005]。结论:MMF治疗LN的疗效优于CYC,安全性与CYC相当。由于纳入研究质量不高、样本量较小,该结论尚需高质量、大样本且长时间随访的RCT进一步验证。

OBJECTIVE：To systematically evaluate the effectiveness and safety of mycophenolate mofetil（MMF）and cyclophosphamide（CYC）for lupus nephritis（LN）,and to provide reference for evidence-based reference for the clinic. METHODS：Retrieved from PubMed,Medline,Cochrane Library,EMBase,CNKI,VIP and Wanfang database,RCT about MMF in the treatment of LN were collected;Meta-analysis was conducted by using RevMan5.0 software. RESULTS：A total of 9 RCT were included,involving 846 patients. Meta-analysis showed that remission rate [OR=1.72,95%CI（1.12,2.62）,P=0.01] and complete remission rate [OR=1.66,95%CI（1.12,2.46）,P=0.01] were significantly higher for MMF than for CYC;there was no statistically significant difference in death rate between CYC and MMF [OR=0.72,95%CI（0.38,1.35）,P=0.30]. The incidence of irregular menses in MMF group was significantly lower than in CYC group [OR=0.36,95% CI（0.17,0.74）,P=0.005]. CONCLUSIONS：MMF is superior to CYC for the treatment of LN but its safty is lower than CYC. Due to low-quality and small-scale of included studies,more high-quality and large-scale RCT are required for further validation.