• 1. 四川大學華西醫(yī)院腎病內(nèi)科（成都 610041） 2. 瀘州醫(yī)學院消化內(nèi)科（瀘州 646000） 3. 瀘州醫(yī)學院腎病內(nèi)科（瀘州 646000）;

目的 　評價在糖皮質(zhì)激素基礎上使用霉酚酸酯治療增生性狼瘡腎炎的有效性和安全性。
方法 　計算機檢索中國生物醫(yī)學文獻光盤數(shù)據(jù)庫（1979.11～2006.2）、中國循證醫(yī)學/ Cochrane 中心數(shù)據(jù)庫（2005年）、Cochrane圖書館臨床對照試驗資料庫（2005年第4期）、MEDLINE（1966.11～2006.2）、EMbase（1975～2006.2）和SCI（1985～2006.2）等數(shù)據(jù)庫，收集霉酚酸酯治療增生性狼瘡腎炎的隨機對照試驗, 對納入研究的方法學質(zhì)量進行評價。選擇臨床總有效率及完全緩解率作為近期療效指標，腎臟存活率、患者生存率及狼瘡腎炎復發(fā)率作為遠期療效指標，治療期及隨訪期發(fā)生感染、閉經(jīng)、白細胞減少、腹瀉等副作用的患者比例作為安全性評價指標，提取數(shù)據(jù)并采用Cochrane 協(xié)作網(wǎng)推薦的RevMan 4.2.7軟件進行統(tǒng)計分析。
結(jié)果 　共檢索到符合納入標準的隨機對照試驗9篇（512例）。對近期療效指標的Meta分析結(jié)果顯示，霉酚酸酯與環(huán)磷酰胺/硫唑嘌呤比較治療臨床療效差異無統(tǒng)計學意義。腎臟存活率、腎病復發(fā)率的Meta分析結(jié)果顯示，霉酚酸酯與環(huán)磷酰胺/硫唑嘌呤比較,其臨床療效差異無統(tǒng)計學意義。遠期療效指標和安全性評價各項指標的Meta分析提示，霉酚酸酯優(yōu)于環(huán)磷酰胺/硫唑嘌呤。
結(jié)論 　霉酚酸酯在改善增生性狼瘡腎炎患者的近期療效、腎臟存活率及防止腎病復發(fā)方面并不優(yōu)于目前常規(guī)的環(huán)磷酰胺/硫唑嘌呤治療，但在提高患者生存率及藥物安全性方面可能優(yōu)于后者。由于本系統(tǒng)評價納入文獻的方法學質(zhì)量不夠高，加之例數(shù)有限，尚需開展多中心、大樣本隨機雙盲試驗進一步證實霉酚酸酯的療效和安全性。

引用本文： 歐三桃,鐘利春,杜 新,黃頌敏,劉 琦,趙安菊,陳澤君. 霉酚酸酯治療增生性狼瘡腎炎的系統(tǒng)評價. 中國循證醫(yī)學雜志, 2006, 06(10): 712-720. doi: 復制

