双重滤过血浆置换联合药物治疗重症狼疮性肾炎的临床效果以及安全性的Meta分析

Meta-analysis of clinical effect and safety of double filtration plasmapheresis combined with drugs in the treatment of severe lupus nephritis

目的评价双重滤过血浆置换(DFPP)联合药物治疗重症狼疮性肾炎(LN)的临床效果以及安全性。方法对PubMed、Cochrane Library、Embase、CNKI、VIP、万方、中国生物医学文献数据库进行计算机检索,检索时间为建库至2022年1月31日。收集DFPP联合糖皮质激素(GCs)和/或免疫抑制剂(ISA)治疗重症LN的随机对照试验、队列研究,采用Review Manager 5.4统计学软件对文献的临床缓解率、抗双链DNA(dsDNA)抗体转阴率、抗磷脂抗体转阴率、不良反应发生率进行Meta分析。结果共纳入10篇文献,总计537例重症LN患者。Meta分析结果显示,与单纯药物治疗比较,DFPP联合药物治疗在提升临床缓解率[OR=3.37,95%CI(1.87,6.08),P<0.0001]、抗dsDNA抗体转阴率[OR=2.08,95%CI(1.09,4.00),P=0.03]、抗磷脂抗体转阴率[OR=8.47,95%CI(3.90,18.41),P<0.00001]方面有着明显的优势,但证据不足以证明DFPP增加不良反应发生率[RD=0.03,95%CI(-0.04,0.10),P=0.35]。结论DFPP联合药物治疗重症LN安全、有效,但纳入的文献总体质量不高,仍需要高质量、大样本、多中心的临床试验来进一步证实。

Objective To evaluate the clinical effect and safety of double filtration plasmapheresis(DFPP)combined with drugs in the treatment of severe lupus nephritis(LN).Methods The PubMed,Cochrane Library,Embase,CNKI,VIP,Wanfang and Chinese biological and medical database were searched by computer,and the search time was from inception to 31 January 2022.The literatures of randomized controlled trials and cohort studies of DFPP combined with glucocorticoids(GCs)and/or immunosuppressive agent(ISA)in the treatment of severe LN were collected.The clinical remission rate,negative conversion rate of anti-double stranded DNA(dsDNA)antibody,negative conversion rate of antiphospholipid antibody and incidence of adverse reactions were given Meta analysis by Review Manager 5.4 statistical software.Results A total of 10 literatures were included,with a total of 537 patients with severe LN.Meta-analysis results showed that compared with drug therapy alone,DFPP combined with drug therapy had obvious advantages in improving the clinical remission rate[OR=3.37,95%CI(1.87,6.08),P<0.0001],negative conversion rate of anti-dsDNA antibody[OR=2.08,95%CI(1.09,4.00),P=0.03],and negative conversion rate of antiphospholipid antibody[OR=8.47,95%CI(3.90,18.41),P<0.00001];however,the evidence was insufficient to prove that DFPP increased the incidence of adverse reactions[RD=0.03,95%CI(-0.04,0.10),P=0.35].Conclusion DFPP combined with drugs is safe and effective in the treatment of severe LN,but the overall quality of the included literature is not high,which still needs to be further confirmed by high-quality,large sample and multi center clinical trials.