系统评价巴利昔单抗诱导的无激素免疫抑制方案在肝移植中的有效性

The efficacy of basiliximab-induced steroid-free immunosuppressive regimen in liver transplantation:a systematic review

目的系统评价肝移植术后应用巴利昔单抗进行诱导的无激素免疫抑制方案的有效性。方法检索中国知网、万方、维普、PubMed、Embase、Cochrance图书馆等数据库,收集从建库至2020年12月发表的相关中英文文献,对文献进行二次筛选、质量评价及数据提取,采用RevMan 5.3软件进行Meta分析。结果共纳入10篇文献,合计1152例患者。Meta分析结果显示,与未使用巴利昔单抗且含激素免疫抑制方案比较,巴利昔单抗诱导的无激素免疫抑制方案可以显著降低肝移植患者术后的急性排斥反应发生率(OR=0.68,95%CI=0.48~0.98,P=0.04)、总感染率(OR=0.44,95%CI=0.32~0.62,P<0.001)、新发糖尿病的发生率(OR=0.11,95%CI=0.55~0.26,P<0.001)、1年内肝癌转移和复发率(OR=0.29,95%CI=0.16~0.55,P<0.001)、乙型肝炎复发率(OR=0.24,95%CI=0.08~0.76,P=0.02)以及非亚洲患者新发高血压的发生率(OR=0.22,95%CI=0.08~0.65,P=0.006),能有效提高患者术后生存率(HR=0.48,95%CI=0.36~0.64,P<0.001)。结论基于现有发表文献的数据,肝移植术后应用巴利昔单抗诱导的无激素免疫抑制方案较常规激素联合方案更有效,且相关并发症发生率更低。

Objective To systematically evaluate the efficacy of basiliximab-induced steroid-free immunosuppression after liver transplantation.Methods CNKI,Wanfang Data,VIP,PubMed,Embase,Cochrane Library were searched for Chinese and English articles published up before December 2020.Secondary screening,quality assessment and data extraction were performed,and then RevMan 5.3 were used for meta-analysis.Results A total of 10 articles with 1152 patients were included.The results showed that compared with steroid immunosuppression regimen without basiliximab,the basiliximab-induced steroid-free immunosuppression regimen could effectively decrease the incidence of postoperative acute rejections(OR=0.68,95%CI=0.48~0.98,P=0.04),total infection rate(OR=0.44,95%CI=0.32~0.62,P<0.001),de novo diabetes rate(OR=0.11,95%CI=0.55~0.26,P<0.001),recurrence and metastasis rate of liver cancer within one year(OR=0.29,95%CI=0.16~0.55,P<0.001),hepatitis B recurrence rate(OR=0.24,95%CI=0.08~0.76,P=0.02),and the incidence of new-onset hypertension in non-Asian liver transplant(OR=0.22,95%CI=0.08~0.65,P=0.006).It could effectively improve the postoperative survival rate of patients(HR=0.48,95%CI=0.36~0.64,P<0.001).Conclusion Based on the available data in the published literature,basiliximab-induced steroid-free immunosuppressive regimen after liver transplantation is more effective and has lower related complications than the conventional steroid combination regimen.