他克莫司和环孢素在类固醇耐药肾病综合征患者中的比较评价:系统回顾和荟萃分析

Y. Ravanshad, A. Zeraati, M. Golsorkhi, S. Ravanshad, A. Azarfar, H. Jafari
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引用次数: 0

摘要

引言:到目前为止,几项随机试验比较了钙调神经磷酸酶抑制剂,特别是他克莫司,与环孢素在激素耐药肾病综合征患者中的作用,提出了相互矛盾的结果。使用免疫抑制疗法治疗耐药肾病综合征仍然是一个有争议的问题,其疗效和安全性的证据尚不确定。本研究旨在比较他克莫司和环孢菌素治疗激素抵抗性肾病综合征的疗效和局限性。方法:通过检索PubMed、Scopus、ScienceDirect、Cochrane Library和Web of Science等电子数据库中截至2018年1月进行的相关试验,进行系统综述和荟萃分析。总共确定了285篇潜在的相关文章,并选择了四篇文章进行审查。使用随机效应模型分析数据,并使用基于卡方的Cochran Q和I2统计数据评估文章的异质性,I2>50%的异质性被认为具有统计学意义。结果以95%置信区间的相对风险表示,P值小于0.05被认为具有统计学意义。此外,荟萃分析用于进一步的数据分析。结果:本系统综述对4项符合条件的随机对照试验进行了评价。在部分和完全缓解方面,他克莫司和环孢菌素之间没有观察到显著差异。然而,与环孢菌素相比,他克莫司对治疗的无反应显著降低(RR=0.289;P=0.02)。在感染率、高血压、ALT/AST升高和胃肠道症状方面,两种药物之间没有观察到显著差异,而他克莫司的肾毒性(RR=0.395;P=0.004)和多毛症(RR=0.018;P<0.001)显著降低。结论:总之,他克莫司在治疗激素抵抗性肾病综合征方面优于环孢菌素,其治疗无效、肾毒性和多毛症均优于环孢霉素
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative Evaluation of Tacrolimus and Cyclosporine in Patients with Steroid-resistant Nephrotic Syndrome: A Systematic Review and Meta-analysis
Introduction: To date, several randomized trials have compared calcineurin inhibitors, especially tacrolimus, with cyclosporine in patients with steroid-resistant nephrotic syndrome, proposing conflicting results. Use of immunosuppressive therapy for the treatment of resistant nephrotic syndrome remains a matter of debate, and the evidence on its efficacy and safety is inconclusive.The present study aimed to compare the benefits and limitations of tacrolimus and cyclosporine in the treatment of steroid-resistant nephrotic syndrome. Methods: This systematic review and meta-analysis was conducted via searching for the relevant trials performed until January 2018 in electronic databases such as PubMed, Scopus, ScienceDirect, Cochrane Library, and Web of Science. In total, 285 potentially relevant articles were identified, and four articles were selected for the review. A random effects model was used to analyze data, and the heterogeneity of the articles was assessed using Chi-square-based Cochran’s Q and I2 statistics, and heterogeneity was considered statistically significant with I2>50%. The outcomes were presented as relative risk with 95% confidence interval, and P-value of less than 0.05 was considered statistically significant. In addition, meta-analysis was used for further data analysis.  Result: Four eligible randomized controlled trials were evaluated in this systematic review. In terms of partial and complete remission, no significant differences were observed between tacrolimus and cyclosporine. However, lack of response to therapy was significantly lower with tacrolimus (RR=0.289; P=0.02) compared to cyclosporine. No significant differences were observed between the drugs in terms of the infection rate, hypertension, ALT/AST elevation, and gastrointestinal symptoms, while nephrotoxicity (RR=0.395; P=0.004) and hypertrichosis (RR=0.018; P<0.001) were significantly lower with tacrolimus. Conclusions: In conclusion, Tacrolimus is superior to Cyclosporine in treating in patients with steroid resistance nephrotic syndrome in terms of no response to therapy, nephrotoxicity and hypertrichosis
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