雷帕霉素为基础的免疫抑制剂治疗中CsA保留和撤除有效性、安全性的系统评价

目的评价雷帕霉素为基础免疫抑制剂治疗中环孢素A保留与撤除近期与远期有效性和安全性。方法采用Cochrane系统评价方法，检索Medline，EMBASE，Cochrane图书馆、VIP、CNKI电子资料。由2名评价者共同评价纳入研究质量。对同质研究进行Meta分析．结果共纳入8个研究，肾移植术后患者959例。纳入研究根据随机方法、分配隐藏和盲法描述评分，6个为B级，2个为C级。结论研究结果显示，肾移植术后病情稳定患者，以雷帕霉素为基础对免疫抑制剂治疗中环孢素A撤除，1年之内易导致急性排斥反应发生，但是对于人肾存活率影响无统计学意义，有助于肾功能恢复，撤除环孢素A组患者血胆固醇高于环孢素A保留组。但是由于纳入研究存在选择性偏倚和测量性偏倚的高度可能性，势必影响结果的证据强度。期待高质量的随机双盲对照试验提供高质量的证据。

Effectiveness and safety of rapamycin-based immunosuppression regimens on preserving or withdrawing CsA in renal transplantation: a systematic review

Objective To evaluate the shortterm and long-term effectiveness and safety of rapamycin-based immunosuppression regimens with cyclosporine A(CsA) preserving versus CsA withdrawal for renal transplantation patients. Method The electronic databases such as Medline,EMBASE,Cochrane Library,CNKI were searched;the quality of included trials was evaluated by two estimators.Meta-analysis in the homogenous studies was made. Results Eight studies(959 patients) undergoing renal transplantation were included.Six studies were B class,and 2 studies were C class according to the randomization,allocation concealment and blinding. Conclusion The kidney recipients receiving the rapamycin-based immunosuppression regimens CsA withdrawal group had higher risk of the acute rejection than that in CsA preserving group within one year,but there is no statistical significance in rate of human/kidney graft survival,and CsA withdrawal benefits to recovery of graft function.The blood lipid in CsA withdrawal group was higher than that in CsA preserving group.The selection and measurement bias in the studies affect the intensity of evidences.High quality randomization doubleblinded control trials providing high quality evidence are expected.