儿童肾移植术后激素减撤对生长和预后影响的随机对照试验Meta分析

The effect of steroid withdrawal on growth and prognosis in pediatric kidney transplantation:a meta-analysis of randomised controlled trials

目的对比激素减撤/避免与基于类固醇的免疫抑制方案在儿童肾移植受者中的安全性和有效性。方法全面检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据、维普等数据库,纳入研究儿童肾移植受者行激素减撤/避免与使用激素方案对比的文献,并用RevMan 5.4进行分析。结果最终纳入6项随机对照实验,共634例患者,其中激素减撤组320例,激素使用组314例。结果显示,激素的减撤/避免与身高的改善有关〔MD=0.39,95%CI(0.14,0.65),P<0.01〕,青春期前的患者获益更大。身高的增长在短期内并未伴随排斥反应的增加或人肾存活率的降低,长期预后同样乐观。结论在儿童肾移植受者中施行激素减撤/避免方案,对儿童的身高增长有显著改善,其中青春期前的患者受益更大。最为重要的是,从短期来看,生长发育的获益并非以急性排斥反应的增加为代价,从长期随访来看,人/肾存活率与使用激素的受者相当。

Objective To compare the safety and efficacy between steroid withdrawal/avoidance regimen and steroid-based immunosuppressive regimen in pediatric renal transplant recipients.Methods The relevant literatures of steroid withdrawal/avoidance regimen and steroid-based regimen in pediatric renal transplant recipients were searched in the databases of PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang Data and VIP.The data were evaluated by RevMan 5.4 software.Results A total of 634 patients with 6 randomized controlled trials were included,including steroid withdrawal group(n=320)and steroid-based group(n=314).The results showed significant improvement in height in steroid withdrawal/avoidance group compared with steroid-based group〔MD=0.39,95%CI(0.14,0.65),P<0.01〕,and prepuberty patients benefit more from steroid withdrawal/avoidance.The increase in height was not accompanied by an increase in rejection or a decrease in the survival rate of patients and allografts in the short term,and the long-term prognosis was also optimistic.Conclusion The steroid withdrawal/avoidance regimen in pediatric renal transplant recipients can significantly improve the growth of children's height,among which the prepuberty patients benefit more.Most importantly,the benefits of growth and development were not at the expense of an increase in acute rejection in the short term,and long-term follow-up data showed that recipient and kidney survival were comparable to those in steroid-based recipients.