• 1. 成都市第三人民醫(yī)院神經(jīng)科,成都,610031 2. 四川大學(xué)華西醫(yī)院泌尿外科,成都,6100413. 中國(guó)循證醫(yī)學(xué)中心,成都,6100414. 四川大學(xué)華西醫(yī)院衛(wèi)生部移植工程與移植免疫重點(diǎn)實(shí)驗(yàn)室,成都,6100415. 成都中醫(yī)藥大學(xué),成都,610072;

目的 　客觀評(píng)價(jià)腎移植術(shù)后驍悉(mycohpenolate mofetil,MMF)與硫唑嘌呤(azathioprine,AZA)抗排斥反應(yīng)效果的差別.
方法 　計(jì)算機(jī)檢索Medline(1996～2002.6)、Embase(1984～2002.6)、Cochrane圖書(shū)館(2002年第二期)及中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(1979～2002.6),鑒定有關(guān)隨機(jī)對(duì)照試驗(yàn),并采用Revman 4.11進(jìn)行Meta-分析.
結(jié)果 　共納入22個(gè)隨機(jī)對(duì)照試驗(yàn),涉及不同劑量MMF與AZA用于腎移植術(shù)后抗排斥治療,發(fā)現(xiàn)MMF 2 g/d比AZA可提高移植腎短期存活率及病人長(zhǎng)期存活率,而MMF3 g/d與 AZA對(duì)提高病人及移植腎存活率無(wú)統(tǒng)計(jì)學(xué)差異.術(shù)后6月至1年內(nèi),MMF 2g/d或MMF 3 g/d均較AZA明顯降低移植腎急性排斥發(fā)生率.
結(jié)論 　MMF較AZA免疫抑制效力更強(qiáng),MMF降低腎移植術(shù)后急性排斥反應(yīng)發(fā)生率明顯優(yōu)于AZA,運(yùn)用MMF對(duì)提高腎移植術(shù)后移植腎存活率及病人長(zhǎng)期生存率有利.MMF 2 g/d是較理想的使用劑量.

引用本文： 張海濤,王坤杰,李幼平,高勵(lì),劉瑾,蔡羽嘉. 腎移植術(shù)后驍悉與硫唑嘌呤抗排斥反應(yīng)隨機(jī)對(duì)照試驗(yàn)的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2004, 04(2): 79-91. doi: 復(fù)制

1. ［1］Duquesnoy RT, Li YP. Editor-in-chief. Transplant Immunobiology 1st ed. Beijing: Science Press, 2003; 376Duquesnoy RT,.
2. 李幼平,主編.移植免疫生物學(xué)[M].北京:科學(xué)出版社,2000;376.
3. ［2］US Renal Transplant Mycophenolate Mofetil Study Group.Mycophenolate mofetil in cadaveric renal transplantation. Am J Kidney Disease[ J]. 1999; 34 (2): 296-303.
4. ［3］DanovithGM. Mycophenolatemofetilinrenaltransplantation [J].Kidney International, 1995; 52(suppl): 93-96.
5. ［4］Miller J, Mendez R, Pirsch JD, Jensik SC. Safety and efficacy of tacrolimus in combination with mycophenolate mofetil in cadaveric renal transplant recipients [ J ]. Transplantation,2000; 69(5): 875-880.
6. ［5］Ahsan N, Johnson C, Gonwa T, Hallorax P, Stegall M,Hardy M, Metzger R, Shield C, Rocher L, Scandling J.Randomized trial of tacrolimus plus mycophenolate mofetil or azathioprine versus cyclosporine oral solution (modified) plus mycophenolate mofetil after cadaveric kidney transplantation:results at 2 years[J]. Transplantation,2001; 72(2): 245-250.
7. ［6］The Mycophenolate Mofetil Acute Renal Rejection Study Group. Mycophenolate mofetil for the treatment of a first acute renal allograft rejection: three-year follow-up [ J ].Transplantation, 2001; 71 (8): 1091-1097.
8. ［7］Johnson C, Ahsan N, Gonwa T, Hallorax P, Stegall M,Hardy M, Metzger R, Shield C, Rocher L, Scandling J.Random trial of tacrolimus in combination with azathioprine or mycophenolate mofetil versus cyclosponne with mycophenolate mofetil after cadaveric kidney transplantation[J]. Transplantation, 2000; 69 (5): 834-841.
9. ［8］Jirasiritham S, Sumethkul V, Mavichak V, Chalermsanyakom P. The treatment of chronic rejection with mycophenolate mofetil versus azathioprine in kidney transplantation [ J ].Transplant Proc, 2000; 32(7): 2040-2042.
