程序性活检在肾移植受者中的应用

Utility of protocol biopsy in renal recipients:Meta analysis and systematic review

目的:通过Meta分析及系统性评价的方法为程序性活检在肾移植受者中的应用价值提供循证医学依据。方法:采用电子检索进行文献初检,电子检索数据库有Medline数据库、Embase和Cochrane图书馆。纳入涉及程序性活检在肾移植受者中应用的随机对照研究(RCT),数据由两名作者独立提取,纳入研究的偏倚风险采用Cochrane协作网推荐的偏倚风险评估工具进行评估,使用Cochrane协作网提供的专用RevMan5.0软件进行统计数据分析。结果:纳入5篇关于程序性活检在肾移植受者中的应用的RCT。在程序性活检对肾移植受者移植肾存活率、肾功能的影响进行了Meta分析,并从文献中提取亚临床排异、钙调神经蛋白抑制剂(CNI)中毒、BK病毒相关性肾病、程序性活检的不良反应及患者对程序性活检的顺应性等的发病学资料进行合并分析。Meta分析的结果提示:程序性活检可提高移植肾存活率,降低移植肾丢失率(RR 0.43,95%CI 0.26~0.70,P<0.001)。程序性活检可使血清肌酐降低38.21μmol/L(95%CI 54.83~21.60,P<0.001)。结论:程序性活检可发现亚临床阶段的排异反应、BK病毒感染、CNI中毒等疾病。对这些疾病的发现和及时干预可提高移植肾存活率。程序性活检可能提高长期肾功能,尤其是以环孢素为主要基础免疫抑制剂的患者。程序性活检严重不良反应发生率较低,可以认为是一个比较安全的临床措施。

Objective： To evaluate the value of protocol biopsy in patients after renal transplantation. Methodology： Searches were applied to the following electronic database： Medline, Embase Database, and Cochrane Library. Randomized controlled trials evaluating the value of protocol biopsy for renal allograft recipients were included. Data were extracted independently by two reviewer. The risk of bias of included studies was assessed by the the Cochrane collaboration＇s tool for assessing risk of bias. Statistical analysis were performed with Ravman 5. 0. Results： 5 RCTs were included. Long term graft loss was significantly reduced （ RR 0. 43,95% CI 0. 26 to 0. 70, P 〈 0. 001 ） by protocol biopsy after renal transplantation. Protocol biopsy may reduce the long term serum creatinine （WMD 38. 21 p, mol/L, 95% CI 54. 83 to 21.60,P〈0. 001）. For renal recipients whose basal immunosuppression was CNI （ tacrolimus or cyclosporine）. However, for those whose basa/immunosuppression was tacrolimus, this effect was not notable. Conclusion： Treatment of subclinical changes detected by protocol biopsy could significantly improve the graft survival and might improve the allograft function. The incidence of main complication of protocol biopsy was rare.