ObjectiveTo systematically review the efficacy and safety of mycophenolate mofetil (MMF) for Henoch-Schonlein purpura nephritis (HSPN). MethodsDatabases such as PubMed, EMbase, CENTRAL, VIP, CNKI, CBM and WanFang Data were electronically searched for comprehensively collecting the randomized controlled trials (RCTs) on the efficacy and safety of MMF for HSPN from inception to December, 2013. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. ResultsA total of 10 RCTs involving 426 patients (231 in the trial group and 195 in the control group) were included. The trial group was treated with MMF and corticosteroids, and the control group was treated with corticosteroids monotherapy or combined with cyclophosphamide (CTX), leflunomide (LEF), or azathioprine (AZA). The results of meta-analysis showed that, as for efficacy, no significant difference was found between the two groups after six-mouth treatment (OR=1.36, 95%CI 0.67 to 2.73, P=0.85), while after twelve-mouth treatment, MMF was superior to CTX with a significant difference (OR=6.58, 95%CI 2.45 to 17.33, P=0.002). In addition, the efficacy of MMF was still superior to the azathioprine group, but not better than either LEF or prednisone monotherapy. Lower incidence of side effects were found in the MMF group, compared with the CTX group (OR=0.25, 95%CI 0.13 to 0.45, P < 0.000 01) and the prednisone monotherapy group (OR=0.26, 95%CI, 0.09 to 0.79, P=0.02), while there was no significant difference between the MMF group and the LEF group in side effects. ConclusionBased on the current evidence, the efficacy of MMF for HSPN is better than CTX, and its side effects are less than those of CTX and prednisone.
Objective To assess the efficacy and safety of mycophenolate mofetil (MMF) versus cyclophosphamide (CTX) in the induction treatment for lupus nephritis (LN). Methods Such databases as MEDLINE, EMBASE, SCIE, The Cochrane Library, the Cochrane Controlled Trials Register, CBM, and CNKI were searched from their establishment date to August of 2010 to retrieve the randomized controlled trials (RCTs) about MMF versus CTX for LN. The methodology quality of included studies was evaluated. The efficacy indexes i.e. the clinical total remission (TR), complete remission (CR), partial remission (PR), pathological activity index, the chronicity index and complete induction therapy rate (CIR), and the safety indexes i.e. the rate of patient intolerance-to-drug, the incidence of infection, leukopenia and diarrhea, were abstracted. Finally the Meta-analyses were conducted by using Cochrane Collaboration’s RevMan 4.2. Results Eight RCTs involving 773 patients met the inclusive criteria. The results of meta-analyses showed that the total remission rate (OR=1.49, 95%CI 1.10 to 2.02) and complete remission rate (OR=1.67, 95%CI 1.08 to 2.57) were significantly higher in the MMF group than the CTX group. There was no significant difference in the rate of partial remission, the complete induction rate, the rate of patient intolerance-to-drug, the incidence of infection and leukopenia. However, the incidence of diarrhea was higher in the MMF group (OR=2.99, 95%CI 1.87 to 4.78). The results of meta-analyses for type IV LN were the same. Conclusion MMF is superior to CTX in the induction therapy to Lupus Nephritis (type III, IV, V), but the incidence of diarrhea is higher.
Objective To assess the effects of combining intravenous immunoglobulin for systemic lupus erythematosus (SLE) by analyzing the randomized controlled trials (RCT). Methods The electronic databases such as PubMed (1966 to Aug. 2010), EMbase (1974 to Aug. 2010), The Cochrane Library (Issue 2, 2010), CNKI (1994 to Aug. 2010), VIP (1989 to Aug. 2010), CBM (1978 to Aug. 2010) and Chinese Medical Association Digital Periodicals (1998 to Aug. 2010) were searched to collect RCTs of intravenous immunoglobulin for the patients with SLE. The methodology quality of the included studies was evaluated in accordance with RCTs quality evaluation standard of the Cochrane Handbook 4.2.6, and meta-analyses were performed by using RevMan 5.0 software. Results Four RCTs involving 154 participants were included. The results of meta-analyses showed that compared with cyclophosphamide pulse therapy, the combining intravenous immunoglobulin markedly reduced the SLE disease activity index (MD= –3.09, 95%CI –4.21 to –1.97), the incidence of infection (OR=0.24, 95%CI 0.11 to 0.54), the proteinuria (MD= –1.09, 95%CI –2.11 to –0.06), and the relapse of SLE (OR=0.07, 95%CI 0.01 to 0.37). But there was no significant difference in elevating of complement between two groups. Conclusion According to the results of meta-analyses, compared with cyclophosphamide pulse therapy, cyclophosphamide combining intravenous immunoglobulin may be more efficient in improving clinical symptoms, decreasing incidence rate of infectious diseases, and reducing relapse for SLE patients.
