他克莫司联合小剂量激素治疗成人难治性肾病疗效及安全性的系统评价

Effectiveness and safety of tacrolimus combined with small dose of prednisone for refractory nephrotic syndrome in adults:A Systematic Review

目的系统评价他克莫司(TAC)联合小剂量激素治疗成人难治性肾病的疗效和安全性。方法计算机检索中国知网(CNKI)、维普、万方、Medline、PubMed、The Cochrane Library、Embase、Up To Date数据库,时限为建库至2014年12月,同时手工检索相关杂志及研究资料,查找TAC联合小剂量激素治疗成人难治性肾病的随机对照试验(RCT),由2名评价者独立筛选文献、提取资料、评价质量并交叉核对,采用RevMan5.2进行Meta分析。结果共纳入11个研究,593例成人难治性肾病患者,Meta分析结果显示总缓解率:TAC+激素(Pred)组优于对照组[OR=2.16,95%CI(1.48,3.14),P<0.01],总体不良反应:TAC+Pred组不良反应发生率低于对照组[OR=0.35,95%CI(0.18,0.68),P<0.01]。结论 TAC联合小剂量激素可提高成人难治性肾病的总缓解率,降低总体不良反应发生率,基于研究的局限性,仍需高质量的临床RCT进一步论证。

Objective To systematically evaluate the effectiveness and safety of Tacrolimus combined with small dose of prednisone for refractory nephrotic syndrome in adults.Methods Databases including CNKI,Wan Fang Data,VIP,Medline,PubMed,The Cochrane Library,Embase,Up To Date,were searched from beginning of the database to December 2014,and the relevant magazines and information were also searched manually.All randomized controlled trials on refractory nephrotic syndrome in adults were independently collected and evaluated by two reviewers,the meta-analysis was performed using RevMan5.2.Results 11 trials involving 593 patients with refractory nephrotic syndrome of adults were included.The results of meta-analysis showed the total remission：the TAC＋ Pred group was higher than the control group[OR =2.16,95%CI（1.48,3.14）,P〈0.01].Adverse reaction：the incidence rate of adverse reaction in the TAC＋Pred group was lower than the control group[OR =0.35,95%CI（0.18,0.68）,P〈0.01].Conclusion Tacrolimus combined with small dose of prednisone in treating refractory nephrotic syndrome of adults can increase the total remission,decrease the incidence rate of adverse reaction.Based on the limitation of the study,it is necessary to carry out more high-quality clinical RCTs.