10. ［9］Suhail SM, Vathsala A, Lou HX, Woo KT. Safety and efficacy of mycophenolate mofetil for prophylaxis in Asian renal transplant recipients [ J ]. Transplant Proc, 2000; 32 (7):1757-1758.
11. ［10］MathewTH. Ablinded, long-time, randomizedmulticenter study of mycophenolate mofetil in cadaveric renal transplantation: result at three years [ J ]. Transplantation,1998; 65(11): 1450-1454.
12. ［11］Mendez R. FK 5 0 6 and mycophenolate mofetil in renal transplant recipients: six-month result of a multicenter,randomized dose ranging trial. Transplantation Proc, 1998; 30(4): 1287-1289.
13. ［12］The Mycophenolate mofetil Acute Renal Rejection Study Group. Mycophenolate mofetil for the treatment of a first acute renal allograft rejection [ J ]. Transplantation, 1998; 65(2): 235-241.
14. ［13］Neylan JE. Immunosupppressive therapy in high-risk transplant patients: dose-dependent efficacy of mycophenolate mofetil in African-American renal allograft recipients [ J ].Transplantation, 1997; 64(9): 1277-1282.
15. ［14］The U. S. Mycophenolate Mofetil Study Group. Mycophenolate mofetil for the prevention of acute rejection of primary cadaveric kidney transplants: status of the MYC 1866 study at 1 year[J]. Transplant Proc, 1997; 29(1-2): 348-349.
16. ［15］Halloran P, Mathew T, Tomlanovich S, Groth C, Hooftman L, Barker C. Mycophenolate mofetil in renal allograft recipients: a pooled efficacy analysis of three randomized,double-blind, clinical studies in prevention of rejection [J ].Transplantion, 1997; 63(1): 39-47.
17. ［16］The Tricontinental Mycophnolate Mofetil Rneal Transplantation Study Group. A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation[J]. Transplantation, 1996; 61(7): 1029-1037.
18. ［17］Solinger HW. Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients[J]. Transplantation, 1995 ;60(3) :225-232.
19. ［18］European Mycophenolate Mofetil Cooperative Study Group.Mycophenolate in renal transplantation: 3-year results from the placebo-controlled trial [J ]. Transplantation, 1999; 68 (3):391-396.
20. ［19］European Mycophenolate Mofetil Cooperative Study Group.Placebo-controlled study of mycophenolate mofetil combined with cyclosporin and corticosteroid for prevention of acute rejection[J]. Lancet, 1995; 345(8961): 1321-1325.
21. ［20］ChoS, HodgeE, NavarroM. Mycophenolatemofetilimproves long-term graft survival following renal transplantation in patients experiencing delayed graft function [ J ].Transplantation Proc, 1999; 31 (1-2): 322-323.
22. ［21］Ji YL,Yang YQ,Yang GB, Yu XQ, Jiang ZP, Cheng QD,Wu PG. The clinical investigation of mycophenolate mofetil for the prevention of acute rejection [ J ]. Acad J SUMS,2001; 22(3): 215-217.
23. 紀(jì)玉蓮,楊彥強(qiáng),楊光寶,余學(xué)清,姜宗培,沈清端,吳培根,朱蘭英.霉酚酸酯預(yù)防腎移植術(shù)后急性排斥反應(yīng)臨床觀察[J].中山醫(yī)科大學(xué)學(xué)報(bào),2001;22(3):215-217.
24. ［22］Huang LP, Yang SY, Wu XT, Cheng ZB, Wang ZX, Wei X. Clinical observation on the early application of cellcept following cadaveric renal tansplantation [ J ]. Chin J Organ Transplant, 2000; 21 (5): 294-295.
25. 黃麗萍,楊詩(shī)玉,武小桐,陳再彬,王振興,衛(wèi)燾.腎移植患者術(shù)后早期應(yīng)用霉酚酸酯的臨床觀察[J].中華器官移植雜志,2000;21(5):294-295.
26. ［23］Hongbo G, Yuhai Z. The use of mycophenolate mofetil in renal tansplantation[J]. China J New Drug, 1998; 7 (6):444-446.
27. 郭宏波,張玉海.霉酚酸酯(MMF)在腎移植中的應(yīng)用[J].中國(guó)新藥雜志,1998;7(6):444-446.
28. ［24］Ling JY, Zhu Y, Shun FK. Combined use of MMF with low dosage of cyclosporine A in renal tansplantation[J ]. Chin J Organ Transplant, 1998; 19(3): 175-176.