bjectiveTo observe the effecacy of immunosuppressive agents on modulation of the disorders of inflammatory and antiinflammatory cytokines in acute pancreatitis, and to investigate the mechanism of treatment of acute pancreatitis with immunosuppressive agents. MethodsSD male rats were divided into 6 groups: group 1, the normal control group (n=6); group 2, acute pancreatitis induced by ductual injection of 5%sodium cholate sulfur at the volume of 1.0 ml/kg without treatment (n=8). After the pancreatitis were induced, the rest rats were injected intravenously with 5Fu 40 mg/kg (group 3, n=6); or methylprednisolone 30 mg/kg (group 4, n=6); or cyclophosphamide 20 mg/kg (group 5, n=6); or methotrexate 1.2 mg/kg (group 6, n=6). Twentyfour hours afteroperation, the animals were killed, the blood samples were taken for measurement of TNFα, IL1, IL6 (by bioassay), and IL10, TGFβ (by ELISA) as well as amylase. ResultsThe inflammatory cytokines (TNFα,IL1,IL6 ) and the antiinflammatory cytokines (IL10 and TGFβ), in blood of acute pancreatitis were increased significantly. After treated with immunosuppressive agents, both the inflammatory and antiinflammatory cytokines were decreased in different degrees. Some indexes of the severity of acute pancreatitis, such as amylase and pancreatic weight were improved obviously.ConclusionImmunosuppressive agents can regulate inflammatoryassociated cytokines increased remarkably in the acute pancreatitis. Therefore, improvement of acute pancreatitis can be achieved through rectifying the abnormal immunity and relieving the pathophysiological disorders of the acute pancreatitis by immunosuppressive agents.
Objective To assess the clinical effectiveness and safety of fludarabine and cyclophosphamide (FC) combined with rituximab chemotherapy regimen (FCR regimen) for patients with chronic lymphoblastic leukemia (CLL). Methods The databases such as PubMed, The Cochrane Library, SpringerLink, CNKI, and CBM were searched from 2000 to 2011. The randomized controlled trials (RCTs) on FC regimen versus FCR regimen for CLL were retrieved. The methodological quality of the included studies was assessed according to the Cochrane Reviewer’s Handbook, and meta-analyses were performed using RevMan 5.0 software. Results Three RCTs involving 1 623 patients with CLL were included. The results of meta-analyses showed that significant differences were found in the progression-free survival (PSF)(Plt;0.001), overall response (OR=1.94, 95%CI 1.49 to 2.53, Plt;0.000 01), complete remission (OR=2.54, 95%CI 2.00 to 3.22, Plt;0.000 01), and grade III or IV neutropenia (OR=1.60, 95%CI 1.33 to 1.92, Plt;0.000 01); but no significant differences were found in the partial response (OR=0.74, 95%CI 0.35 to 1.55, P=0.43), grade III or IV thrombocytopenia (OR=0.97, 95%CI 0.74 to 1.27, P=0.83) and autoimmune hemolytic anemia (OR=0.86, 95%CI 0.59 to 1.27, P=0.45) between FCR and FC regimen. Conclusion The FCR regimen can improve the progression-free survival, overall response and complete remission. Meanwhile, it sometimes increases the incidence of Grade III or IV events, such as neutropenia, thrombocytopenia, autoimmune hemolytic anemia and nausea and vomiting.
