腎移植術后驍悉與硫唑嘌呤抗排斥反應隨機對照試驗的系統評價_《中國循證醫學雜志》

作者：

張海濤 ¹ , 王坤杰 ² , 李幼平 ³⁴ , 高勵 ⁵ , 劉瑾 ⁴ , 蔡羽嘉 ³

1. 成都市第三人民醫院神經科,成都,610031 2. 四川大學華西醫院泌尿外科,成都,6100413. 中國循證醫學中心,成都,6100414. 四川大學華西醫院衛生部移植工程與移植免疫重點實驗室,成都,6100415. 成都中醫藥大學,成都,610072;

關鍵詞：

驍悉硫唑嘌呤腎移植系統評價

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目的　客觀評價腎移植術后驍悉(mycohpenolate mofetil,MMF)與硫唑嘌呤(azathioprine,AZA)抗排斥反應效果的差別.
方法　計算機檢索Medline(1996～2002.6)、Embase(1984～2002.6)、Cochrane圖書館(2002年第二期)及中國生物醫學文獻數據庫(1979～2002.6),鑒定有關隨機對照試驗,并采用Revman 4.11進行Meta-分析.
結果　共納入22個隨機對照試驗,涉及不同劑量MMF與AZA用于腎移植術后抗排斥治療,發現MMF 2 g/d比AZA可提高移植腎短期存活率及病人長期存活率,而MMF3 g/d與 AZA對提高病人及移植腎存活率無統計學差異.術后6月至1年內,MMF 2g/d或MMF 3 g/d均較AZA明顯降低移植腎急性排斥發生率.
結論　MMF較AZA免疫抑制效力更強,MMF降低腎移植術后急性排斥反應發生率明顯優于AZA,運用MMF對提高腎移植術后移植腎存活率及病人長期生存率有利.MMF 2 g/d是較理想的使用劑量.

引用本文： 張海濤,王坤杰,李幼平,高勵,劉瑾,蔡羽嘉. 腎移植術后驍悉與硫唑嘌呤抗排斥反應隨機對照試驗的系統評價. 中國循證醫學雜志, 2004, 04(2): 79-91. doi: 復制

