霉酚酸酯與環磷酰胺比較治療狼瘡性腎炎的系統評價_《中國循證醫學雜志》

作者：

李遠發 ¹ , 余喬 ¹ , 於文麗 ² , 鄒艷麗 ¹ , 趙磊 ³ ,  郭毅 ³

1. 武漢大學第二臨床學院（武漢?430072）；2. 中南醫院腎內科（武漢?430071）；3. 武漢大學公共衛生學院流行病學教研室（武漢?430072）;

關鍵詞：

環磷酰胺霉酚酸酯狼瘡性腎炎系統評價 Meta 分析隨機對照試驗

DOI：

10.7507/1672-2531.20110141

視頻：

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目的　系統評價霉酚酸酯和環磷酰胺誘導緩解治療狼瘡性腎炎的療效和安全性。
方法　計算機檢索MEDLINE、EMbase、SCIE、Cochrane Library、Cochrane臨床對照試驗注冊資料庫、CBM和CNKI等數據庫，查找霉酚酸酯與環磷酰胺比較治療狼瘡性腎炎的隨機對照試驗（檢索時間均從建庫至2010年8月），按納入排除標準選擇文獻、評價質量和提取有效數據后，采用RevMan 5.0軟件進行Meta分析。
結果　共納入8個隨機對照試驗，共773例患者。 Meta分析結果顯示，霉酚酸酯組總緩解率、完全緩解率高于環磷酰胺組［OR=1.49，95%CI（1.10，2.02）；OR=1.67，95%CI（1.08，2.57）］，但兩組在部分緩解率、完成誘導治療比例方面差異無統計學意義。兩組在藥物不耐受比例、感染和白細胞減少發生率方面差異無統計學意義，但霉酚酸酯組腹瀉的發生率高于環磷酰胺組，差異有統計學意義［OR=2.99，95%CI（1.87，4.78）］。Ⅳ型狼瘡性腎炎患者的Meta分析結果也顯示了相似的結果。
結論　霉酚酸酯治療狼瘡性腎炎患者（Ⅲ型、Ⅳ型、Ⅴ型）的總誘導緩解療效優于環磷酰胺，但腹瀉發生率高于環磷酰胺。

引用本文： 李遠發,余喬,於文麗,鄒艷麗,趙磊,郭毅. 霉酚酸酯與環磷酰胺比較治療狼瘡性腎炎的系統評價. 中國循證醫學雜志, 2011, 11(7): 826-834. doi: 10.7507/1672-2531.20110141 復制

1.	1 Waldman M, Appel GB. Update on the treatment of lupus nephritis. Kidney Int , 2006, 70(8): 1403-1412.
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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.
5.	Martin F, Lauwerys B, Lefèbvre C, et al . Side-effects of intravenous cyclophosphamide pulse therapy. Lupus , 1997, 6(3): 254-257.
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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: 北京大學醫學出版社, 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. 霉酚酸酯在狼瘡性腎炎誘導及維持治療中療效的系統評價和Meta分析. 浙江大學碩士論文, 2010．.
20.	齊華林, 江薇, 嚴海東. 霉酚酸酯治療增殖性狼瘡性腎炎的Meta分析. 腎臟病與透析腎移植雜志, 2007, 16(5): 426-434.
21.	殷蕾, 周緯, 金燕樑, 等. 環磷酰胺與霉酚酸酯治療狼瘡性腎炎療效比較的系統評價. 臨床兒科雜志, 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: 北京大學醫學出版社, 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. 霉酚酸酯在狼瘡性腎炎誘導及維持治療中療效的系統評價和Meta分析. 浙江大學碩士論文, 2010．.
20. 齊華林, 江薇, 嚴海東. 霉酚酸酯治療增殖性狼瘡性腎炎的Meta分析. 腎臟病與透析腎移植雜志, 2007, 16(5): 426-434.
21. 殷蕾, 周緯, 金燕樑, 等. 環磷酰胺與霉酚酸酯治療狼瘡性腎炎療效比較的系統評價. 臨床兒科雜志, 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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霉酚酸酯與環磷酰胺比較治療狼瘡性腎炎的系統評價

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