霉酚酸酯用于狼疮肾炎的循证治疗

目的探讨霉酚酸酯治疗增生性狼疮肾炎的最佳方案。方法计算机检索Cochrane图书馆(2005年第4期)、MEDLINE(1990~2006.12)、CMB(1980~2006.12)、CNKI(1979~2007.10)和中国循证医学/Cochrane中心数据库(2006年第2期),收集霉酚酸酯治疗增生性狼疮肾炎的系统评价、临床随机对照试验等,并对所获证据的质量进行评价。并将证据应用于临床实践。结果共纳入4篇系统评价和6篇高质量随机对照研究(A级证据)。高质量的临床证据表明霉酚酸酯联合激素用于诱导期及缓解期能有效治疗弥漫增殖型狼疮肾炎,与环磷酰胺相比毒副作用较少。结论据患者意愿,结合我们的经验与当前最佳临床证据,制定出霉酚酸酯起始用量为1000mg/d的治疗方案。对患者进行3个月的随访,未发现明显副作用。

Evidenced-Based Therapy of Lupus Nephritis with Mycophenolate Mofetil

Objective We searched for evidence on mycophenolate mofetil(MMF) as a treatment for patients with di use proliferative lupus nephritis. Methods We attempted to nd the current best evidence by searching The Cochrane Library(Issue 4, 2005), MEDLINE(1990 to June 2007), CMB(1980 to December 2006), CNKI(1979 to October 2007). We critically appraised the available evidence. Results Four systematic reviews and 6 randomized controlled trials of high quality were available. MMF and prednisolone were found to be an e ective continuous induction-maintenance treatment for di use proliferative lupus nephritis. MMF was associated with less drug toxicity. Conclusion Given the current evidence and our clinical experience, and considering the patient and the values and preferences of his family,MMF was given at 1 g daily in combination with steroids at the beginning. No obvious adverse e ects occurred during 3 months of follow-up.