1.	［1］Duquesnoy RT, Li YP. Editor-in-chief. Transplant Immunobiology 1st ed. Beijing: Science Press, 2003; 376Duquesnoy RT,.
2.	李幼平,主編.移植免疫生物學[M].北京:科學出版社,2000;376.
3.	［2］US Renal Transplant Mycophenolate Mofetil Study Group.Mycophenolate mofetil in cadaveric renal transplantation. Am J Kidney Disease[ J]. 1999; 34 (2): 296-303.
4.	［3］DanovithGM. Mycophenolatemofetilinrenaltransplantation [J].Kidney International, 1995; 52(suppl): 93-96.
5.	［4］Miller J, Mendez R, Pirsch JD, Jensik SC. Safety and efficacy of tacrolimus in combination with mycophenolate mofetil in cadaveric renal transplant recipients [ J ]. Transplantation,2000; 69(5): 875-880.
6.	［5］Ahsan N, Johnson C, Gonwa T, Hallorax P, Stegall M,Hardy M, Metzger R, Shield C, Rocher L, Scandling J.Randomized trial of tacrolimus plus mycophenolate mofetil or azathioprine versus cyclosporine oral solution (modified) plus mycophenolate mofetil after cadaveric kidney transplantation:results at 2 years[J]. Transplantation,2001; 72(2): 245-250.
7.	［6］The Mycophenolate Mofetil Acute Renal Rejection Study Group. Mycophenolate mofetil for the treatment of a first acute renal allograft rejection: three-year follow-up [ J ].Transplantation, 2001; 71 (8): 1091-1097.
8.	［7］Johnson C, Ahsan N, Gonwa T, Hallorax P, Stegall M,Hardy M, Metzger R, Shield C, Rocher L, Scandling J.Random trial of tacrolimus in combination with azathioprine or mycophenolate mofetil versus cyclosponne with mycophenolate mofetil after cadaveric kidney transplantation[J]. Transplantation, 2000; 69 (5): 834-841.
9.	［8］Jirasiritham S, Sumethkul V, Mavichak V, Chalermsanyakom P. The treatment of chronic rejection with mycophenolate mofetil versus azathioprine in kidney transplantation [ J ].Transplant Proc, 2000; 32(7): 2040-2042.
10.	［9］Suhail SM, Vathsala A, Lou HX, Woo KT. Safety and efficacy of mycophenolate mofetil for prophylaxis in Asian renal transplant recipients [ J ]. Transplant Proc, 2000; 32 (7):1757-1758.
11.	［10］MathewTH. Ablinded, long-time, randomizedmulticenter study of mycophenolate mofetil in cadaveric renal transplantation: result at three years [ J ]. Transplantation,1998; 65(11): 1450-1454.
12.	［11］Mendez R. FK 5 0 6 and mycophenolate mofetil in renal transplant recipients: six-month result of a multicenter,randomized dose ranging trial. Transplantation Proc, 1998; 30(4): 1287-1289.
13.	［12］The Mycophenolate mofetil Acute Renal Rejection Study Group. Mycophenolate mofetil for the treatment of a first acute renal allograft rejection [ J ]. Transplantation, 1998; 65(2): 235-241.
14.	［13］Neylan JE. Immunosupppressive therapy in high-risk transplant patients: dose-dependent efficacy of mycophenolate mofetil in African-American renal allograft recipients [ J ].Transplantation, 1997; 64(9): 1277-1282.
15.	［14］The U. S. Mycophenolate Mofetil Study Group. Mycophenolate mofetil for the prevention of acute rejection of primary cadaveric kidney transplants: status of the MYC 1866 study at 1 year[J]. Transplant Proc, 1997; 29(1-2): 348-349.
16.	［15］Halloran P, Mathew T, Tomlanovich S, Groth C, Hooftman L, Barker C. Mycophenolate mofetil in renal allograft recipients: a pooled efficacy analysis of three randomized,double-blind, clinical studies in prevention of rejection [J ].Transplantion, 1997; 63(1): 39-47.
17.	［16］The Tricontinental Mycophnolate Mofetil Rneal Transplantation Study Group. A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation[J]. Transplantation, 1996; 61(7): 1029-1037.
18.	［17］Solinger HW. Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients[J]. Transplantation, 1995 ;60(3) :225-232.
19.	［18］European Mycophenolate Mofetil Cooperative Study Group.Mycophenolate in renal transplantation: 3-year results from the placebo-controlled trial [J ]. Transplantation, 1999; 68 (3):391-396.
20.	［19］European Mycophenolate Mofetil Cooperative Study Group.Placebo-controlled study of mycophenolate mofetil combined with cyclosporin and corticosteroid for prevention of acute rejection[J]. Lancet, 1995; 345(8961): 1321-1325.
21.	［20］ChoS, HodgeE, NavarroM. Mycophenolatemofetilimproves long-term graft survival following renal transplantation in patients experiencing delayed graft function [ J ].Transplantation Proc, 1999; 31 (1-2): 322-323.
22.	［21］Ji YL,Yang YQ,Yang GB, Yu XQ, Jiang ZP, Cheng QD,Wu PG. The clinical investigation of mycophenolate mofetil for the prevention of acute rejection [ J ]. Acad J SUMS,2001; 22(3): 215-217.
23.	紀玉蓮,楊彥強,楊光寶,余學清,姜宗培,沈清端,吳培根,朱蘭英.霉酚酸酯預防腎移植術后急性排斥反應臨床觀察[J].中山醫科大學學報,2001;22(3):215-217.
24.	［22］Huang LP, Yang SY, Wu XT, Cheng ZB, Wang ZX, Wei X. Clinical observation on the early application of cellcept following cadaveric renal tansplantation [ J ]. Chin J Organ Transplant, 2000; 21 (5): 294-295.
25.	黃麗萍,楊詩玉,武小桐,陳再彬,王振興,衛燾.腎移植患者術后早期應用霉酚酸酯的臨床觀察[J].中華器官移植雜志,2000;21(5):294-295.
26.	［23］Hongbo G, Yuhai Z. The use of mycophenolate mofetil in renal tansplantation[J]. China J New Drug, 1998; 7 (6):444-446.
27.	郭宏波,張玉海.霉酚酸酯(MMF)在腎移植中的應用[J].中國新藥雜志,1998;7(6):444-446.
28.	［24］Ling JY, Zhu Y, Shun FK. Combined use of MMF with low dosage of cyclosporine A in renal tansplantation[J ]. Chin J Organ Transplant, 1998; 19(3): 175-176.
29.	凌建煜,祝宇,孫福康.驍悉與小劑量環孢素A在尸體腎移植中的聯合應用[J].中華器官移植雜志,1998;19(3):175-176.
30.	［25］Wang QW, Ji SM, ChengJS, Ying LP, Xu B, Cheng HP,Li LS. Prevention acute rejection of MMF in renal tansplantion [J]. J Nephrol Dialy Transplant, 1998; 7 (1): 34-37.
31.	王慶文,季曙明,陳勁松,陳勁松,殷立平,徐斌,陳惠萍,黎磊石.霉酚酸酯預防尸體腎移植急性排斥反應[J].腎臟病與透析腎移植雜志,1998;7(1):34-37.
32.	［26］European Mycophenolate Mofetil Cooperation Study Group.Mycophenolate mofetil in renal transplantation: 3-year results from the placebo-controlled trial [J ]. Transplantation, 1999;68(3): 391-396.

