29 5 2 0 0 8 1 0 ( ) J ournal of Xiπan J iaot ong U niversity (Medical Sciences) V ol. 29 No. 5 Oct. 2008 Meta 1, 1, 2, 1, 1 (1., 510515 ;2. 456, 250031) : PUBMED,, Meta 24 h 10, ( P < 0. 05),, ( P < 0. 05) : ; ; ; :R593. 241 :A :167128259 (2008) 0520549207 Meta2analysis of mycophenolate mofetil versus cyclophosphamide f or diff use proliferative lupus nephritis Chen Mingyu 1, Sun Ledong 1, Zhao Jia 2, Zeng Kang 1, Zhou Zaigao 1 (1. Department of Dermatology, Nanfang Hospital, Nanfang Medical University, Guangzhou 510515 ; 2. Cadresπ Ward, No. 456 Hospital of PL A, Jiπnan 250031, China) ABSTRACT : Objective To evaluate t he efficacy and saf ety of mycop henolate mof etil and cyclop hosp hamide in t reating diff use p rolif erative lup us nep hritis. Methods Published p ap ers on randomized, cont rolled and p rospective clinical t rials about mycop henolate mof etil and cyclop hosp hamide used t o t reat diff use p rolif erative lup us nep hritis were collected f rom PUBM ED a nd CN KI, meta2a nalysis was made t o evaluate t he re mission, relapse, deat h, 242hr urine p rotein, serum creatinine, activity index of disease, chronic index of disease, inf ection, leucop enia, amenorrhea and diarrhea. Re sults Alt oget her 10 p apers are included in t he study. In declining activity index of disease, mycop he nolate mof etil is better t han cyclop hosp hamide in t reat ment f or diff use p rolif erative lup us nep hritis ( P < 0. 05 ), and t he incidence of inf ection, leucop enia a nd a menorr hea af ter mycop he nolate mof etil t reat ment is lower t ha n cyclop hosp ha mide in t reat me nt f or diff use p rolif erative lup us nep hritis ( P < 0. 05). Conclusion In t reating diff use p rolif erative lup us nep hritis, mycop henolate mof etil is better t han cyclop hosp hamide on t he decline of activity index and saf ety. KEY WORDS : mycop henolate mof etil ; cyclop hosp hamide ; diff use p rolif erative lup us nep hritis ; meta2analysis (diff use proliferative lup us nep hritis, DPL N),, (cyclop hosp hamide, CTX) DPLN, MMF CTX L N, DPLN,, DPL N,,, ( mycop henolate mofetil, MMF) Meta, DPL N (lup us nep hritis, L N),LN, :2007211213 :2007212230 :,,,. E2mail : npfk @fimmu. com : (19752), ( ),,,. E2mail : chenmingyu3w @163. com 1 1. 1 1. 1. 1 (ARA),
550 ( ) 29 DPLN ; : ( RCT),, ; MMF CTX ( T ) (C ) ; 3 1. 1. 2 MMF ; MMF, 1. 2 1. 2. 1 : PUBM ED ; : : (Mycop he2 nolate Mofetil or Cyclop ho sp hamide) and ( L up us Nep hritis or systemic lup us eryt hematosus) ; : ( ) 1. 2. 2, ( ) 16 ( 1980. 1-2007. 9), 1. 3 1. 3. 1 24 h ( A I) (CI) 1. 3. 2 1. 4 2, 2 1 MMF CTX DPLN Table 1 The methodology quality table of MMF and CTX for DPLN Studies n( T/ C) Age (years) Sex ( F/ M) Chan TM2000 [1 ] 21/ 21 Chan TM2005 [2 ] 33/ 31 Fang J A [3 ] 36/ 32 Hu WX [4 ] 23/ 23 Jiang W G [5 ] 25/ 21 Liu GP [6 ] 20/ 20 Li H [7 ] 20/ 19 Wang J [8 ] 9/ 11 Yi L 9 ] 38/ 40 Zhu B 10 ] 14/ 14 T :32. 0 11. 0 C :33. 