利妥昔单抗治疗儿童难治性肾病综合征疗效的meta分析

目的 系统性评价利妥昔单抗（rituximab，RTX）对儿童难治性肾病综合征（nephritic syndrome，NS）的有效性与安全性。方法 检索相关数据库，依照纳入与排除标准，获取RTX治疗儿童难治性NS的相关研究，分别针对RTX对NS患儿血浆白蛋白（albumin，Alb）、血肌酐（serum creatinine，Scr）、尿蛋白定量水平的影响，对患儿病情缓解率及无复发生存率的影响进行meta分析。结果 对RTX治疗儿童难治性NS的缓解率进行meta分析，总体效应显示RTX治疗组的病情缓解率明显优于常规治疗组OR=4.15，95%CI （1.80，9.57），P<0.01]。将NS患儿的血浆Alb、Scr、尿蛋白定量进行meta分析，结果表明RTX治疗可改善其血浆Alb水平WMD=0.46，95%CI （0.00，0.92），P=0.05]和尿蛋白总量WMD=-0.25，95%CI （-0.29，-0.21），P<0.01]，而对患儿Scr水平无明显统计学意义（P=0.89）。采用固定效应模型对NS患儿无复发生存率进行meta分析，结果发现RTX治疗可改善患儿的无复发生存率OR=0.43，95%CI （0.31，0.61），P<0.01]。结论 RTX治疗可改善难治性NS患儿的临床病情缓解率与无复发生存率，有利于NS患儿的长期预后。

Meta-analysis of Efficacy of Rituximab Therapy on Pediatric Refractory Nephrotic Syndrome

OBJECTIVE To evaluate the efficacy and safety of rituximab(RTX) therapy on pediatric refractory nephrotic syndrome (NS). METHODS According to the selection criteria and elimination criteria, retrieved relevant databases and obtained literatures about RTX in the treatment of pediatric refractory NS. The extractive data(serum albumin, serum creatinine, proteinuria) was performed statistical analysis. The effects of RTX on remission rate and relapse-free survival rate of pediatric refractory NS were meta-analyzed. RESULTS A meta-analysis of complete remission rate of pediatric refractory NS treated with RTX showed that RTX treatment group was significantly better than that in control groupOR=4.15, 95%CI(1.80, 9.57), P<0.01]. RTX therapy could improve the serum albuminWMD=0.46, 95%CI(0.00, 0.92), P=0.05] and reduce the urinary proteinWMD=-0.25, 95%CI(-0.29, -0.21), P<0.01] in pediatric refractory NS. However, there was no significant difference in serum creatinine level(P=0.89). Meta-analysis suggested that there was a significant difference in relapse-free survival rateOR=0.43, 95%CI(0.31, 0.61), P<0.01]. CONCLUSION RTX therapy can improve the complete remission rate and relapse-free survival rate, which is benefit to long-term prognosis in pediatric refractory NS.