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静脉滴注免疫球蛋白治疗多发性硬化随机对照试验的meta分析
作者: 刘振宝 苗玲 李焰生 钟根龙 张博恒
单位:刘振宝,苗玲,李焰生,钟根龙(上海交通大学医学院附属仁济医院神经内科,上海,200001)张博恒(复旦大学循证医学中心)
关键词: 免疫球蛋白 多发性硬化 复发缓解型 继发进展型 meta分析
分类号:
出版年·卷·期(页码):2009·35·第 9 期(0-0)
摘要:
目的 系统评价静脉滴注免疫球蛋白(intravenous immunoglobulin,IVIG)维持治疗多发性硬化(multiple sclerosis,MS)的临床疗效.方法 采崩Cochrane系统评价方法,通过电子检索MEDLINE、EMbas、CBMdisc、Cochrane Library、ISI和美国临床试验登记中心等的数据库文献(1990~2008).评价纳入文献的方法学质量后,采用RevMan 4.2.10软件对提取的数据进行分析.结果 共纳入10个随机对照试验研究.IVIG治疗组与安慰剂组比较,研究期限内复发缓解型多发性硬化(relapsing-remitting muhiple sclerosis,RRMS)患者的复发状况差异有统计学意义(P=0.04,OR:0.40.95%CI=0.19~0.86),RRMS患者EDSS评分的变化差异有统计学意义(P<0.0001,WMD=-0.27,95%CI=-0.40~-0.13),不同剂量IVIG(每个月0.2 g/kg与0.4 g/kg)治疗RRMS的复发状况比较差异无统计学意义(P=0.69,OR=1.16,95%CI=0.56~2.41);IVIG与干扰素-β1a治疗RRMS的疗效比较,显示二者均能降低疾病的复发率,二者之间无统计学差异(P>0.1),而在治疗前后EDSS评分的比较中,仅IVIG治疗前后的差异有统计学意义.IVIG治疗组与安慰剂组比较,研究期限内进展型MS患者的疾病进展状况差异无统计学意义(P=0.32,OR=0.68,95%CI=0.31~1.46),继发进展型多发性硬化(secondary-progressivemultiple sclerosis,SPMS)患者的复发状况差异无统计学意义(P=0.70,OR=0.93,95%CI=0.66~1.32).结论 IVIG用于维持治疗MS,其安全性好,可降低RRMS的复发率及EDSS评分显示的神经功能障碍.不同剂量的IVIG治疗RRMS无剂量-效应关系.IVIG与干扰素-β1a均能降低RRMS的复发率,IVIG改善神经功能方面的疗效优于低剂量的干扰素-β1a.目前尚不能认为IVIG用于进展型MS的维持治疗可以阻止疾病的进展及复发.
参考文献:
  • Dalakas MC Mechanism of action of intravenous imniunoglobulin and therapeutic considerations in the treatment of autoimmune neurologic diseases 1998(z5)
  • Kazatchkine MD.Kaveri SV Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin 2001(10)
  • Noseworthy JH.O'Brien PC.van Engelen BC Intravenous imniunoglobulin therapy in multiple sclerosis:progress from remy elination in the Theiler's virus model to a randomised,double blind,placebo-controlled clinical trial 1994(zk)
  • Filippi M.Rocca MA.Pagani E European study on intravenous imniunoglobulin in multiple sclerosis ? results of magnetization transfer magnetic resonance imaging analysis 2004(09)
  • Teksam M.Tali T.Kocer B Qualitative and quantitative volumetric evaluation of the efficacy of intravenous immunoglobulin in multiple sclerosis:preliminary report 2000(12)
  • Stangel M.Boegner F.Klatt CH Placebo controlled pilot trial to study the remyelinating potential of intravenous immunoglob ulins in multiple sclerosis 2000(01)
  • Achiron A.Kishner I.Sarova-Pinhas I Intravenous immunoglobulin treatment following the first demyelinating event suggestive of multiple sclerosis;a randomized,double-blind,placebo controlled trial 2004(10)
  • Fazekas F.Sorensen PS.Filippi M MRI results from the European Study on Intravenous Immunoglobulin in Secondary Progressive Multiple Sclerosis(ESIMS) 2005(04)
  • Petereit HF.Reske D.Pukrop R No effect of intravenous immunoglobulins on cytokine-producing lymphocytes in secondary progressive multiple sclerosis 2006(01)
  • Haas J.Homines OR A dose comparison study of IVIC in postpar tum relapsing-remitting multiple sclerosis 2007(07)
  • Visser LH.Beekman R.Tijssen CC A randomized,double-blind,placebo-controlled pilot study of i,v.immune globulins in combination with i.v.methylprednisolone in the treatment of relapses in patients with MS 2004(01)
