霉酚酸酯与环磷酰胺比较治疗狼疮性肾炎的系统评价_《中国循证医学杂志》

作者：

李远发 ¹ , 余乔 ¹ , 於文丽 ² , 邹艳丽 ¹ , 赵磊 ³ ,  郭毅 ³

1. 武汉大学第二临床学院（武汉?430072）；2. 中南医院肾内科（武汉?430071）；3. 武汉大学公共卫生学院流行病学教研室（武汉?430072）;

关键词：

环磷酰胺霉酚酸酯狼疮性肾炎系统评价 Meta 分析随机对照试验

DOI：

10.7507/1672-2531.20110141

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价霉酚酸酯和环磷酰胺诱导缓解治疗狼疮性肾炎的疗效和安全性。
方法　计算机检索MEDLINE、EMbase、SCIE、Cochrane Library、Cochrane临床对照试验注册资料库、CBM和CNKI等数据库，查找霉酚酸酯与环磷酰胺比较治疗狼疮性肾炎的随机对照试验（检索时间均从建库至2010年8月），按纳入排除标准选择文献、评价质量和提取有效数据后，采用RevMan 5.0软件进行Meta分析。
结果　共纳入8个随机对照试验，共773例患者。 Meta分析结果显示，霉酚酸酯组总缓解率、完全缓解率高于环磷酰胺组［OR=1.49，95%CI（1.10，2.02）；OR=1.67，95%CI（1.08，2.57）］，但两组在部分缓解率、完成诱导治疗比例方面差异无统计学意义。两组在药物不耐受比例、感染和白细胞减少发生率方面差异无统计学意义，但霉酚酸酯组腹泻的发生率高于环磷酰胺组，差异有统计学意义［OR=2.99，95%CI（1.87，4.78）］。Ⅳ型狼疮性肾炎患者的Meta分析结果也显示了相似的结果。
结论　霉酚酸酯治疗狼疮性肾炎患者（Ⅲ型、Ⅳ型、Ⅴ型）的总诱导缓解疗效优于环磷酰胺，但腹泻发生率高于环磷酰胺。

引用本文： 李远发,余乔,於文丽,邹艳丽,赵磊,郭毅. 霉酚酸酯与环磷酰胺比较治疗狼疮性肾炎的系统评价. 中国循证医学杂志, 2011, 11(7): 826-834. doi: 10.7507/1672-2531.20110141 复制

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3.	Kang I, Park SH. Infectious complications in SLE after immunosuppressive therapies. Curr Opin Rheumatol , 2003, 15(5): 528-534.
4.	Cunha I, Saavedra MJ, Pereira SD, et al . Cyclophosphamide induced amenorrhoea in pre-menopausal women with systemic lupus erythematosus. Acta Reumatol Port , 2008, 33(1): 69-76.
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7.	Contreras G, Pardo V, Leclercq B, et al . Sequential therapies for proliferative lupus nephritis. N Engl J Med , 2004, 350(10): 971-980.
8.	Appel GB, Contreras G, Dooley MA, et al . Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol , 2009, 20(5): 1103-1112.
9.	Ginzler EM, Dooley MA, Aranow C, et al . Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med , 2005, 353(21): 2219-2228.
10.	Hochberg MC. Updating the american college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum , 1997, 40(9): 1725.
11.	Straus SE. Evidence-based medicine : how to practice and teach EBM.. 3rd ed. Beijing: 北京大学医学出版社, 2005: 127.
12.	Ong LM, Hooi LS, Lim TO, et al . Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis. Nephrology (Carlton) , 2005, 10(5): 504-510.
13.	Chan TM, Li FK, Tang CS, et al . Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group. N Engl J Med , 2000, 343(16): 1156-1162.
14.	Wang J, Hu W, Xie H, et al . Induction therapies for class IV lupus nephritis with non-inflammatory necrotizing vasculopathy:mycophenolate mofetil or intravenous cyclophosphamide. Lupus , 2007, 16(9): 707-712.
15.	Hu W, Liu Z, Chen H, et al . Mycophenolate mofetil vs cyclophosphamide therapy for patients with diffuse proliferative lupus nephritis. Chin Med J (Engl) , 2002, 115(5): 705-709.
16.	Chan TM, Tse KC, Tang CS, et al . Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol , 2005, 16(4): 1076-1084.
17.	El-shafey EM, Abdou SH. Is mycophenolate mofetil superior to pulse intravenous cyclophosphamide for induction therapy of proliferative lupus nephritis in egyptian patients? Clin Exp nephrol , 2010, 14(3): 214-221.
18.	Lee YH, Woo JH, Choi SJ, et al . Induction and Maintenance Therapy for Lupus Nephritis: a Systematic Review and meta-Analysis. Lupus , 2010, 19(6): 703-710.
19.	徐云芬. 霉酚酸酯在狼疮性肾炎诱导及维持治疗中疗效的系统评价和Meta分析. 浙江大学硕士论文, 2010．.
20.	齐华林, 江薇, 严海东. 霉酚酸酯治疗增殖性狼疮性肾炎的Meta分析. 肾脏病与透析肾移植杂志, 2007, 16(5): 426-434.
21.	殷蕾, 周纬, 金燕樑, 等. 环磷酰胺与霉酚酸酯治疗狼疮性肾炎疗效比较的系统评价. 临床儿科杂志, 2008, 26(1): 69-72.
22.	Wilson EC, Jayne DR, Dellow E, et al . The cost-effectiveness of mycophenolate mofetil as firstline therapy in active lupus nephritis. Rheumatology (Oxford) , 2007, 46(7): 1096-1101.

