利妥昔单抗治疗难治性肾病综合征疗效的Meta分析

A meta-analysis of the efficacy of rituximab in the treatment of refractory nephrotic syndrome

目的系统评价利妥昔单抗对于难治性肾病综合征的有效性。方法通过检索EMBASE、Cochrane library、Pubmed、CNKI、万方和维普数据库,依据纳入标准及排除标准筛选利妥昔单抗治疗难治性肾病综合征的临床试验文献,检索时间从数据库建库至2020年1月,由2名评价者对文献进行筛选及质量评价,采用Review Manager 5.3软件进行Meta分析。结果一共纳入7篇文献,共409例患者。Meta分析结果显示,利妥昔单抗治疗难治性肾病综合征的患者缓解率高于对照组[RR=1.68,95%CI(1.16,2.42),P<0.05],且能够有效升高患者血清白蛋白(SMD=0.80,95%CI 0.27~1.34,P<0.05],但是对于患者尿蛋白[SMD=-0.71,95%CI(-1.45,0.03),P>0.05]、血肌酐[SMD=0.18,95%CI(-0.20,0.56),P>0.05]、估算肾小球滤过率[SMD=0.05,95%CI(-0.72,0.82),P>0.05]无明显改善效果。结论利妥昔单抗对难治性肾病综合征有一定作用,可以成为难治性肾病综合征的替代药物,但是其疗效仍需更多高质量临床试验的证实。

Objective To systematically evaluate the efficacy of rituximab in the treatment of refractory nephrotic syndrome by meta-analysis.Methods This study searched the databases of PubMed,EMBASE,Cochrane Library,CNKI,WanFang and VIP to collect the clinical randomized controlled trials of rituximab in the treatment of refractory nephrotic syndrome.And the retrieval time was from the establishment of the database to January 2020.After the inclusion and exclusion criteria were jointly formulated by two evaluators,the literature was screened independently and the quality evaluated.Review Manager 5.3 software was utilized for meta-analysis.Results A total of 7 studies involving 409 subjects were retrieved.The results of meta-analysis showed that rituximab elevating serum albumin[SMD=0.80,95%CI(0.27,1.34),P<0.05]was superior to control group and the remission rate[RR=1.68,95%CI(1.16,2.42),P<0.05]was better than control group.As compared with control group,there was no significant effect on relieving urinary protein[SMD=-0.71,95%CI(-1.45,0.03),P>0.05],serum creatinine[SMD=0.18,95%CI(-0.20,0.56),P>0.05]or eGFR[SMD=0.05,95%CI(-0.72,0.82),P>0.05].Conclusions Rituximab can effectively alleviate refractory nephrotic syndrome and elevate serum albumin.However,due to limited inclusion studies,the above conclusions should be verified by more high-quality studies.