环磷酰胺在难治性肾病综合征治疗中的应用——30年文献Meta分析

目的 明确环磷酰胺能否有效治疗难治性肾病综合征,以及不同的环磷酰胺应用方案中何种最佳,为临床用药以及进一步大规模、多中心的临床流行病学研究提供指导。方法 通过MEDLINE、AHRQ、Cochrane、ACP Journal Club计算机检索系统,以nephrotic syndrome和cyclophosphamide为主题词,检索1970－2000年的前瞻性临床、随机、对照研究的英文文献及上述文献中符合条件的参考文献,以有效率（肾病综合征完全缓解率＋部分缓解率）作为统计指标,采用加权百分率法进行Meta分析。结果 应用环磷酰胺（口服）与泼尼松联合治疗肾病综合征的有效率为49．1％,单纯应用泼尼松治疗的有效率为16．2％,两者比较差异有显著意义（P＜0．05）;大剂量环磷酰胺（累积剂量为168－192mg/kg）与泼尼松联合口服治疗的有效率为44％,小剂量环磷酰胺（累积剂量为42－168mg/kg）与泼尼松联合口服治疗的有效率为25％,两者比较差异有显著意义（P＜0．05）;应用环磷酰胺冲击治疗的有效率为76％,应用环磷酰胺口服治疗的有效率为59％,两者比较差异无显著意义（P＞0．05）。结论 环磷酰胺能有效治疗难治性肾病综合征,且以大剂量环磷酰胺和泼尼松同时口服治疗的效果最佳。

Cyclophosphamide therapy in refractory nephrotic syndrome: a meta-analysis of clinical trials from 1970 to 2000

Objective Studies on the treatment of nephrotic syndrome with cyclophosphamide were reported frequently,but the effect of cyclophosphamide varied from one report to another because of the different study criteria and conditions In order to determine whether cyclophosphamide is effective in the treatment of refractory nephrotic syndrome, and what is the best regimes with cyclophosphamide, a meta analysis of clinical trials on the treatment of nephrotic syndrome with cyclophosphamide from 1970 to 2000 was conducted Methods Published papers on randomized, controlled and prospective clinical trials were identified from MEDLINE (from 1970 to 2000) ,AHRQ,Cochrane and ACP Journal Club with the subject headings "nephrotic syndrome & cyclophosphamide",and the similar papers listed in the references of above papers were also included The papers identified were divided into three groups according to the cyclophosphamide regime: oral cyclophosphamide and prednisone combined treatment group versus oral prednisone treatment group, large dose oral cyclophosphamide and prednisone combined treatment group versus small dose oral cyclophosphamide and prednisone combined treatment group,and intravenous pulse cyclophosphamide treatment group versus oral cyclophosphamide treatment group All the identified papers were analyzed with the meta analysis of weight percentage The statistical analysis was based on the effective rate of cyclophosphamide treatment, which included the percentage of the complete remission and the partial remission of refractory nephrotic syndrome. Results The effective rate of the oral cyclophosphamide and prednisone combined treatment group (49 11%) was significantly higher than that of the oral prednisone treatment group (16 22%, P <0 05) The large dose oral cyclophosphamide combined with oral prednisone treatment(total dose varied from 168 to 192 mg/kg)was more effective than the small dose oral cyclophosphamide combined with oral prednisone treatment(total dose varied from 42 to 168 mg/kg) The effective rate was 44 29% and 18 03%, respectively ( P <0 05) While the intravenous pulse cyclophosphamide treatment was not significantly effective than the oral cyclophosphamide treatment The effective rate was 76 0% and 58 82%, respectively ( P <0 05).Conclusion Cyclophosphamide is effective in the treatment of refractory nephrotic syndrome,and the large dose oral cyclophosphamide combined with oral prednisone showed to be the best cyclophosphamide regime