Yang Meng, Liao Chifeng, Zhu Qinghuan, Lin Xiaoying, Yang Binbin, Zhao Di, Li Jianmin, Deng Danqi, Zhang Wei
Department of Dermatology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, Yunnan, China.
Department of Dermatology, The Third Affiliated Hospital of Guangxi Medical University, 13 Dancun Road, Nanning, 530031, Guangxi, China.
Clin Rheumatol. 2020 Dec;39(12):3581-3592. doi: 10.1007/s10067-020-05156-7. Epub 2020 May 28.
To systematically evaluate the efficacy and safety of immunoadsorption (IAS) versus non-IAS for systemic lupus erythematosus (SLE) among Chinese population. A meta-analysis was performed by all the literatures germane to estimate the SLE patients treated with IAS and non-IAS from published randomized controlled trials (RCTs) from 1990 to February 2020. Mean differences (MDs), relative ratios (RRs), and 95% confidence intervals (CIs) were calculated, and the meta-analysis was conducted with Stata 12.0 software. A total of 18 RCTs involving 457 patients were included. The results of meta-analysis demonstrated that the IgG, Scr, Bun, ANA, 24-h urine protein, leptin, and TNF-α of IAS combined with a drug therapy group were lower than that of non-IAS, and the levels of C3 and C4 were higher than that of non-IAS after treatment in terms of laboratory parameters. In terms of adverse reactions, the incidence of fever or chills, low blood pressure, or bleeding risk was higher in the treatment group. However, there was no difference in the incidence of puncture point bleeding, thrombocytopenia, mild rash, death due to severe infection, tightness, palpitation, or chest tightness between the two groups. However, most of the adverse effects could be considered as tolerable after timely treatment. Our results indicate that IAS may be superior to non-IAS in treating SLE patients. However, due to the lower quality of included studies, high quality of multicenter, large sample size, randomized, and double-blind controlled trials are needed to validate the results.
为系统评价免疫吸附(IAS)与非免疫吸附治疗中国人群系统性红斑狼疮(SLE)的疗效和安全性。通过检索1990年至2020年2月发表的随机对照试验(RCT)中所有关于接受IAS和非IAS治疗的SLE患者的相关文献进行荟萃分析。计算平均差(MD)、相对比(RR)和95%置信区间(CI),并使用Stata 12.0软件进行荟萃分析。共纳入18项RCT,涉及457例患者。荟萃分析结果显示,就实验室指标而言,IAS联合药物治疗组治疗后的IgG、Scr、Bun、ANA、24小时尿蛋白、瘦素和TNF-α低于非IAS组,C3和C4水平高于非IAS组。在不良反应方面,治疗组发热或寒战、低血压或出血风险的发生率较高。然而,两组在穿刺点出血、血小板减少、轻度皮疹、严重感染导致的死亡、胸闷、心悸或胸痛的发生率方面无差异。不过,大多数不良反应经及时治疗后可认为是可耐受的。我们的结果表明,IAS在治疗SLE患者方面可能优于非IAS。然而,由于纳入研究的质量较低,需要高质量的多中心、大样本量、随机、双盲对照试验来验证结果。