环磷酰胺治疗增殖性狼疮性肾炎的Meta分析

目的 评价环磷酰胺治疗增殖性狼疮性肾炎的疗效和安全性。方法 检索Cochrane图书馆、PubMed、EMBASE、CBMdisc 、CNKI 、VIP等数据库中的RCT文献，检索时间均从建库至2009年06月30日，由3名系统评价员进行资料提取和质量评价，对同质资料运用RevMan 5．0软件进行Meta分析。结果 共纳入符合标准的29篇RCT文献（n＝1900）进入Meta分析。22项为B级，7项为C级。Meta 分析结果示：①大剂量环磷酰胺组肌酐倍增发生率要显著低于小剂量环磷酰胺组；余指标均无统计学意义。②环磷酰胺联合激素组ESRD、肌酐倍增发生率及复发率要显著低于单用激素组，而肾功能稳定、带状疱疹及闭经要显著高于单用激素组，余指标均无统计学意义。③环磷酰胺组带状疱疹及闭经的发生率要显著高于硫唑嘌呤组；余指标均无统计学意义。④环磷酰胺联合激素组完全缓解率及总缓解率显著低于霉酚酸酯联合激素组，闭经及白细胞减少显著高于霉酚酸酯联合激素组，余指标均无统计学意义。⑤环磷酰胺联合硫唑嘌呤组闭经及白细胞减少的发生率要显著高于霉酚酸酯组，余指标均无统计学意义。结论 现有的证据显示：环磷酰胺联合激素治疗增殖性狼疮性肾炎的疗效方面要优于单用激素，副作用要高于单用激素；环磷酰胺联合激素在治疗增殖性狼疮性肾炎疗效及保护肾功能方面不如霉酚酸酯联合激素，副作用要高于霉酚酸酯联合激素；环磷酰胺联合硫唑嘌呤治疗增殖性狼疮性肾炎的疗效方面与霉酚酸酯相似，副作用要高于霉酚酸酯；环磷酰胺治疗增殖性狼疮性肾炎的疗效方面与硫唑嘌呤相似，副作用要高于硫唑嘌呤；环磷酰胺应选择最小的治疗剂量及最短的治疗时间来减少环磷酰胺的副作用

Meta-analysis of cyclophosphamide treating proliferative lupus nephritis

Objective To assess the effect and safety of cyclophosphamide in the treatment of proliferative lupus nephritis.Methods The Cochrane library,PubMed,EMBASE,CBMdisc,CNKI,VIP were searched from the establishment of the database to November 30 2010.All included studies were graded in term of randomization,allocation concealment and blinding.Three reviewers assessed the quality of included studies,extracted data and meta-analysis for the result of homogenous studies were made with RevMan 5.0.Results Thirty-seven...