Xu Gaosi, Tu Weiping, Jiang Dongfeng, Xu Chengyun
Department of Nephrology, Second Affiliated Hospital, Nanchang University, 1 Minde Road, Nanchang, PR China.
Am J Nephrol. 2009;29(5):362-7. doi: 10.1159/000168483. Epub 2008 Oct 31.
Worldwide, IgA nephropathy (IgAN) is the most common type of glomerulonephritis. Mycophenolate mofetil (MMF) is relatively selective for lymphocytes and inhibits antibody production by B cells more than other immunosuppressants. Several randomized controlled trials (RCTs) have analyzed the role of MMF in patients with IgAN. We conducted this meta-analysis of all available RCTs to ascertain the benefits and risks of MMF treatment in comparison with placebos or steroids in patients with IgAN.
The studies were identified by extended computer-based searches of the PubMed database (April, 2008) and the Cochrane Library, without language restriction. References in Medline-cited studies were reviewed to identify additional reports not indexed by Medline. RCTs comparing treatment of IgAN with mycophenolate against placebo or steroids were included in the analysis.
We identified 32 potentially relevant articles, but only 4 RCTs, which had enrolled a total of 168 patients, were included. Our meta-analysis demonstrated that MMF treatment did not have statistically significant effects in reducing proteinuria or protecting renal function in patients with IgAN.
The currently available evidence does not support the routine use of MMF in patients with IgAN. Larger international collaborations should be put in place to further address this issue.
在全球范围内，IgA肾病（IgAN）是最常见的肾小球肾炎类型。霉酚酸酯（MMF）对淋巴细胞具有相对选择性，并且比其他免疫抑制剂更能抑制B细胞产生抗体。多项随机对照试验（RCT）分析了MMF在IgAN患者中的作用。我们对所有可用的RCT进行了这项荟萃分析，以确定与安慰剂或类固醇相比，MMF治疗在IgAN患者中的益处和风险。
通过对PubMed数据库（2008年4月）和Cochrane图书馆进行基于计算机的扩展检索来识别研究，无语言限制。对Medline引用研究中的参考文献进行审查，以识别未被Medline索引的其他报告。将比较霉酚酸酯与安慰剂或类固醇治疗IgAN的RCT纳入分析。
我们识别出32篇潜在相关文章，但仅纳入了4项RCT，共纳入168例患者。我们的荟萃分析表明，MMF治疗在降低IgAN患者蛋白尿或保护肾功能方面没有统计学上的显著效果。
目前可得的证据不支持在IgAN患者中常规使用MMF。应开展更大规模的国际合作以进一步解决这一问题。