1. ［1］Duquesnoy RT, Li YP. Editor-in-chief. Transplant Immunobiology 1st ed. Beijing: Science Press, 2003; 376Duquesnoy RT,.
2. 李幼平,主編.移植免疫生物學[M].北京:科學出版社,2000;376.
3. ［2］US Renal Transplant Mycophenolate Mofetil Study Group.Mycophenolate mofetil in cadaveric renal transplantation. Am J Kidney Disease[ J]. 1999; 34 (2): 296-303.
4. ［3］DanovithGM. Mycophenolatemofetilinrenaltransplantation [J].Kidney International, 1995; 52(suppl): 93-96.
5. ［4］Miller J, Mendez R, Pirsch JD, Jensik SC. Safety and efficacy of tacrolimus in combination with mycophenolate mofetil in cadaveric renal transplant recipients [ J ]. Transplantation,2000; 69(5): 875-880.
6. ［5］Ahsan N, Johnson C, Gonwa T, Hallorax P, Stegall M,Hardy M, Metzger R, Shield C, Rocher L, Scandling J.Randomized trial of tacrolimus plus mycophenolate mofetil or azathioprine versus cyclosporine oral solution (modified) plus mycophenolate mofetil after cadaveric kidney transplantation:results at 2 years[J]. Transplantation,2001; 72(2): 245-250.
7. ［6］The Mycophenolate Mofetil Acute Renal Rejection Study Group. Mycophenolate mofetil for the treatment of a first acute renal allograft rejection: three-year follow-up [ J ].Transplantation, 2001; 71 (8): 1091-1097.
8. ［7］Johnson C, Ahsan N, Gonwa T, Hallorax P, Stegall M,Hardy M, Metzger R, Shield C, Rocher L, Scandling J.Random trial of tacrolimus in combination with azathioprine or mycophenolate mofetil versus cyclosponne with mycophenolate mofetil after cadaveric kidney transplantation[J]. Transplantation, 2000; 69 (5): 834-841.
9. ［8］Jirasiritham S, Sumethkul V, Mavichak V, Chalermsanyakom P. The treatment of chronic rejection with mycophenolate mofetil versus azathioprine in kidney transplantation [ J ].Transplant Proc, 2000; 32(7): 2040-2042.
10. ［9］Suhail SM, Vathsala A, Lou HX, Woo KT. Safety and efficacy of mycophenolate mofetil for prophylaxis in Asian renal transplant recipients [ J ]. Transplant Proc, 2000; 32 (7):1757-1758.
11. ［10］MathewTH. Ablinded, long-time, randomizedmulticenter study of mycophenolate mofetil in cadaveric renal transplantation: result at three years [ J ]. Transplantation,1998; 65(11): 1450-1454.
12. ［11］Mendez R. FK 5 0 6 and mycophenolate mofetil in renal transplant recipients: six-month result of a multicenter,randomized dose ranging trial. Transplantation Proc, 1998; 30(4): 1287-1289.
13. ［12］The Mycophenolate mofetil Acute Renal Rejection Study Group. Mycophenolate mofetil for the treatment of a first acute renal allograft rejection [ J ]. Transplantation, 1998; 65(2): 235-241.
14. ［13］Neylan JE. Immunosupppressive therapy in high-risk transplant patients: dose-dependent efficacy of mycophenolate mofetil in African-American renal allograft recipients [ J ].Transplantation, 1997; 64(9): 1277-1282.
15. ［14］The U. S. Mycophenolate Mofetil Study Group. Mycophenolate mofetil for the prevention of acute rejection of primary cadaveric kidney transplants: status of the MYC 1866 study at 1 year[J]. Transplant Proc, 1997; 29(1-2): 348-349.
