霉酚酸酯对狼疮性肾炎诱导治疗的疗效及安全系统分析的Meta

Meta-Analysis on the Efficacy and Safety of Mycophenolate Mofete in the Induction Therapy of Lupus Nephritis

摘要: 目的：在应用糖皮质激素治疗的基础上，通过与环磷酰胺对比，评价霉酚酸酯对狼疮性肾炎诱导治疗的疗效和安全。方法：通过Cochrance Library、EMBASE、PubMed、中文科技期刊全文数据库(VIP)、中国期刊全文数据库(CNKI)和万方期刊全文数据库查询相关文献，时间均从建库至2020年2月，以纳入及排除标准为依据，获得关于霉酚酸酯对狼疮性肾炎诱导治疗的随机对照试验，汇总疗效指标：临床缓解率(CR + PR)、完全缓解率(CR)和部分缓解率(PR)，安全指标：感染、白细胞减少、胃肠道反应(恶心、呕吐及腹泻)、脱发及月经紊乱。结果：共纳入20篇(中文12篇和英文8篇)，经Meta分析得出：在临床缓解率[OR = 2.37, 95%CI (1.69~3.33), P < 0.00001]及完全缓解率[OR = 1.83, 95%CI (1.38~2.44), P < 0.0001]方面，MMF组均较高于CTX组，且有统计学意义；但两组的部分缓解率[OR = 1.14, 95%CI (0.90~1.44), P = 0.29]，无统计学意义。安全指标：MMF组在感染、脱发、白细胞减少、月经紊乱及恶心、呕吐发生率方面均低于CTX组，结果提示两组差异均具有统计学意义，但在腹泻发生率方面较高。结论：MMF在狼疮性肾炎诱导阶段的治疗效果优于CTX，且不良反应发生率较低。

Abstract: Objective: On the basis of glucocorticoid therapy, the efficacy and safety of mycophenolate in induction therapy of lupus nephritis were evaluated by comparing with cyclophosphamide. Methods: Cochrance Library, PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), VIP and Wanfang database were screened about mycophenolate mofetil in induction therapy of lupus nephritis, until February 2020. The clinical remission rate (CR + PR), complete remission rate (CR) and partial remission rate (PR) were regarded as curative effect index. Infection, leukopenia, gastrointestinal reactions (nausea, vomiting and diarrhea), alopecia and menstrual disorders were regarded as safety indicators. Results: A total of 20 articles (12 in Chinese and 8 in English) were included. The clinical remission rate [OR = 2.37, 95%CI (1.69 - 3.33), P < 0.00001] and complete remission rate [OR = 1.81, 95%CI (1.43 - 2.28), P < 0.01] in MMF group were higher than those in CTX group, showing statistical significance differences. Safety indicators: The incidence of infection, leukopenia, alopecia, menstrual disorders, nausea and vomiting in MMF group were lower than that in CTX group, indicating statistically significant differences; but being higher than CTX group in the incidence of diarrhea. Conclusion: MMF is better than CTX in the induction therapy of lupus nephritis, and the incidence of adverse reactions is lower.