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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。
Objective To evaluate the efficacy and safety of mycophenolate mofetil and cyclophosphamide in the treatment of lupus nephritis. Methods The databases of MEDLINE, EMbase, SCIE, Cochrane Library, Cochrane Central Register of Controlled Trials, CBM and CNKI were searched by computer to find out the randomized controlled trials of mycophenolate mofetil and cyclophosphamide in the treatment of lupus nephritis Library until August 2010). Meta-analysis was performed using RevMan 5.0 software after selecting the literature by inclusion exclusion criteria, evaluating quality and extracting valid data. Results A total of 8 randomized controlled trials were included, with a total of 773 patients. Meta analysis showed that the total remission rate and complete remission rate of mycophenolate mofetil group were higher than that of cyclophosphamide group [OR = 1.49,95% CI (1.10,2.02); OR = 1.67,95% CI (1.08,2.57)] , But there was no significant difference between the two groups in the partial remission rate and completion of the proportion of induction therapy. There was no significant difference in the rates of drug intolerance, infection and leukopenia between the two groups, but the prevalence of diarrhea in mycophenolate mofetil group was higher than that in cyclophosphamide group (OR = 2.99, 95 % CI (1.87, 4.78)]. Meta-analysis of patients with type IV lupus nephritis also showed similar results. Conclusion Mycophenolate mofetil is superior to cyclophosphamide in the induction of lupus nephritis (Ⅲ, Ⅳ and Ⅴ), but the incidence of diarrhea is higher than that of cyclophosphamide.