肝移植术后应用依维莫司的Meta分析

摘要

Objective To compare everolimus (EVR) with calcineurin inhibitor (CNI) minimization or withdrawal on renal function of liver transplant patients with standard CNI therapy.Methods A search was conducted on databases which included the PubMed,Embase and Cochrane library for randomized controlled trials (RCTs) comparing EVR with CNI with minimization or withdrawal (the EVR group) with standard CNI therapy (the standard CNIs group) on renal function of liver transplant patients.A metaanalysis was performed using RevMan 5.3 software.Results Five RCTs which included 1 264 patients were selected into this study.There were 790 patients in the EVR group and 474 patients in the standard CNIs group.On meta-analysis,the EVR group had significantly better renal function (SMD =0.36,95％ CI 0.09 ～ 0.64,P ＜ 0.05),but higher rates of infection (RR =1.37,95％ CI 1.08 ～ 1.74,P ＜ 0.05),dyslipidemia (RR =2.46,95％ CI 1.79 ～ 3.38) and leukopenia (RR =2.37,95％ CI 1.32 ～ 4.26).No significant differences were found on the mortality and the acute rejection rates between the two groups (all P ＜ 0.05).Conclusions EVR with CNI minimization or withdrawal after liver transplantation provided effective immunosuppression and improved patients' renal function.The treatment increased the rates of infection,dyslipidemia and leukopenia.%目的 评估肝移植术后单用依维莫司或与减量的钙调磷酸酶抑制剂(CNIs)联用对患者肾功能的影响.方法 于PubMed、Embase和The Cochrane Library数据库检索2015年9月前发表的评价肝移植术后使用依维莫司对肾功能影响的随机对照试验.对符合纳入标准的文献进行质量评价与数据提取,并使用RevMan5.3软件进行Meta分析.结果 共纳入5项随机对照试验、1264例患者,其中依维莫司组(加或不加用CNIs)790例,标准量CNIs组474例.Meta分析结果显示,与标准量CNIs组比较,使用依维莫司的肝移植患者术后肾功能显著改善(SMD=0.36,95％ CI:0.09 ～0.64,P ＜0.05),感染(RR=1.37,95％ CI:1.08～1.74,P＜0.05)、血脂异常(RR =2.46,95％ CI:1.79～3.38,P＜0.05)和白细胞减少症的发生率升高(RR =2.37,95％CI:1.32 ～4.26,P＜0.05).两组患者术后急性排斥反应发生率及病死率差异无统计学意义(均P＞0.05).结论 肝移植术后单用依维莫司或与减量的CNIs联用,可在维持有效免疫抑制强度的同时,在一定程度上改善肝移植患者的肾功能,但也增加了术后感染、血脂异常和白细胞减少症的发生率.