  • Sorensen PS.Haas J.Sellebjerg F Ⅳ immunoglobulins as add-on treatment to methylprednisolone for acute relapses in MS 2004(11)
  • Fazekas F.Deisenhammer F.Strasser-Fuchs S Randomised placebo-controlled trial of monthly intravenous immunoglobulin therapy in relapsing-remitting multiple sclerosis.Austrian Immunoglobulin in Multiple Sclerosis Study Group 1997(9052)
  • Achiron A.Gabbay U.Gilad R Intravenous immunoglobulin treatment in multiple sclerosis.Effect on relapses 1998(02)
  • Sorensen PS.Wanscher B.Jensen CV Intravenous immunoglobulin G reduces MRI activity in relapsing multiple sclerosis 1998(05)
  • Noseworthy JH.O'Brien PC.Weinshenker BG Ⅳ immunoglobulin does not reverse established weakness in MS 2000(08)
  • Lewanska M.Siger-Zajdel M.Selmaj K No difference in efficacy of two different doses of intravenous immunoglobulins in MS:clinical and MRI assessment 2002(06)
  • Kocer B.Yildirim-Gurel S.Tali ET The role of qualitative and quantitative MRI assessment of multiple sclerosis lesions according to their in evaluating the efficacy of intravenous immunoglobulin G 2004(04)
  • Hommes OR.Sorensen PS.Fazekas F Intravenous immunoglobulin in secondary progressive multiple sclerosis;randomised placebo-controlled trial 2004(9440)
  • Kalanie H.Gharagozli K.Hemmatie A Interferon Beta-1a and intravenous immunoglobulin treatment for multiple sclerosis in Iran 2004(04)
  • Pohlau D.Przuntek H.Sailer M Intravenous immunoglobulin in primary and secondary chronic progressive multiple sclerosis:a randomized placebo controlled multicentre study 2007(09)
  • Fazekas F.Lublin FD.Li D Intravenous immunoglobulin in relapsing-remitting multiple sclerosis;a dose-finding trial 2008(04)
  • 中国多发性硬化及相关中枢神经系统脱髓鞘疾病的诊断和治疗专家组 中国多发性硬化及相关中枢神经系统脱髓鞘疾病的诊断和治疗专家共识(草案) [期刊论文] -中华神经科杂志2006(12)
  • Sorensen PS Treatment of multiple sclerosis with intravenous immunoglobulin;review of clinical trials 2003(02)
  • The IFNB Multiple Sclerosis Study Group Interferon beta-lb is effective in relapsing-remitting multiple sclerosis.I.Clinical results of a multicenter,randomized,double-blind,placebo-controlled trial 1993(04)
  • Jacobs LD.Cookfair DL.Rudick RA Intramuscular Interferon beta-1a for disease progression in relapsing multiple sclerosis.The Multiple Sclerosis Collaborative Research Group(MSCRG) 1996(03)
  • PRISMS Study Group Randomised double-blind placebo-controlled study of Interferon beta-1a in relapsing/remitting multiple sclerosis 1998(9139)
  • Clanet M.Radue EW.Kappos L A randomized,double-blind,dose-comparison study of weekly Interferon beta-1 a in relapsing MS 2002(10)
  • Filippini G.Munari L.Incorvaia B Interferons in relapsing remitting multiple sclerosis:a systematic review 2003(9357)
  • Whitaker JN.McFarland HF.Rudge P Outcomes assessment in multiple sclerosis clinical trials:a critical analysis 1995(01)
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