ObjectiveTo compare tacrolumus (FK506) with cyclosporine A (CsA) in clinical application to organ transplantation.MethodsThe literature in recent years has been reviewed and compared. ResultsFK506 was a powerful immunosuppression with a mechanism of action similar to that of CsA, but significantly superiori to CsA in terms of prophylaxis and treatment of allograft acute rejection, delay of chronic rejection, and withdrawal of steroid in early period. The cardiovascular mortality and chronic graft nephropathy (CGN),such as hypertension and hyperlipidemia were less frequently seen in FK506treated patients and FK506 also had an acceptable safety profile, including a low incidence of hypertrichosis,gingival hyperplasia and infections.However, CsA had been showed a better result in prevention of posttransplantation diabetes mellitus (PTDM ) and more economic agent than FK506. Pharmacokinetic studies showed CsA in the form of Sandimmun Neoral showed less inter an intrapatient variability than FK506.Meanwhile, the combination of MMF and FK506 or CsA has been proved effectively with excellent graft and patients survival. Conclusion FK506 and CsA are safe and effective long term maintenance immunosuppressive agents in organ transplantation with wonderful prospect.
【摘要】 目的 探讨肾移植术后药物（环孢素A和钙离子拮抗剂）、口腔卫生与牙龈增生的关系。 方法 随访2003年1月—2010年3月间321例肾移植患者，记录患者术后药物使用和口腔卫生情况，观察牙龈增生程度。结果 〖HTSS〗口腔卫生水平与牙龈增生程度之间存在统计学相关性（rs=0.344，P=0.000），口腔卫生水平越差，牙龈增生越严重。服用环孢素A和钙离子拮抗剂患者（A组）牙龈增生发生率为62.15%，高于单纯服用环孢素A患者（B组）23.40%，二者比较，差异有统计学意义（χ2=39.220，P=0.000）。结论 〖HTSS〗肾移植术后环孢素A和钙离子拮抗剂联合应用明显增加了牙龈增生的发病率。口腔卫生水平与牙龈增生程度之间存在重要关联，口腔卫生差是牙龈增生的危险因素。【Abstract】 Objective To investigate the correlation between drugs (cyclosporine A and calcium channel blocker), oral hygiene and gingival hyperplasia in patients after renal transplantation. Methods We continuously followed up 321 patients undergoing renal transplantation from January 2003 to July 2009 in our hospital. The levels of oral hygiene, medication and gingival hyperplasia were recorded. Results There was a close relationship between the level of oral hygiene and the degree of gingival hyperplasia (rs=0.344, P=0.000). Higher grades of gingival hyperplasia (grades Ⅱ and Ⅲ) were found exclusively in patients who did not have good oral hygiene. There was a higher tendency of developing gingival hyperplasia among patients who received cyclosporine A and calcium channel blocker than those who only received cyclosporine A (62.15% vs. 23.40%; χ2=39.220, P=0.000). Conclusion The prevalence of gingival hyperplasia is higher in renal transplant recipients taking cyclosporine A and calcium channel blockers. There is a significant relationship between the level of oral hygiene and the development of gingival hyperplasia. Poor oral hygiene is a risk factor of gingival hyperplasia.