16. ［15］Halloran P, Mathew T, Tomlanovich S, Groth C, Hooftman L, Barker C. Mycophenolate mofetil in renal allograft recipients: a pooled efficacy analysis of three randomized,double-blind, clinical studies in prevention of rejection [J ].Transplantion, 1997; 63(1): 39-47.
17. ［16］The Tricontinental Mycophnolate Mofetil Rneal Transplantation Study Group. A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation[J]. Transplantation, 1996; 61(7): 1029-1037.
18. ［17］Solinger HW. Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients[J]. Transplantation, 1995 ;60(3) :225-232.
19. ［18］European Mycophenolate Mofetil Cooperative Study Group.Mycophenolate in renal transplantation: 3-year results from the placebo-controlled trial [J ]. Transplantation, 1999; 68 (3):391-396.
20. ［19］European Mycophenolate Mofetil Cooperative Study Group.Placebo-controlled study of mycophenolate mofetil combined with cyclosporin and corticosteroid for prevention of acute rejection[J]. Lancet, 1995; 345(8961): 1321-1325.
21. ［20］ChoS, HodgeE, NavarroM. Mycophenolatemofetilimproves long-term graft survival following renal transplantation in patients experiencing delayed graft function [ J ].Transplantation Proc, 1999; 31 (1-2): 322-323.
22. ［21］Ji YL,Yang YQ,Yang GB, Yu XQ, Jiang ZP, Cheng QD,Wu PG. The clinical investigation of mycophenolate mofetil for the prevention of acute rejection [ J ]. Acad J SUMS,2001; 22(3): 215-217.
23. 紀玉蓮,楊彥強,楊光寶,余學清,姜宗培,沈清端,吳培根,朱蘭英.霉酚酸酯預防腎移植術后急性排斥反應臨床觀察[J].中山醫科大學學報,2001;22(3):215-217.
24. ［22］Huang LP, Yang SY, Wu XT, Cheng ZB, Wang ZX, Wei X. Clinical observation on the early application of cellcept following cadaveric renal tansplantation [ J ]. Chin J Organ Transplant, 2000; 21 (5): 294-295.
25. 黃麗萍,楊詩玉,武小桐,陳再彬,王振興,衛燾.腎移植患者術后早期應用霉酚酸酯的臨床觀察[J].中華器官移植雜志,2000;21(5):294-295.
26. ［23］Hongbo G, Yuhai Z. The use of mycophenolate mofetil in renal tansplantation[J]. China J New Drug, 1998; 7 (6):444-446.
27. 郭宏波,張玉海.霉酚酸酯(MMF)在腎移植中的應用[J].中國新藥雜志,1998;7(6):444-446.
28. ［24］Ling JY, Zhu Y, Shun FK. Combined use of MMF with low dosage of cyclosporine A in renal tansplantation[J ]. Chin J Organ Transplant, 1998; 19(3): 175-176.
29. 凌建煜,祝宇,孫福康.驍悉與小劑量環孢素A在尸體腎移植中的聯合應用[J].中華器官移植雜志,1998;19(3):175-176.
30. ［25］Wang QW, Ji SM, ChengJS, Ying LP, Xu B, Cheng HP,Li LS. Prevention acute rejection of MMF in renal tansplantion [J]. J Nephrol Dialy Transplant, 1998; 7 (1): 34-37.
31. 王慶文,季曙明,陳勁松,陳勁松,殷立平,徐斌,陳惠萍,黎磊石.霉酚酸酯預防尸體腎移植急性排斥反應[J].腎臟病與透析腎移植雜志,1998;7(1):34-37.
32. ［26］European Mycophenolate Mofetil Cooperation Study Group.Mycophenolate mofetil in renal transplantation: 3-year results from the placebo-controlled trial [J ]. Transplantation, 1999;68(3): 391-396.

《中國循證醫學雜志》

腎移植術后驍悉與硫唑嘌呤抗排斥反應隨機對照試驗的系統評價

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《中國循證醫學雜志》

腎移植術后驍悉與硫唑嘌呤抗排斥反應隨機對照試驗的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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