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| 肝移植术后环孢素微乳剂与他克莫司疗效比较Meta分析 |
| 肖亮,傅宏,倪之嘉,丁国善*,施晓敏,郭闻渊,谢江平,刘炜,阳揭宇,高晓刚,马钧,王正昕,傅志仁 |
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| (第二军医大学长征医院肝移植科,上海 200003) |
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| 摘要: |
| 目的：评价肝移植术后以环孢素微乳剂(Neoral)或他克莫司(FK506)为基础的免疫抑制治疗的疗效差异。方法：根据纳入标准，摘录15篇文献中有关试验设计、研究对象特征、研究结果等内容，用RevMan4.2.8软件进行分析。结果：两组的患者/移植物存活率、肾毒性和感染发生率差别无统计学意义，RR(95%CI，P)分别为：0.99(0.96～1.02，0.37)，0.97(0.92～1.03,0.30)，0.99(0.87～1.13，0.86)，1.08(0.97～1.20，0.16)；FK506组高血压、急性排斥反应发生率相对较低，而急性排斥反应严重程度无差别，RR(95%CI，P)分别为：1.34(1.15～1.55,0.000 1)，1.15(1.06～1.25,0.001)，1.00(0.92～1.22,0.98)；FK506组术后1年的糖尿病发病率显著较高，1年后差异不明显，RR(95%CI，P)分别为：0.72(0.62～0.83,<0.000 1),1.47(0.98～2.20,0.06)。结论：两组患者/移植物存活率、肾毒性、感染发生率无显著差异；FK506相对于Neoral能减少急性排斥反应发生，但并不能减轻其严重程度；肝移植术后对于糖尿病患者推荐使用Neoral，高血压患者则以FK506为宜。 |
| 关键词: 环孢素微乳剂 他克莫司 肝移植 Meta分析 |
| DOI：10.3724/SP.J.1008.2008.00663 |
| 投稿时间：2007-10-13修订日期：2008-02-26 |
| 基金项目: |
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| A meta-analysis of therapeutic effect of cyclosporine microemulsion and tacrolimus for patients undergoing liver transplantation |
| XIAO Liang,FU Hong,NI Zhi-jia,DING Guo-shan*,SHI Xiao-min，GUO Wen-yuan，XIE Jiang-ping,LIU Wei,YANG Jie-yu,GAO Xiao-gang，MA Jun，WANG Zheng-xin，FU Zhi-r |
| (Department of Liver Transplantation,Changzheng Hospital,Second Military Medical University,Shanghai 200003,China) |
| Abstract: |
| Objective：To evaluate the efficacy and safety of microemulsified cyclosporine (Neoral) and tacrolimus (FK506) for immunodepression after liver transplantation.Methods: According to the including criteria,fifteen randomized controlled trials were enrolled in this analysis.The data of trial design,characteristics of the subjects,and findings of the studies were reviewed and analyzed by RevMan 4.2.8 software.Results: The patient survival rate,graft survival rate,incidence of nephrotoxicity,and incidence of infection were not significantly different between Neoral and FK506 groups,with the relative risk and (95% CI,P) being 0.99(0.96-1.02，0.37)，0.97(0.92-1.03,0.30)，0.99(0.87-1.13，0.86) and 1.08(0.97-1.20，0.16),respectively.The incidences of hypertension (1.34\[1.15-1.55,0.000 1\]) and acute rejection (1.15\[1.06-1.25,0.001\])were significantly lower in the FK506 group,with no significant difference found in the degree of acute rejection (1.00\[0.92-1.22\],0.98).Interestingly,the incidence of diabetes was significantly higher in the FK506 group within 1 year after the operation,but was similar to that of the Neoral group thereafter,with relative risk(95%CI，P)being 0.72(0.62-0.83,<0.000 1) and 1.47(0.98-2.20,0.06)，respectively.Conclusion: The 2 drugs have comparable patient/graft survival rates and incidences of nephrotoxicity and infection.FK506 can better reduce the incidence of acute rejection,but can not alleviate the degree of rejection.FK506 should be recommended for patients suffering from hypertension after liver transplantation and Neoral should be recommended for patients with diabetes. |
| Key words: cyclosporine microemulsion tacrolimus liver transplantation Meta-analysis |
