肾移植术后低剂量与常规剂量环孢素A比较进行免疫抑制治疗有效性与安全性的Meta分析

目的系统评价肾移植术后环孢素A低剂量与常规剂量比较的免疫抑制效果和安全性。方法计算机检索MEDLINE、EMbase、SCI、CBM、Cochrane图书馆检索时间均从建库至2009年12月,纳入肾移植术后环孢素A低剂量与常规剂量比较进行免疫抑制治疗的随机对照试验（RCT）。在评价纳入研究的方法学质量和提取有效数据后,采用RevMan5.0进行Meta分析。结果共纳入6个RCT,包括1551例患者,质量评价结果显示4个研究为A级、2个为B级。Meta分析结果显示：随访6个月及12个月两组急性排斥反应发生率[RR=1.07,95%CI（0.69,1.65）;RR=1.06,95%CI（0.71,1.57）]、受者病死率[RR=0.64,95%CI（0.20,2.03）;RR=0.61,95%CI（0.30,1.24）];以及移植物丢失率[RR=0.72,95%CI（0.38,1.36）;RR=0.82,95%CI（0.54,1.25）]差异均无统计学意义,肾脏功能及纳入分析的安全性指标差异均无统计学意义。结论基于当前临床证据,肾移植术后CsA低剂量与常规剂量相比,近期疗效和安全性相似;远期结果有待进一步研究探讨。

Low-Dose and Standard-dose Cyclosporine Immunosuppressive Therapy in Kidney Transplant Recipients: A Meta-analysis of Effectiveness and Safety

Objective To evaluate the efficacy and safety of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients.Methods We searched MEDLINE,EMbase,SCI,CBM and The Cochrane Library from the establishment to December 2009 to screen randomized controlled trials（RCTs） of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients.Quality assessment and metaanalyses were performed for the included studies.Results A total of 6 RCTs involving 1551 patients were identified,among which 4 RCTs were graded A and two were graded B.The meta-analyses indicated that there were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the acute rejection rate at a RR 1.07,95%CI 0.69 to 1.65 and a RR 1.06,95%CI 0.71 to 1.57,respectively.There were no signif icant differences between the two groups at the end of 6-month and 12-month follow-up in the patients＇ death rate at a RR 0.64,95%CI 0.20 to 2.03 and a RR 0.61,95%CI 0.30 to 1.24,respectively.There were no signif icant differences between the two groups in renal function and safety.Conclusion Based on the current evidence,compared with standard-dose CsA,low-dose CsA has the same effect and safety for the short-term results,but the long-term results need to be further studied.