In order to investigate the mechanism of enterogenous infection, sixty SD rats were randomly allocated into four groups∶ group of intestinal obstruction; group of cyclophosphamide+intestinal obstruction; group of cyclophosphamide and group of sham-operation. Each group included 15 rats. Twenty four hours after obstruction of the terminal ileum, the bacteria in blood of portal vein, blood of heart, peritoneal fluid, mesenteric lymph node (MLN) and content of gut were determined quantitatively, the concentration of endotoxin in portal system were measured. The results showed that early (24 hours) intestinal obstruction led to endotoxemia in portal vein, overgrowth of enteric G－bacili and bacterial translocation into the MLN. The immunosuppressive agent cyclophosphamide not only increased the rate of bacterial translocation into MLN and the number of living bacteria in MLN, but also promoted bacteria to spread into the systemic circulation. The authors conclude that under immunosuppression the bacterial translocation from gut by way of lymphatic channel plays an important role in enterogenous infection.
摘要:目的:探讨系统性红斑狼疮（SLE）肝损害的临床特点、肝损害发生率与SLE的病情严重程度的关系。方法:对98例SLE的临床资料进行分析,收集所有研究对象的临床资料,对肝损害组(30例)的症状与体征、病情程度、肝功能指标、影像学检查结果进行数据分析,并将其部分生化及免疫学指标与无肝损害组(68对照组)进行比较。结果:SLE患者中SLE肝损害的发生率为30.61%。肝损害组中,病情重度16例(53.33%),17例患者(56.67%)无明显自觉症状,以ALT、AST轻中度升高为主。7例患者肝脏B超异常。肝损害组患者的白细胞值明显低与无肝损害组(Plt;0.05)。而2组的血红蛋白、血小板、CRP、ESR、抗核抗体、抗dsDNA抗体、IgG、补体3等比较差异均无统计学意义(P均gt;0.05)。11例患者接受肾上腺皮质激素(激素)、免疫抑制剂(环磷酰胺、甲氨蝶呤)等药物治疗,9例在出院时复查肝功能正常或好转,另2例肝功能无明显改善;19例患者在接受激素、免疫抑制剂治疗的同时,给予护肝治疗,15例出院复查肝功能正常或好转,另4例无明显改善。而对照组68例中病情重度8例(11.76%)。结论:肝脏是SLE常见累及的靶器官之一,SLE肝损害的临床表现缺乏特异性,以轻至中度肝细胞损害多见,肝损害发生率与SLE病情严重程度成正相关、与SLE的近期预后无关、与长期预后有待进一步研究。Abstract: Objective: To discuss the relationship between the clinical characteristic, The incidence of liver damage and the severity of SLE. Methods: Carries on the mathematical analysis to 98 example SLE clinical material, the collection all object of study clinical material, to liver harm group (30 examples) the symptom and the symptom，Severity the liver function target， the phantom study inspection result carries on the mathematical analysis, and (68 control groups) carries on its part of biochemistry and the immunology target with the nonliver harm group the comparison.Results: In the SLE patient the SLE liver harms the formation rate is 30.61%.In liver harm group, severe illness in 16 cases (53.33%), 17 example patient (56.67%) not obvious subjective symptom, by ALT, AST light moderate ascension primarily.7 example patient liver B ultra exceptionally.The liver harm group patient’s white blood cell value is lower than the nonliver harm group obviously (Plt;0.05), but 2 groups of hemoglobins, the blood platelet, CRP, ESR, the antinuclear immune body, the antidsDNA immune body, IgG, the complement 3 and so on the comparison differences do not have statistics significance (Pgt;0.05). 11 example patients accept the adrenal cortex hormone (hormone), the immunity inhibitor (endoxan, armor ammonia pterin) and so on the medicine treatments, 9 examples when out of hospital reexamines the liver function normal or the change for the better, another 2 example liver function improves not obviously; 19 example patients while accept the hormone, immunity inhibitor treatment, gives protects the liver treatment, 15 example out of hospital reexamination liver function normal or change for the better, another 4 examples improve not obviously. While the control group, 68 cases of severe illness in 8 cases (11.76%).Conclusion: The liver is one of target organs which SLE implicates common, the SLE liver harm. the clinical manifestation lacks the specificity, by sees lightly to the moderate liver cell harm,The incidence of liver damage and SLE severity is positively correlated with shortterm prognosis of SLE has nothing to do with the longterm prognosis remains to be further studied.