小剂量环孢素联合左旋咪唑治疗非重型再生障碍性贫血疗效及安全性的meta分析

目的 系统评价小剂量环孢素联合左旋咪唑治疗非重型再生障碍性贫血的疗效及安全性。方法 计算机检索The Cochrane Library、EMbase、PubMed、CBM、CNKI、维普及万方数据库,查找有关小剂量环孢素联合左旋咪唑治疗非重型再生障碍性贫血的随机对照试验,检索时间为建库至2019年7月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3进行Meta分析。结果 共纳入12项研究,共1071例患者。Meta分析结果显示,小剂量环孢素联合左旋咪唑与标准剂量环孢素治疗非重型再生障碍性贫血的总有效率差异无统计学意义OR=1.23,95% Cl(0.82,1.86),P=0.31]；但两种治疗方案的不良反应发生率差异具有统计学意义OR=0.10,95% Cl(0.07,0.16),P<0.00001]；且在血液学指标变化方面,两种治疗方案的血小板升高水平差异具有统计学意义MD=18.23,95% Cl(14.54,21.92),P<0.00001]。结论 小剂量环孢素联合左旋咪唑与标准剂量环孢素比较,治疗非重型再生障碍性贫血的疗效相当,不良反应发生率更低,且更能升高血小板水平。但受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Efficacy and Safety of Low-dose Cyclosporine Combined with Levamisole in the Treatment of Non-severe Aplastic Anemia: A Meta-analysis

OBJECTIVE To systematically evaluate the efficacy and safety of low-dose cyclosporine combined with levamisole in the treatment of non-severe aplastic anemia. METHODS The Cochrane Library, EMbase, PubMed, CBM, CNKI, VIP and Wanfang Date were searched from inception to July 2019 to collect randomized controlled trials of low-dose cyclosporine combined with levamisole in the treatment of non-severe aplasmosis anemia.Two reviewers independently screened studies,extracted date,and evaluated risk of bias of included studies.Meta-analysis was performed using RevMan 5.3 software. RESULTS Twelve literatures with a total of 1071 patients were involved in this rasearch.Meta-analysis showed that the total effective rate of low-dose cyclosporine combined with levamisole and standard dose cyclosporine in the treatment of non-severe aplastic anemia was not statistically significant differenceOR=1.23, 95% Cl (0.82, 1.86), P=0.31].However, there was statistically significance difference in the incidence of adverse reactions between the two therapeutic regimentsOR=0.10, 95% Cl (0.07, 0.16), P<0.00001].And in terms of hematological indicators, there was statistically significant difference in platelet elevation between the two therapeutic regiments MD=18.23, 95% Cl (14.54, 21.92), P<0.00001]. CONCLUSION The total effective rate of low dose cyclosporine combined with levamisole is comparable to standard dose cyclosporine in the treatment of non-severe aplastic anemia.But the adverse reactions is lower and the platelet levels is higher in low dose cyclosporine combined with levamisole.Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.