1. 1 Waldman M, Appel GB. Update on the treatment of lupus nephritis. Kidney Int , 2006, 70(8): 1403-1412.
2. Contreras G, Pardo V, Cely C, et al . Factors associated with poor outcomes in patients with lupus nephritis. Lupus , 2005, 14(11): 890-895.
3. Kang I, Park SH. Infectious complications in SLE after immunosuppressive therapies. Curr Opin Rheumatol , 2003, 15(5): 528-534.
4. Cunha I, Saavedra MJ, Pereira SD, et al . Cyclophosphamide induced amenorrhoea in pre-menopausal women with systemic lupus erythematosus. Acta Reumatol Port , 2008, 33(1): 69-76.
5. Martin F, Lauwerys B, Lefèbvre C, et al . Side-effects of intravenous cyclophosphamide pulse therapy. Lupus , 1997, 6(3): 254-257.
6. Cross J, Dwomoa A, Andrews P, et al . Mycophenolate mofetil for remission induction in severe lupus nephritis. Nephron Clin Pract , 2005, 100(3): c92-100.
7. Contreras G, Pardo V, Leclercq B, et al . Sequential therapies for proliferative lupus nephritis. N Engl J Med , 2004, 350(10): 971-980.
8. Appel GB, Contreras G, Dooley MA, et al . Mycophenolate mofetil versus cyclophosphamide for induction treatment of lupus nephritis. J Am Soc Nephrol , 2009, 20(5): 1103-1112.
9. Ginzler EM, Dooley MA, Aranow C, et al . Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med , 2005, 353(21): 2219-2228.
10. Hochberg MC. Updating the american college of rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum , 1997, 40(9): 1725.
11. Straus SE. Evidence-based medicine : how to practice and teach EBM.. 3rd ed. Beijing: 北京大学医学出版社, 2005: 127.
12. Ong LM, Hooi LS, Lim TO, et al . Randomized controlled trial of pulse intravenous cyclophosphamide versus mycophenolate mofetil in the induction therapy of proliferative lupus nephritis. Nephrology (Carlton) , 2005, 10(5): 504-510.
13. Chan TM, Li FK, Tang CS, et al . Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. Hong Kong-Guangzhou Nephrology Study Group. N Engl J Med , 2000, 343(16): 1156-1162.
14. Wang J, Hu W, Xie H, et al . Induction therapies for class IV lupus nephritis with non-inflammatory necrotizing vasculopathy:mycophenolate mofetil or intravenous cyclophosphamide. Lupus , 2007, 16(9): 707-712.
15. Hu W, Liu Z, Chen H, et al . Mycophenolate mofetil vs cyclophosphamide therapy for patients with diffuse proliferative lupus nephritis. Chin Med J (Engl) , 2002, 115(5): 705-709.
16. Chan TM, Tse KC, Tang CS, et al . Long-term study of mycophenolate mofetil as continuous induction and maintenance treatment for diffuse proliferative lupus nephritis. J Am Soc Nephrol , 2005, 16(4): 1076-1084.
17. El-shafey EM, Abdou SH. Is mycophenolate mofetil superior to pulse intravenous cyclophosphamide for induction therapy of proliferative lupus nephritis in egyptian patients? Clin Exp nephrol , 2010, 14(3): 214-221.
18. Lee YH, Woo JH, Choi SJ, et al . Induction and Maintenance Therapy for Lupus Nephritis: a Systematic Review and meta-Analysis. Lupus , 2010, 19(6): 703-710.
19. 徐云芬. 霉酚酸酯在狼疮性肾炎诱导及维持治疗中疗效的系统评价和Meta分析. 浙江大学硕士论文, 2010．.
20. 齐华林, 江薇, 严海东. 霉酚酸酯治疗增殖性狼疮性肾炎的Meta分析. 肾脏病与透析肾移植杂志, 2007, 16(5): 426-434.
21. 殷蕾, 周纬, 金燕樑, 等. 环磷酰胺与霉酚酸酯治疗狼疮性肾炎疗效比较的系统评价. 临床儿科杂志, 2008, 26(1): 69-72.
22. Wilson EC, Jayne DR, Dellow E, et al . The cost-effectiveness of mycophenolate mofetil as firstline therapy in active lupus nephritis. Rheumatology (Oxford) , 2007, 46(7): 1096-1101.

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霉酚酸酯与环磷酰胺比较治疗狼疮性肾炎的系统评价

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