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巴利昔单抗和抗胸腺细胞球蛋白在肾移植免疫诱导中有效性和安全性的Meta分析

何跃, 郑瑾, 李杨, 等. 巴利昔单抗和抗胸腺细胞球蛋白在肾移植免疫诱导中有效性和安全性的Meta分析[J]. 器官移植, 2022, 13(4): 495-502. doi: 10.3969/j.issn.1674-7445.2022.04.013
引用本文: 何跃, 郑瑾, 李杨, 等. 巴利昔单抗和抗胸腺细胞球蛋白在肾移植免疫诱导中有效性和安全性的Meta分析[J]. 器官移植, 2022, 13(4): 495-502. doi: 10.3969/j.issn.1674-7445.2022.04.013
He Yue, Zheng Jin, Li Yang, et al. Efficacy and safety of basiliximab and antithymocyte globulin in immune induction in kidney transplantation: a Meta-analysis[J]. ORGAN TRANSPLANTATION, 2022, 13(4): 495-502. doi: 10.3969/j.issn.1674-7445.2022.04.013
Citation: He Yue, Zheng Jin, Li Yang, et al. Efficacy and safety of basiliximab and antithymocyte globulin in immune induction in kidney transplantation: a Meta-analysis[J]. ORGAN TRANSPLANTATION, 2022, 13(4): 495-502. doi: 10.3969/j.issn.1674-7445.2022.04.013

巴利昔单抗和抗胸腺细胞球蛋白在肾移植免疫诱导中有效性和安全性的Meta分析

doi: 10.3969/j.issn.1674-7445.2022.04.013
基金项目: 

国家自然科学基金面上项目 82170768

详细信息
    作者简介:
    通讯作者:

    奉友刚,男,1974年生,医学博士,教授,研究方向为肾移植,Email:uroygfeng@sina.com

  • 中图分类号: R617, R392.4

Efficacy and safety of basiliximab and antithymocyte globulin in immune induction in kidney transplantation: a Meta-analysis

More Information
  • 摘要:   目的  通过系统评价和Meta分析评估巴利昔单抗(BAS)和抗胸腺细胞球蛋白(ATG)在肾移植免疫诱导治疗中的有效性和安全性。  方法  系统检索国内外数据库,筛选比较BAS和ATG在肾移植免疫诱导治疗中的前瞻性随机对照临床研究文献。采用Jadad评分量表对文献质量评价并提取数据。分析BAS和ATG对肾移植术后1年急性排斥反应发生率、移植肾存活率、受者生存率、移植肾功能延迟恢复发生率、感染率、巨细胞病毒感染率、恶性肿瘤发生率、白细胞和血小板减少发生率的影响。  结果  纳入10篇英文文献,共1 721例肾移植受者,其中883例使用ATG,838例使用BAS。ATG组和BAS组术后1年急性排斥反应发生率、移植肾存活率、受者生存率、移植肾功能延迟恢复发生率、感染率、巨细胞病毒感染率和血小板减少发生率的差异均无统计学意义(均为P > 0.05)。ATG组术后1年内恶性肿瘤发生率、白细胞减少发生率均高于BAS组,差异均有统计学意义(均为P < 0.05)。  结论  使用ATG和BAS进行肾移植免疫诱导治疗,其术后1年有效性相当,但BAS安全性较好。未来应进行不同的免疫风险分层的临床研究,以达到个体化精准治疗。

     

  • 图  1  文献的筛选纳入流程

    Figure  1.  Process of literature screening and inclusion

    图  2  BAS和ATG在肾移植受者免疫诱导中的有效性分析

    注:A图为活检证实的急性排斥反应发生率的森林图;B图为移植肾存活率的森林图;C图为受者生存率的森林图;D图为移植肾功能延迟恢复发生率的森林图。

    Figure  2.  Efficacy analysis of BAS and ATG in immune induction of kidney transplant recipients

    图  3  BAS和ATG在肾移植受者免疫诱导中的安全性分析

    注:A图为肾移植术后1年感染率的森林图;B图为巨细胞病毒感染率的森林图;C图为恶性肿瘤发生率的森林图;D图为白细胞减少发生率的森林图;E图为血小板减少发生率的森林图。

    Figure  3.  Safety analysis of BAS and ATG in immune induction of kidney transplant recipients

    表  1  纳入文献的基本特征

    Table  1.   Basic characteristics of the included articles

    研究者 年份 国家、地区 研究中心 ATG组 BAS组 免疫抑制方案 Jadad评分(分)
    例数(n) 年龄(岁) 活体供肾(n) 尸体供肾(n) 例数(n) 年龄(岁) 活体供肾(n) 尸体供肾(n)
    Sollinger H, et al[9] 2001 美国 多中心 65 50±12 23 42 70 45±14 28 42 CsA+MMF+Pred 3
    Lebranchu Y, et al[10] 2002 法国 多中心 50 46±11 0 50 50 44±11 0 50 CsA+MMF+Pred 3
    Tullius SG, et al[11] 2003 德国 单中心 62 19~71 0 62 62 16~69 0 62 Tac+Pred 3
    Mourad G, et al[12] 2004 法国 多中心 53 45±13 1 52 52 45±12 2 50 CsA+MMF+Pred 3
    Brennan DC, et al[13] 2006 美国、欧洲 多中心 141 51±13 0 141 137 50±13 0 137 CsA+MMF+Pred 4
    Kyllönen LE, et al[14] 2007 芬兰 单中心 53 22~64 0 53 58 22~65 0 58 CsA+AZA+Pred 4
    Pilch NA, et al[15] 2014 美国 单中心 102 52±13 19 83 98 49±14 19 79 CsA+MMF+Pred 4
    Patel HV, et al[16] 2014 印度 单中心 80 36 49 31 20 45 15 5 CsA/Tac+MMF/AZA +Pred 3
    Tedesco-Silva H, et al[17] 2015 巴西 单中心 85 44±14 18 67 102 45±14 36 66 Tac+EVR 4
    Thomusch O, et al[18] 2016 德国 多中心 192 54±12 24 168 189 54±13 20 169 Tac+MMF+Pred 4
    注:①年龄的表示方法有均数±标准差、范围、平均数。
    ②CsA为环孢素。
    ③MMF为吗替麦考酚酯。
    ④Pred为泼尼松。
    ⑤Tac为他克莫司。
    ⑥AZA为硫唑嘌呤。
    ⑦EVR为依维莫司。
    下载: 导出CSV
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  • 收稿日期:  2022-03-20
  • 网络出版日期:  2022-07-14
  • 刊出日期:  2022-07-15

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