29. 凌建煜,祝宇,孫?？?驍悉與小劑量環(huán)孢素A在尸體腎移植中的聯(lián)合應(yīng)用[J].中華器官移植雜志,1998;19(3):175-176.
30. ［25］Wang QW, Ji SM, ChengJS, Ying LP, Xu B, Cheng HP,Li LS. Prevention acute rejection of MMF in renal tansplantion [J]. J Nephrol Dialy Transplant, 1998; 7 (1): 34-37.
31. 王慶文,季曙明,陳勁松,陳勁松,殷立平,徐斌,陳惠萍,黎磊石.霉酚酸酯預(yù)防尸體腎移植急性排斥反應(yīng)[J].腎臟病與透析腎移植雜志,1998;7(1):34-37.
32. ［26］European Mycophenolate Mofetil Cooperation Study Group.Mycophenolate mofetil in renal transplantation: 3-year results from the placebo-controlled trial [J ]. Transplantation, 1999;68(3): 391-396.
  1. 1. ［1］Duquesnoy RT, Li YP. Editor-in-chief. Transplant Immunobiology 1st ed. Beijing: Science Press, 2003; 376Duquesnoy RT,.
  2. 2. 李幼平,主編.移植免疫生物學(xué)[M].北京:科學(xué)出版社,2000;376.
  3. 3. ［2］US Renal Transplant Mycophenolate Mofetil Study Group.Mycophenolate mofetil in cadaveric renal transplantation. Am J Kidney Disease[ J]. 1999; 34 (2): 296-303.
  4. 4. ［3］DanovithGM. Mycophenolatemofetilinrenaltransplantation [J].Kidney International, 1995; 52(suppl): 93-96.
  5. 5. ［4］Miller J, Mendez R, Pirsch JD, Jensik SC. Safety and efficacy of tacrolimus in combination with mycophenolate mofetil in cadaveric renal transplant recipients [ J ]. Transplantation,2000; 69(5): 875-880.
  6. 6. ［5］Ahsan N, Johnson C, Gonwa T, Hallorax P, Stegall M,Hardy M, Metzger R, Shield C, Rocher L, Scandling J.Randomized trial of tacrolimus plus mycophenolate mofetil or azathioprine versus cyclosporine oral solution (modified) plus mycophenolate mofetil after cadaveric kidney transplantation:results at 2 years[J]. Transplantation,2001; 72(2): 245-250.
  7. 7. ［6］The Mycophenolate Mofetil Acute Renal Rejection Study Group. Mycophenolate mofetil for the treatment of a first acute renal allograft rejection: three-year follow-up [ J ].Transplantation, 2001; 71 (8): 1091-1097.
  8. 8. ［7］Johnson C, Ahsan N, Gonwa T, Hallorax P, Stegall M,Hardy M, Metzger R, Shield C, Rocher L, Scandling J.Random trial of tacrolimus in combination with azathioprine or mycophenolate mofetil versus cyclosponne with mycophenolate mofetil after cadaveric kidney transplantation[J]. Transplantation, 2000; 69 (5): 834-841.
  9. 9. ［8］Jirasiritham S, Sumethkul V, Mavichak V, Chalermsanyakom P. The treatment of chronic rejection with mycophenolate mofetil versus azathioprine in kidney transplantation [ J ].Transplant Proc, 2000; 32(7): 2040-2042.
  10. 10. ［9］Suhail SM, Vathsala A, Lou HX, Woo KT. Safety and efficacy of mycophenolate mofetil for prophylaxis in Asian renal transplant recipients [ J ]. Transplant Proc, 2000; 32 (7):1757-1758.
  11. 11. ［10］MathewTH. Ablinded, long-time, randomizedmulticenter study of mycophenolate mofetil in cadaveric renal transplantation: result at three years [ J ]. Transplantation,1998; 65(11): 1450-1454.
  12. 12. ［11］Mendez R. FK 5 0 6 and mycophenolate mofetil in renal transplant recipients: six-month result of a multicenter,randomized dose ranging trial. Transplantation Proc, 1998; 30(4): 1287-1289.
  13. 13. ［12］The Mycophenolate mofetil Acute Renal Rejection Study Group. Mycophenolate mofetil for the treatment of a first acute renal allograft rejection [ J ]. Transplantation, 1998; 65(2): 235-241.
  14. 14. ［13］Neylan JE. Immunosupppressive therapy in high-risk transplant patients: dose-dependent efficacy of mycophenolate mofetil in African-American renal allograft recipients [ J ].Transplantation, 1997; 64(9): 1277-1282.