Objective To evaluate the short and long term effectiveness and safety of rapamycin-based immunosuppression regimes with CsA preserving versus CsA withdrawal. Methods We searched MEDLINE, EMBASE, The Cochrane Library and CNKI from Jan. 1995 to Dec. 2005. We identified randomized controlled trials of rapamycin-hased immunosuppression regimes with CsA preserving versus CsA withdrawal for renal transplantation patients. The quality of included trials was evaluated by two reviewers. Meta-analysis was conducted on homogeneous studies. Results Ten studies （1 121 patients） undergoing renal transplantation were included. All included studies were graded in term of randomization, allocation concealment and bhnding. Six studies were graded A and the other 4 were graded B. Meta-analysis results showed CsA withdrawal in sirolimus-based therapy in renal transplantation patients survival rate OR.（95% CI ） values were 0,77（0.17, 3.52）, 1.24（0.48, 3.16）, 1.32（0.57, 3.08）, 1.21（0.60, 2.41） at the end of 6, 12, 24, 36 months respectively; renal allografts survival rate OR. （95% CI） values were 1.79 （0.63, 5.06）, 1.15 （ 0.56, 2.36） , 1.39 （0.68, 2.85）, 1.80（0.99, 3.29）, 2. 13（1.16, 3.89）, 2.01（1.15, 3.51） at the end of 6, 12, 24, 36, 48, 54 months respectively; and acute rejection OP,（95% CI） values were 0.92（0.48, 1.78）, 1.90（1.25, 2.89）, 2. 01 （0.94,4.27）, 1.93（0.93, 4.00）, 1.52（0.77, 3.02） at the end of6, 12, 24, 36, 48 months respectively. Conclusions Available evidence shows that compared with CsA preserving, CsA withdrawal in rapamycin-based immunosuppression regimes can lead to higher incidence rates of acute rejection at the end of one year while there is no statistical difference to survival rate of patients/renal allograft in cases with stabilized renal function post-transplantation. And CsA withdrawal is of benefit to allografts for long term survival rate and is helpful to recovery of renal function. Owing to high possibility of selection bias and measurement bias in included studies, there must be a negative impact on evidence intensity of our results. We expect best evidence from with high quality double blind randomized control trials.
Objective To asses the clinical effectiveness and safety of combined treatment with antilymphocyte globulin (ATG) and cyclosporine A (CSA) versus antilymphocyte globulin alone in patients with aplastic anemia (AA). Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to September 2007), EMBASE (1984 to September 2007), The Cochrane Library (issue 4, 2007) and CBM-disc (1978 to September 2007). The references of eligible studies were hand searched. RCTs involving ATG and CSA in the treatment of AA were included. Data were evaluated and extracted by two reviewers independently with designed extraction form. The Cochrane Collaboration’ s RevMan 4.2.10 software was used for data analyses. Results Two RCTs involving 160 patients were included. Two studies showed that the effective rate in the ATG+CSA group was significantly higher than that in the ATG group (Plt;0.0001). Two studies indicated that the survival rate in the ATG+CSA group was improved compared with the ATG group (P=0.0002). One study reported adverse effect. The ATG group caused more fever and serum diseases compared with the ATG+CSA group, but the ATG+CSA group had a higher incidence of hepatotoxicity. Conclusion Treatment with ATG+CSA for aplastic anemia has higher effective rate and survival rate than ATG alone. More trials of high quality are required.
目的 为红皮病型银屑病患者制定循证治疗方案。 方法 2012年3月收治1例红皮病型银屑病患者，充分评估患者情况后，提出临床问题，计算机检索Cochrane图书馆、 Medline、中文全文期刊医学数据库中相关研究，根据检索结果结合患者实际情况，制定治疗方案。 结果 共检索到相关文献3篇。通过对检索结果进行分析，并结合患者意愿，为患者制定了采用甲氨喋呤的治疗方案。经过6个月的治疗随访，证实该方案适合该患者。 结论 采用循证医学的方法，为红皮病型银屑病患者制定合理的治疗方案，可提高疗效。
目的:评价皮质激素联合环孢素对比皮质激素单用防治穿透性角膜移植(PKP)术后排斥反应的疗效。方法:计算机检索PubMed,EMBASE.com,SCI,Cochrane图书馆,CBM,CNKI数据库,纳入皮质激素联用环孢素对比皮质激素单用防治PKP术后排斥反应的随机对照试验,进行方法学质量评价并应用RevMan软件进行meta分析。结果:共纳入5篇报道,1篇A级文献,B、C级各2篇。Meta结果:术后排斥反应发生情况组间差异有统计学意义(RR=0.3,95%CI 0.140.65);对既发排斥反应的逆转,组间差异无统计学意义(RR=1.15,95%CI 0.93-1.42)。结论:基于当前证据,皮质激素联合环孢素防治PKP术后排斥反应疗效并不优于皮质激素单用。
Objective To find out the beneficial and harmful effectiveness of tacrolimus (TAC) compared with cyclosporine A (CSA) for simultaneous pancreas-kidney transplant (SPKT) recipients. Methods Randomized controlled trials (RCTs) of TAC versus CSA for SPKT recipients were collected from The Cochrane Library, MEDLINE, EMbase, SCI, and CBM database. Bias risk assessment and meta-analysis were performed based on the methods recommended by the Cochrane Collaboration. Results Five RCTs including 342 recipients were included. Pooled data of pancreas survival favored TAC (RR=1.15, 95%CI 1.04 to 1.27; RD=0.11, 95%CI 0.03 to 0.19). However, there were no significant differences of acute rejection (RR=0.81, 95%CI 0.58 to 1.12), patient survival (RR=1.00, 95%CI 0.94 to 1.05), kidney survival (RR=1.02, 95%CI 0.95 to 1.09), and infection (RR=1.00, 95%CI 0.83 to 1.20). Conclusion Based on the recent evidence, TAC results in higher episodes of pancreas survival compared with CSA after SPKT. Treating 100 patients with TAC instead of CSA would increase pancreas survival in 11 recipients.
