肾移植术后应用咪唑立宾和吗替麦考酚酯的有效性和安全性Meta分析

Efficacy and safety of mizoribine and mycophenolate mofetil after renal transplantation:a Meta-analysis

目的:评价肾移植术后应用咪唑立宾(MZR)和吗替麦考酚酯(MMF)的有效性和安全性。方法:计算机检索PubMed、OVID、EMbase、Cochrane Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普及万方数据库,纳入肾移植术后应用MZR与MMF的随机对照试验(RCT),检索时间范围为建库至2017年6月。由2位评价者按照纳入与排除标准筛选文献、提取资料并评价纳入研究的质量后,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入12项RCT研究。Meta分析结果显示:MZR组与MMF组肾移植受者术后急性排斥反应发生率、受者存活率、移植肾存活率的比较,差异无统计学意义(RR=1.21,95%CI 0.88~1.65,P=0.25;RR=1.00,95%CI 0.96~1.04,P=0.97;RR=1.00,95%CI0.96~1.04,P=0.99)。2组间不良反应发生率比较,差异无统计学意义(RR=0.82,95%CI 0.61~1.10,P=0.18),进一步亚组分析结果显示MZR较少引起胃肠道反应和肺部感染(RR=0.36,95%CI 0.19~0.71,P=0.003;RR=0.49,95%CI 0.29~0.84,P=0.009),但更易导致高尿酸血症的发生(RR=2.17,95%CI 1.69~2.78,P<0.05)。骨髓抑制、肝功能异常和巨细胞病毒感染发生率2组无显著差异(RR=0.59,95%CI 0.30~1.19,P=0.14;RR=1.42,95%CI 0.79~2.54,P=0.24;RR=0.58,95%CI 0.3~1.12,P=0.1)。结论:肾移植术后应用MZR预防排斥反应的疗效与MMF无显著差异,且较少引起胃肠道反应和肺部感染,但更易导致高尿酸血症的发生;骨髓抑制、肝功能异常和巨细胞病毒感染发生率与MMF无显著差异。

OBJECTIVE To evaluate the efficacy and safety of mizoribine and mycophenolate mofetil after renal transplantation.METHODS Databases including PubMed,OVID,EMbase,Cochrane Library,CBM,CNKI,VIP and WanFang were searched electronically for randomized controlled trials（RCTs）of mizoribine and mycophenolate mofetil after renal transplantation from the inception to June 2017.Two reviewers selected literatures according to inclusion and exclusion criteria,extracted data,and assessed the quality of the included studies.The Meta-analysis was performed using RevMan5.3 software.RESULTS A total of 12 RCTs were enrolled.The results of Meta-analysis showed that there was no significant difference between MZR group and MMF group in the incidence of acute rejection,recipient survival rate and graft survival rate（RR=1.21,95%CI0.88-1.65,P=0.25;RR=1.00,95%CI 0.96-1.04,P=0.97;RR=1.00,95%CI 0.96-1.04,P=0.99）.There was no significant difference in incidence of adverse reactions between two groups（RR=0.82,95%CI 0.61-1.10,P=0.18）,further subgroup analysis showed that MZR induced fewer gastrointestinal reaction and pulmonary infection than MMF（RR=0.36,95%CI 0.19-0.71,P=0.003;RR=0.49,95%CI 0.29-0.84,P=0.009）,but more hyperuricemia（RR=2.17,95%CI 1.69-2.78,P〈0.05）.Myelosuppression,hepatic dysfunction and cytomegalovirus infection rate showed no significant difference between two groups（RR=0.59,95%CI 0.30-1.19,P=0.14;RR=1.42,95%CI 0.79-2.54,P=0.24;RR=0.58,95%CI0.3-1.12,P=0.1）.CONCLUSION MZR and MMF have no difference when used to prevent acute rejection after renal transplantation.Moreover,MZR rarely results in less gastrointestinal reaction and pulmonary infection than MMF,but easier hyperuricemia.MZR and MMF show no significant difference in myelosuppression,hepatic dysfunction and cytomegalovirus infection rate.