吗替麦考酚酯治疗系统性硬化症相关间质性肺病疗效的Meta分析

Efficacy of mycophenolate mofetil for treatment of systemic sclerosis related interstitial lung disease by Meta-analysis

目的:利用Meta分析对吗替麦考酚酯治疗系统性硬化症相关间质性肺病的疗效进行系统评价。方法:检索Cochrane Library、PubMed、EmBase、中国期刊全文数据库等相关数据库,对符合纳入标准的临床研究进行资料提取,采用Rev Man 5.3软件进行Meta分析。结果:本文纳入11项研究,共323例病例,治疗前基线肺功能与治疗后肺功能参数差异无统计学意义,用力肺活量(FVC)%pred:加权平均差(MD)=3.19,95%CI:-0.61~6.99,P=0.10;一氧化碳弥散量(DLCO)%pred:MD=-0.62,95%CI:-4.46~3.23,P=0.75;肺活量(VC)%pred:MD=5.59,95%CI:-4.22~15.40,P=0.26。第1秒用力呼气量(FEV1)%pred:MD=4.95,95%CI:-12.69~22.59,P=0.58。3项研究对比了吗替麦考酚酯与环磷酰胺的疗效,两药物治疗组间治疗前后FVC改变量无统计学差异(MD=0.28,95%CI:-0.10~0.66,P=0.15)。结论:吗替麦考酚酯用于治疗系统性硬化症相关间质性肺病可阻止肺功能恶化,使肺功能维持在基线水平,与环磷酰胺相比,疗效相似,耐受性更好,不良反应发生率及严重程度更低,可作为新的治疗药物。

Objective:Meta-analysis was performed to evaluate clinical efficacy of mycophenolate mofetil in treatment of systemic sclerosis-related interstitial lung disease.Methods:Cochrane Library,PubMed,EmBase database,Chinese Journal Full-text Database were searched,data were extracted from clinical studies that met inclusion criteria,and Meta analysis was performed by RevMan 5.3 software.Results:A total of 11 studies involving 323 patients were included.No statistical difference was observed in lung function tests before and after treatment.Forced vital capacity(FVC)%of pred weighted mean difference(MD)=3.19,95%CI:-0.61-6.99,P=0.10,diffusion capacity for carbon monoxide(DLCO)%pred MD=-0.62,95%CI:-4.46-3.23,P=0.75,vital capacity(VC)%pred MD=5.59,95%CI:-4.22-15.40,P=0.26,forced expiratory volume in first second(FEV1)%pred MD=4.95,95%CI:-12.69-22.59,P=0.58.No significant difference was found in FVC after treatment between mycophenolate mofetil and cyclophosphamide(MD=0.28,95%CI:-0.10-0.66,P=0.15).Conclusion:Mycophenolate mofetil for treatment of systemic sclerosis related interstitial lung disease contributes to stability of lung function and prevents its deterioration.Compared with cyclophosphamide,mycophenolate mofetil has similar efficacy,better tolerance,lower incidence and lower severity of adverse reactions,which may be used as a new treatment drug.