0 12. 0 T :38. 1 10. 2 C :41. 8 8. 9 T :27. 2 2. 2 C :27. 9 2. 1 T :28. 0 8. 8 C :29. 5 10. 2 T :37. 0 10. 0 C :39. 0 11. 0 T :37. 0 10. 0 C :35. 0 8. 0 T :31. 0 7. 0 C :33. 0 6. 0 T :32. 3 10. 9 C :31. 6 11. 6 T :29. 5 3. 2 C :25. 5 4. 8 T :27. 2 3. 9 C :28. 7 5. 4 Cochrane Reviewer Handbook4. 2. 2,,, 1. 5 ReVman4. 2 Meta ( P > 0. 05),, ( P < 0. 05), ( OR) 95 % CI, (W M D) 2 2. 1 1 884,,,, 10 ( RCT) [ 1210 ], 1 188. 4 2. 2 1 2. 2. 1 10, 2. 2. 2 2 [122 ] 2. 2. 3 2 [ 122 ], 2. 2. 4, T :19/ 2 C :18/ 3 T :26/ 6 C :26/ 4 T :28/ 8 C :27/ 5 T :19/ 4 C :19/ 4 T : 24/ 1 C : 19/ 2 T : 18/ 2 C : 19/ 1 T :16/ 4 C :16/ 3.. T : 33/ 5 C : 34/ 6 T : 12/ 2 C : 12/ 2 Allocation concealment Blinding Grade Sealed envelopes Not blinding B Sealed envelopes Open process B
5,,,. Meta 551 2. 3 Meta 2. 3. 1 ( 1-11) 6 [122,528 ],4 [3,526 ],5 [122,5,728 ], 4 [3,526,9 ] 2 [5,8 ] 3 [ 1,526 ] 3 6 12 24 h,4 [3,526,9 ] 3 [ 526,8 ] 2 [ 526 ] 3 6 12,2 [4,10 ] (CI) ( P 0. 05), Meta, ( P 0. 05) ;2 [4,10 ] (A I), ( P 0. 05), Meta, ( P < 0. 05)
552 ( ) 29 2. 3. 2 ( 12-15 ) 7 [1,2,426,8,10 ],6 [1,2,426,10 ], ( P 0. 05), Meta, ( P < 0. 05), ( P 0. 05)
5,,,. Meta 553 3 CTX DPL N, 80,L N 5 85 % [ 11 ], MMF T B,,, L N CTX [12 ],, 24 h CI,, 95 %,,MMF CTX DPLN Meta,
554 ( ) 29 ( P 0. 05),, (test for over effect) ( P 0. 05), DPL N,,MMF CTX A I, 2 95 %, 2, MMF CTX DPL N A I Meta, ( 2 = 0. 15, P = 0. 69),, ( Z = 4. 40, P < 0. 001), (95 % CI), MMF CTX DPL N A I, DPL N, A I, CI, MMF, A I, CTX CI,,, 7 7 6,
5,,,. Meta 555, 3, 1, MMF CTX DPL N Meta, ( P = 0. 69),, ( P < 0. 05), 3 (95 % CI), MMF CTX 15 MMF CTX DPLN Fig. 15 The diarrhea of MMF and CTX for DPL N DPL N CTX MMF CTX DPL N, 95 %,,MMF CTX DPL N Meta, ( P = 1. 00),, ( P = 0. 14) MMF CTX DPL N, RCT,,, MMF CTX DPL N, : [ 1 ] Cha n TM, Li F K, Ta ng CS, et al. Efficacy of mycop henolate mof etil in patients with diff use p rolif erative lup us nep hritis. Hong Kong2Guangzhou Nep hrology Study Group [J ]. N Engl J Med, 2000, 343 (16) :115621162. [ 2 ] Chan TM, Tse KC, Ta ng CS, et al. L ong2ter m study of myco2 p henolate mof etil as continuous induction and maintenance treat ment f or diff use p rolif erative lupus nep hritis [J ]. J A m Soc Nep hrol,2005,16 (4) :107621084. [ 3 ]. [J ]., 2004, 5 (8) :4622463. [ 4 ] Hu WX, Liu ZH, Chen HP, et al. Mycophenolate mofetil vs cyclo2 phosphamide therapy f or patients with diffuse proliferative lupus ne2 phritis [J ]. Chin Med J, 2002,115 (5) :7052709. [ 5 ],,. [J ].,2002, 3 (4) :2182221. [ 6 ],,. [J ]., 2003, 4(7) :3862388. [ 7 ],. [J ]., 2004, 23 (2) :1602160. [ 8 ],,,. IV [J ]., 2006,15 (3) :2192224. [ 9 ],,,. 38 [J ].,2005, 27 (4) :12213. [ 10 ],,,. IV [J ]. ( ), 2003, 41 ( 6) : 6922694. [ 11 ] Ca meron JS. L up us Nep hritis [J ]. J A m Soc Nep hrol,1999,10 : 4132413. [ 12 ] Allison A C, Eugui EM. Purine metabolism and immunosuppres2 sive eff ects of mycop henolate mof etil ( MM F) [J ]. Clin Trans2 plant, 1996,10 :77284. ( )