他克莫司联合糖皮质激素治疗狼疮肾炎的疗效分析:一项Meta分析

Efficacy of tacrolimus plus glucocorticoid for lupus nephritis:a Meta-analysis

目的狼疮肾炎(lupus nephritis,LN)是系统性红斑狼疮患者常见且严重的器官受累,免疫抑制剂治疗可以明显改善患者肾功能结局。本研究旨在评估他克莫司联合糖皮质激素治疗对LN患者的影响,为临床医生研究及治疗LN提供理论依据。方法检索PubMed、EMBASE、CochraneLibrary、中国知网、万方医学网、维普资讯中文期刊服务平台等中英文数据库,截至时间至2023年2月。使用Review Manager及Sata软件进行系统分析。连续性变量使用选择标准化均数差(SMD)及其95%CI作为其统计量,二分类变量使用相对风险(RR)及其95%CI作为其统计量。对纳入文献使用Cochrane的偏倚风险工具评估符合条件研究的偏倚和风险。结果最终共纳入12篇文献,共计1360例LN患者。他克莫司联合糖皮质激素治疗与对照组对比,可以显著改善患者部分缓解率(RR值为1.33,P=0.02)、有效率(RR值为1.28,P<0.001)、肌酐水平(SMD值为-1.12,P=0.0009)、24 h尿蛋白定量水平(SMD值为-1.88,P<0.001)及尿素氮水平(SMD值为-0.94,P=0.006),且未增加胃肠道不适、肝功能异常及感染等不良反应的发生。结论他克莫司联合糖皮质激素治疗有助于改善LN患者的肾功能结局。

Objective Lupus nephritis(LN)is the most common and serious organ involvement in patients with systemic lupus erythematosus.Immunosuppressant therapy can significantly improve the renal function outcome of patients.The purpose of this study is to evaluate the effect of tacrolimus combined with glucocorticoid on LN patients and provide theoretical rationales for managing LN.Methods Such Chinese and English databases as PubMed,EMBASE,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang Medical Network and VIP Information Chinese Periodical Service Platform were searched until February 2023.Review Manager and Sata software were employed for system analysis.For continuous variables,standardized mean difference(SMD)and its 95%CI were used.And relative risk(RR)and its 95%CI were employed for binary variables.Cochrane's bias risk tool was utilized for evaluating the bias and risks of eligible studies.Results A total of 12 articles involving 1360 LN patients were finally included.As compared with control group,tacrolimus plus glucocorticoid could significantly improve the partial remission rate(RR value of 1.33,P=0.02),effective rate(RR value of 1.28,P<0.001),creatinine level(SMD value of−1.12,P=0.0009)and 24-hour urine protein level(SMD of−1.88,P<0.001).And it did not elevate the occurrence of gastrointestinal discomfort,liver dysfunction or infection.Conclusion Tacrolimus plus glucocorticoid therapy helps to improve renal function outcomes of LN patients.