  15. 15. ［14］The U. S. Mycophenolate Mofetil Study Group. Mycophenolate mofetil for the prevention of acute rejection of primary cadaveric kidney transplants: status of the MYC 1866 study at 1 year[J]. Transplant Proc, 1997; 29(1-2): 348-349.
  16. 16. ［15］Halloran P, Mathew T, Tomlanovich S, Groth C, Hooftman L, Barker C. Mycophenolate mofetil in renal allograft recipients: a pooled efficacy analysis of three randomized,double-blind, clinical studies in prevention of rejection [J ].Transplantion, 1997; 63(1): 39-47.
  17. 17. ［16］The Tricontinental Mycophnolate Mofetil Rneal Transplantation Study Group. A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation[J]. Transplantation, 1996; 61(7): 1029-1037.
  18. 18. ［17］Solinger HW. Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients[J]. Transplantation, 1995 ;60(3) :225-232.
  19. 19. ［18］European Mycophenolate Mofetil Cooperative Study Group.Mycophenolate in renal transplantation: 3-year results from the placebo-controlled trial [J ]. Transplantation, 1999; 68 (3):391-396.
  20. 20. ［19］European Mycophenolate Mofetil Cooperative Study Group.Placebo-controlled study of mycophenolate mofetil combined with cyclosporin and corticosteroid for prevention of acute rejection[J]. Lancet, 1995; 345(8961): 1321-1325.
  21. 21. ［20］ChoS, HodgeE, NavarroM. Mycophenolatemofetilimproves long-term graft survival following renal transplantation in patients experiencing delayed graft function [ J ].Transplantation Proc, 1999; 31 (1-2): 322-323.
  22. 22. ［21］Ji YL,Yang YQ,Yang GB, Yu XQ, Jiang ZP, Cheng QD,Wu PG. The clinical investigation of mycophenolate mofetil for the prevention of acute rejection [ J ]. Acad J SUMS,2001; 22(3): 215-217.
  23. 23. 紀(jì)玉蓮,楊彥強(qiáng),楊光寶,余學(xué)清,姜宗培,沈清端,吳培根,朱蘭英.霉酚酸酯預(yù)防腎移植術(shù)后急性排斥反應(yīng)臨床觀察[J].中山醫(yī)科大學(xué)學(xué)報(bào),2001;22(3):215-217.
  24. 24. ［22］Huang LP, Yang SY, Wu XT, Cheng ZB, Wang ZX, Wei X. Clinical observation on the early application of cellcept following cadaveric renal tansplantation [ J ]. Chin J Organ Transplant, 2000; 21 (5): 294-295.
  25. 25. 黃麗萍,楊詩(shī)玉,武小桐,陳再彬,王振興,衛(wèi)燾.腎移植患者術(shù)后早期應(yīng)用霉酚酸酯的臨床觀察[J].中華器官移植雜志,2000;21(5):294-295.
  26. 26. ［23］Hongbo G, Yuhai Z. The use of mycophenolate mofetil in renal tansplantation[J]. China J New Drug, 1998; 7 (6):444-446.
  27. 27. 郭宏波,張玉海.霉酚酸酯(MMF)在腎移植中的應(yīng)用[J].中國(guó)新藥雜志,1998;7(6):444-446.
  28. 28. ［24］Ling JY, Zhu Y, Shun FK. Combined use of MMF with low dosage of cyclosporine A in renal tansplantation[J ]. Chin J Organ Transplant, 1998; 19(3): 175-176.
  29. 29. 凌建煜,祝宇,孫?？?驍悉與小劑量環(huán)孢素A在尸體腎移植中的聯(lián)合應(yīng)用[J].中華器官移植雜志,1998;19(3):175-176.
  30. 30. ［25］Wang QW, Ji SM, ChengJS, Ying LP, Xu B, Cheng HP,Li LS. Prevention acute rejection of MMF in renal tansplantion [J]. J Nephrol Dialy Transplant, 1998; 7 (1): 34-37.
  31. 31. 王慶文,季曙明,陳勁松,陳勁松,殷立平,徐斌,陳惠萍,黎磊石.霉酚酸酯預(yù)防尸體腎移植急性排斥反應(yīng)[J].腎臟病與透析腎移植雜志,1998;7(1):34-37.
  32. 32. ［26］European Mycophenolate Mofetil Cooperation Study Group.Mycophenolate mofetil in renal transplantation: 3-year results from the placebo-controlled trial [J ]. Transplantation, 1999;68(3): 391-396.