小剂量他克莫司对糖皮质激素依赖性重症肌无力患者影响的meta分析

目的：通过Meta分析方法对比不同研究中小剂量他克莫司对糖皮质激素依赖性重症肌无力患者其糖皮质激素剂量的影响。方法：计算机检索the Cochrane Library、Embase、Pubmed、维普网、CNKI和万方数据库，全面搜索他克莫司治疗重症肌无力相关文献。使用Rev Man5.1软件对提取资料进行统计分析。结果：3篇对照试验文献分析结果显示，他克莫司对少糖皮质激素依赖性重症肌无力患者激素用量有显著差异[WMD=-4.34(95%CI=-5.46,-3.22)]；分析其余自身对照试验文献显示相同结论[12个月：WMD=-22.32(95%CI=-34.35,-10.30)；24个月：WMD=-30.30(95%CI=-55.31,-5.28)]；他克莫司治疗治疗相关不良反应发生率增高[OR=7.98(95%CI=2.52,25.27)]。结论：本研究结果显示早期使用小剂量他克莫司可减少糖皮质激素依赖性重症肌无力患者激素用量，但不良反应可能高于单纯使用糖皮质激素患者。受纳入研究质量限制,上述结果还有待开展更多高质量的临床RCT试验来进一步证实。

Meta-analysis Assessing The Effects Of Low-dose Tacrolimus Treatment In Prednisone-dependent Myasthenia Gravis

Objective:To evaluate the effects of low-dose tacrolimus in prednisone-dependent myasthenia gravis in different clinical studies by the method of Meta-analysis. Methods: We systematically searched Cochrane Library, Embase , pubmed, CNKI , VIP and WF to found articles related to tacrolimus treatment in myasthenia gravis. We performed meta-analysis using Review Manager (Rev Man)5.1 software. Results: Meta-analysis in 3 included controlled trials showed that there were significant differences in the efficacy low-dose tacrolimus treatment in prednisone-dependent myasthenia gravis [WMD=-4.34 (95%CI=-5.46,-3.22) ];Meta-analysis in another included before-after studies showed the same result [12months:WMD=-22.32 (95%CI=-34.35,-10.30);24months:WMD=-30.30(95%CI=-55.31,-5.28)];The efficacy and treatment-related adverse effects showed a significant increase in the treatment of tacrolimus. [OR=7.98 (95%CI=2.52, 25.27)] Conclusion:Based on the current evidence, early administration of low-dose tacrolimus for the treatment of prednisone-dependent myasthenia gravis reduces the dose of prednisone, and tacrolimus was well tolerated in the period of more than one year treatment. Due to the poo r quality of the included trials, more high-quality RCTs are needed.