1. 蔣文功, 肖笑, 方敬愛. 霉酚酸酯治療彌漫增生性狼瘡腎炎的臨床觀察. 中國中西醫(yī)結(jié)合腎病雜志, 2002; 3(4): 218–221.
2. 劉國平, 黃九香, 林琳. 霉酚酸酯對彌漫增生型狼瘡性腎炎患者的療效觀察. 中國中西醫(yī)結(jié)合腎病雜, 2003; 4(7): 386~388.
3. 張江林, 張火亙, 馬麗等. 嗎替麥考酚酯治療系統(tǒng)性紅斑狼瘡的多中心前瞻性研究. 中華風濕病學雜志, 2002; 6(6): 406~410.
4. 朱彬, 周振安, 劉子棟, 等. 霉酚酸酯與環(huán)磷酰胺治療IV型狼瘡性腎炎的療效比較. 山東大學學報 (醫(yī)學版), 2003; 41(6): 692~694.
5. Boumpas DT, Austin HA III, Vaughn EM, et al. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis.Lancet, 1992; 340: 741–745.
6. Dooley MA, Cosio FG, Nachman PH, et al. Mycophenolate mofetil therapy in lupus nephritis: clinical observations. J Am Soc Nephml, 1999;10(4): 833–839.
7. Tan EM, Cohen AS, Fries JF, et al. The1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum, 1982; 25: 1271–1277.
8. Egger M, Smith GD, Altman DG. Systematic Reviews in Heath Care. London: Tavistock Square, Second edition, 2001. 73-78.
9. Jadad AR ,Moore A ,Carrol D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary. Control Clin Trials, 1996 ; 17: 1–12.
10. Cochrane Reviewer’s Handbook 4.2.2. The Cochrane Collaboration, 2000.
11. Schulz KF, Chalmers I, Hayes RJ. Empirical evidence of bias .JAMA, 1995; 273: 408–412.
12. Chan TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. N Engl J Med, 2000; 343(16): 1156–1162.
13. 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.
14. Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med, 2004; 350(10): 971–980.
15. Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Eng J Med, 2005; 353(21): 2219–2228.
16. Jiang WG,Xiao X,Fang JA. Eff icacy of Mycophenolate Mofetil in Patients with Diffuse Prol -iferative Lupus Nephritis. Chinese Journal of Integrated Traditional and Western Nephrology, 2002; 3(4): 218–221.
17. Liu GP, Huang JX, Gui L. Clinical Study of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis.Chinese Journal of Integrated Traditional and Western Nephrology, 2003; 4(7): 386–388.
18. 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, 2005; 10(5): 504–510.
19. Zhang JL, Zhang HH, Ma L, et al. A multicentric and prospective study on mycophenolate mofetil in the treatment of systemic lupus erythematosus. Chinese Journal of Rheumatology, 2002; 6(6): 406–410.
20. Zhu B, Zhou ZA, Liu ZD, et al. Comparision of mycophenolate mofetil therapy versus cyclophosphamide treatment of proliferative lupus nephritis. Journal of Shandong Univenity (health sciences), 2003; 41(6): 692–694.
  1. 1. 蔣文功, 肖笑, 方敬愛. 霉酚酸酯治療彌漫增生性狼瘡腎炎的臨床觀察. 中國中西醫(yī)結(jié)合腎病雜志, 2002; 3(4): 218–221.
  2. 2. 劉國平, 黃九香, 林琳. 霉酚酸酯對彌漫增生型狼瘡性腎炎患者的療效觀察. 中國中西醫(yī)結(jié)合腎病雜, 2003; 4(7): 386~388.
  3. 3. 張江林, 張火亙, 馬麗等. 嗎替麥考酚酯治療系統(tǒng)性紅斑狼瘡的多中心前瞻性研究. 中華風濕病學雜志, 2002; 6(6): 406~410.
  4. 4. 朱彬, 周振安, 劉子棟, 等. 霉酚酸酯與環(huán)磷酰胺治療IV型狼瘡性腎炎的療效比較. 山東大學學報 (醫(yī)學版), 2003; 41(6): 692~694.
  5. 5. Boumpas DT, Austin HA III, Vaughn EM, et al. Controlled trial of pulse methylprednisolone versus two regimens of pulse cyclophosphamide in severe lupus nephritis.Lancet, 1992; 340: 741–745.
  6. 6. Dooley MA, Cosio FG, Nachman PH, et al. Mycophenolate mofetil therapy in lupus nephritis: clinical observations. J Am Soc Nephml, 1999;10(4): 833–839.
  7. 7. Tan EM, Cohen AS, Fries JF, et al. The1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum, 1982; 25: 1271–1277.
  8. 8. Egger M, Smith GD, Altman DG. Systematic Reviews in Heath Care. London: Tavistock Square, Second edition, 2001. 73-78.
  9. 9. Jadad AR ,Moore A ,Carrol D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary. Control Clin Trials, 1996 ; 17: 1–12.
  10. 10. Cochrane Reviewer’s Handbook 4.2.2. The Cochrane Collaboration, 2000.
  11. 11. Schulz KF, Chalmers I, Hayes RJ. Empirical evidence of bias .JAMA, 1995; 273: 408–412.
  12. 12. Chan TM, Li FK, Tang CS, et al. Efficacy of mycophenolate mofetil in patients with diffuse proliferative lupus nephritis. N Engl J Med, 2000; 343(16): 1156–1162.
  13. 13. 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.
  14. 14. Contreras G, Pardo V, Leclercq B, et al. Sequential therapies for proliferative lupus nephritis. N Engl J Med, 2004; 350(10): 971–980.
  15. 15. Ginzler EM, Dooley MA, Aranow C, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Eng J Med, 2005; 353(21): 2219–2228.
  16. 16. Jiang WG,Xiao X,Fang JA. Eff icacy of Mycophenolate Mofetil in Patients with Diffuse Prol -iferative Lupus Nephritis. Chinese Journal of Integrated Traditional and Western Nephrology, 2002; 3(4): 218–221.
  17. 17. Liu GP, Huang JX, Gui L. Clinical Study of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis.Chinese Journal of Integrated Traditional and Western Nephrology, 2003; 4(7): 386–388.
  18. 18. 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, 2005; 10(5): 504–510.
  19. 19. Zhang JL, Zhang HH, Ma L, et al. A multicentric and prospective study on mycophenolate mofetil in the treatment of systemic lupus erythematosus. Chinese Journal of Rheumatology, 2002; 6(6): 406–410.
  20. 20. Zhu B, Zhou ZA, Liu ZD, et al. Comparision of mycophenolate mofetil therapy versus cyclophosphamide treatment of proliferative lupus nephritis. Journal of Shandong Univenity (health sciences), 2003; 41(6): 692–694.