肾移植术后旧三联加抗胸腺细胞球蛋白与旧三联抗排斥反应效果的系统评价

目的评价肾移植术后抗胸腺细胞球蛋白（ATG）组旧三联（环孢霉素A＋硫唑嘌呤＋激素）＋ATG）]与Non-ATG组（旧三联）抗排斥反应的有效性和安全性。方法检索PubMed（1966-2008-03）、EMBASE（1974-2008-03）、Cochrane Library（2008年第1期）、中国生物医学文献数据库（1978-2008-03）、中国期刊全文数据库（1994-2008-03）、中文科技期刊全文数据库（1989-2008-03）等数据库。收集有关肾移植术后旧三联＋ATG与旧三联比较的随机对照试验，采用Handbook 4．2．6推荐的方法评价纳入研究的质量，对符合纳入标准的研究采用RevMan 4．2．10进行Meta分析。结果共纳入3个RCT，包括794例患者。与旧三联组比较，旧三联＋ATG组减少了肾移植术后急性排斥反应和慢性排斥反应发生率，降低了排斥反应的病理分级，但增加了术后巨细胞病毒感染、白细胞减少和血小板减少发生率，而在术后6、12月生存率差异无统计学意义。结论在旧三联基础上使用ATG抗排斥反应时须注意其不良反应，针对不同患者个体化给药。

Systematic review on the anti.rejection efficacy between the therapy of cyclosporine A,azothioprine and hormone and the therapy of cyclosporine A,azothioprine,hormone and antithymocyte globulin after renal transplantation

Objective To compare the anti-rejection efficacy between the therapy of cyclosporine A, azothioprine and hormone and the therapy of cyclosporine A, azothioprine, hormone and antithymocyte globulin after renal transplantation. Methods We searched PubMed （1966 to Mar. 2008）, EMBASE （1974 to Mar. 2008）, Cochrane controlled trials register （Issue 1, 2008）, Cochrane Renal Group Specialized Register of RCTs, Chinese Biomedical Literature Database （1978 to Mar.2008）, China Journal Full-text Database （1994 to Mar. 2008）, Chinese Scientific Journals Fulltext Database （1989 to Mar. 2008） and conference proceedings for the related studies without any language restriction, and evaluated the quality of the included studies with Handbook 4.2.6 recommended standard and analyed data with Cochrane Collaboration＇s RevMan 4.2.10 software. Results 3 RCTs involving 794 patients were included. Meta-analyses showed that the therapy of cyclosporine A, azothioprine, hormone and antithymocyte globulin decreased the incidence of acute and chronic rejection and the pathologic grades of rejection but increased the incidence of cytomegalovirus infection, leucocytopenia and thromboeytopenia when compared with the therapy of cyclosporine A, azothioprine and hormone. There were no significant differences in 6 months survival and 12 months survival after operation between the two therapies. Conclusion Attention on the adverse effects of the therapy of cyelosporine A, azothioprine, hormone and antithymocyte globulin should be paid and individualized therapy should be aimed to anti-rejection after renal transplantation.