Objective To evaluate the efficacy and safety of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients. Methods We searched MEDLINE, EMbase, SCI, CBM and The Cochrane Library from the establishment to December 2009 to screen randomized controlled trials (RCTs) of low-dose versus standard-dose cyclosporine immunosuppressive therapy in kidney transplant recipients. Quality assessment and meta-analyses were performed for the included studies. Results A total of 6 RCTs involving 1551 patients were identified, among which 4 RCTs were graded A and two were graded B. The meta-analyses indicated that there were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the acute rejection rate at a RR 1.07, 95%CI 0.69 to 1.65 and a RR 1.06, 95%CI 0.71 to 1.57, respectively. There were no significant differences between the two groups at the end of 6-month and 12-month follow-up in the patients’ death rate at a RR 0.64, 95%CI 0.20 to 2.03 and a RR 0.61, 95%CI 0.30 to 1.24, respectively. There were no significant differences between the two groups in renal function and safety. Conclusion Based on the current evidence, compared with standard-dose CsA, low-dose CsA has the same effect and safety for the short-term results, but the long-term results need to be further studied.
ObjectivesTo systematically review the efficacy and safety of tacrolimus (TAC) and cyclosporine A (CsA) for patients after renal transplantation.MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CBM, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of TAC vs. CsA after renal transplantation from inception to December, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 12 RCTs involving 3 130 patients were included. The results of meta-analysis showed that: compared with CsA, the TAC had lower incidence of acute rejection at 6 months after renal transplantation (RR=0.61, 95%CI 0.50 to 0.74, P<0.000 01), and had higher glomerular filtration rate (GFR) (MD=4.20, 95%CI 1.07 to 7.34, P=0.009), lower incidence of dyslipidemia (RR=0.46, 95%CI 0.27 to 0.80, P<0.006), higher incidence of diabetes (RR=1.36, 95%CI 1.12 to 1.65, P=0.002) at 12 months after renal transplantation. There was no significant difference between two groups in the incidence of hypertension after renal transplantation (RR=0.90, 95%CI 0.69 to 1.17,P=0.43).ConclusionsCurrent evidence shows that, compared with CsA, TAC can significantly improve renal function, reduce the risk of acute rejection and dyslipidemia, but it can increase the risk of diabetes. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
Objective To assess the effectiveness and safety of cyclosporine A (CsA) for aplastic anemia (AA) in China. Methods Randomized controlled trails (RCTs) of CsA for AA were collected from CBMdisc (1978 to 2008), CNKI (1979 to 2008), and VIP (1989 to 2008). Other relevant journals were also hand searched. The methodological quality of included studies was evaluated, and data analyses were performed with The Cochrane Collaboration’s software RevMan 4.2.0. Results A total of 19 RCTs were included. As for the total effective rate and complete remission rate, significant differences were noted between CsA + androgen vs. androgen alone, CsA + androgen combination vs. androgen combination, as well as CsA + androgen + other drugs vs. androgen + other drugs [total effective rate: RRs and 95%CIs were 1.48 (1.28 to 1.70), 1.67 (1.17 to 2.39), and 1.51 (1.09 to 2.08); complete remission rate: RRs and 95%CIs were 2.06 (1.33 to 3.19), 3.52 (1.19 to 10.39), and 1.54 (1.00 to 2.38)]. Conclusion According to the domestic evidence, treatment with CsA for AA may improve the total effective rate and complete remission rate. However, more high quality clinical trials are expected for further study.