他克莫司与环孢素A比较治疗胰肾联合移植术后排斥反应的Meta分析

目的评价他克莫司（TAC）与环孢素A（CSA）治疗胰肾联合移植（SPKT）术后排斥反应的疗效和安全性。方法检索Cochrane图书馆、MEDLINE、EMbase、SCI、CBM数据库（检索时间从建库至2009年3月）,纳入比较TAC与CSA治疗SPKT术后排斥反应的随机对照试验（RCT）,采用Cochrane协作网推荐的方法进行质量评价和Meta分析。结果共纳入5个RCT,合计342例患者。Meta分析结果显示：TAC组胰腺存活率高于CSA组[RR=1.15,95%CI（1.04,1.27）];[RD=0.11,95%CI（0.03,0.19）],但两组急性排斥反应、病人存活率、肾脏存活率及感染情况差异无统计学意义,其RR（95%CI）分别为0.81（0.58,1.12）、1.00（0.94,1.05）、1.02（0.95,1.09）和1.00（0.83,1.20）。结论基于当前证据,TAC与CSA比较治疗SPKT术后排斥反应能提高胰腺存活率。治疗100例SPKT患者,TAC比CSA多让11例患者的胰腺存活。

Tacrolimus versus Cyclosporine A for Simultaneous Pancreas-Kidney Transplant Recipients: A Meta-Analysis

Objective To find out the beneficial and harmful effectiveness of tacrolimus （TAC） compared with cyclosporine A （CSA） for simultaneous pancreas-kidney transplant （SPKT） recipients. Methods Randomized controlled trials （RCTs） of TAC versus CSA for SPKT recipients were collected from The Cochrane Library, MEDLINE, EMbase, SCI, and CBM database. Bias risk assessment and meta-analysis were performed based on the methods recommended by the Cochrane Collaboration. Results Five RCTs including 342 recipients were included. Pooled data of pancreas survival favored TAC （RR=1.15, 95%CI 1.04 to 1.27; RD=0.11, 95%CI 0.03 to 0.19）. However, there were no significant differences of acute rejection （RR=0.81, 95%CI 0.58 to 1.12）, patient survival （RR=1.00, 95%CI 0.94 to 1.05）, kidney survival （RR=1.02, 95%CI 0.95 to 1.09）, and infection （RR=1.00, 95%CI 0.83 to 1.20）. Conclusion Based on the recent evidence, TAC results in higher episodes of pancreas survival compared with CSA after SPKT. Treating 100 patients with TAC instead of CSA would increase pancreas survival in 11 recipients.