[1]陈晗笑,高睿,张曜耀,等.环孢素A治疗免疫性复发性流产疗效的Meta分析[J].中国计划生育和妇产科,2020,(5):20-24.
　CHEN Hanxiao,GAO Rui,ZHANG Yaoyao,et al.Metaanalysis of the efficacy of cyclosporine A in the treatment of immune recurrent spontaneous abortion[J].Chinese Journal of Family Planning & Gynecotokology,2020,(5):20-24.
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环孢素A治疗免疫性复发性流产疗效的Meta分析
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2020年5期
页码:
20-24
栏目:
不良妊娠诊治专栏
出版日期:
2020-05-25

文章信息/Info

Title:
Metaanalysis of the efficacy of cyclosporine A in the treatment of immune recurrent spontaneous abortion
作者:
陈晗笑1; 高睿1; 张曜耀1; 2; 谢义东1; 2; 秦朗1; 2*
1.四川大学华西第二医院妇产科生殖医学中心；2.四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室
Author(s):
CHEN Hanxiao1;  GAO Rui1;  ZHANG Yaoyao1; 2;  XIE Yidong1; 2;  QIN Lang1; 2*
1. Reproductive Medical Center, Department of Obstetrics and Gynecology;2. Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu Sichuan 610041,P.R.China
关键词:
环孢素A; 免疫性复发性流产; 随机对照试验; Meta分析
Keywords:
cyclosporine A; immune recurrent spontaneous abortion; randomized controlled trials; Metaanalysis
分类号:
R 71421
摘要:
目的系统评价环孢素A治疗免疫性复发性流产的疗效。方法计算机检索PubMed、Cochrane、EBSCOMEDLINE、维普、中国知网、万方数据库，搜集有关环孢素A治疗免疫性复发性流产的随机对照实验（randomized controlled trials, RCT），检索时限均为建库至2019年7月。筛选文献、提取资料和评价纳入研究的偏倚风险后，采用Review Manager 53软件进行Meta分析。结果共纳入4个RCT，包括415例免疫性复发性流产患者。Meta分析结果显示，环孢素A与其它干预措施相比，妊娠成功率没有优势［RR=112, 95 % CI(093,135), P>005］。分析纳入文献中的结局指标，发现环孢素A对于患者外周血中IL2，IL10和ACA的含量具有较明显的影响。结论现有有限证据提示，环孢素A对外周血中IL2，IL10和ACA含量影响明显，提示环孢素A可能通过以上因子调节机体免疫应答，但与其它常规药物相比，对患者临床结局并没有显著改善。但由于现有RCT较少，纳入研究质量有限，尚需高质量的临床试验进一步验证。
Abstract:
ObjectiveTo systematically evaluate the clinical efficacy of cyclosporin A in the treatment of immune recurrent spontaneous abortion. MethodsPubMed, The Cochrane Library, EBSCOMEDLINE, WeiPu Data, CNKI, WanFang Data databases were searched for collecting randomized controlled trials(RCTs) on the treatment of immune recurrent spontaneous abortion with cyclosporin A from inception to July 2019. After literature screening, data extraction and risk of bias in the included studies were evaluated, metaanalysis was performed using Review Manager 53 software. ResultsA total of 4 RCTs were included, including 415 patients with immune recurrent spontaneous abortion. Metaanalysis results showed that compared with other interventions, cyclosporine A had no advantage in pregnancy rate ［RR=112, 95 %CI(093,135), P>005］. By analyzing the outcome indicators in the included literature, we found that cyclosporine A had a significant effect on the levels of IL2, IL10 and ACA in patients' peripheral blood. ConclusionThe available limited evidence suggests that cyclosporine A has obvious effects on the levels of IL2, IL10 and ACA in peripheral blood, but has no obvious advantages over other conventional interventions. However, due to the limited number of existing RCTs and the limited quality of included studies, the conclusion still needs to be further verified by more highquality clinical trials.

参考文献/References:

［1］Royal College of Obstetricians and Gynaecologists.Theinvestigation and treatment of couples with recurrent firsttrimesterand secondtrimester miscarriage (Greentop GuidelineNo. 17). April 2011［EB/OL］. ［20150608］.https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_17.pdf. ［2］Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion ［J］. Fertility and Sterility, 2012, 98(5):11031111. ［3］中华医学会妇产科学分会产科学组．复发性流产诊治的专家共识 ［J］．中华妇产科杂志，2016，51（1）：39． ［4］林其德．复发性流产免疫学诊断和治疗共识 ［J］．生殖医学杂志，2008，17（1）：45． ［5］肖世金，赵爱民．复发性流产病因学研究进展 ［J］．中国实用妇科与产科杂志，2014，30（1）：4145． ［6］陈咏，于月新．联合环胞素A治疗难治性不明原因复发性流产疗效分析 ［J］．临床军医杂志，2017，45（10）：10391041, 1045． ［7］Peralespuchalt A, Vila V J, López M J, et al. Pregnancy outcomes after kidney transplantationimmunosuppressive therapycomparison ［J］. The Journal of Maternalfetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2012, 25 (8): 13631366. ［8］Zhou Wenhui, Dong Lin, Du Meirong, et al. Cyclosporin A improves murine pregnancy outcome in abortionprone matings: involvement of CD80/86 and CD28/CTLA4 ［J］. Reproduction, 2008, 135 (3): 385395. ［9］王丹，翟俊霞，牟振云，等．Meta分析中的异质性及其处理方法 ［J］．中国循证医学杂志，2009，9（10）：11151118． ［10］付锦华，朱霄鹤，孙红，等．环孢素A治疗难治性免疫性复发性流产随机对照研究 ［J］．中国实用妇科与产科杂志，2016，32（5）：441445． ［11］石吟．益气补肾方对母胎免疫识别异常复发性流产患者孕早期免疫调节的影响 ［D］．杭州：浙江中医药大学，2017． ［12］张力鹏，赵骏达，马俊旗．环孢素A联合脂肪乳治疗复发性流产的疗效评价 ［J］．热带医学杂志，2018，18（12）：15621565． ［13］何瑞芝．免疫治疗复发性流产临床疗效的META分析 ［D］．石家庄：河北医科大学，2010． ［14］陈强，刘皋林．环孢素A的临床应用进展 ［J］．中国药学杂志，1995，30（11）：646650． ［15］《环孢素A在肾内科的应用》专家协作组.环孢素A治疗肾小球疾病的应用共识 ［J］.中华肾脏病杂志,2005，21(9):556557. ［16］闫凤亭，李大金，孙晓溪，等．环孢素A对正常早孕期细胞滋养细胞体外生长的调节作用 ［J］．中华妇产科杂志，2002，37（2）：7476． ［17］王爱娟，孙振高，张兴兴，等．复发性流产的免疫学病因研究进展 ［J］．中国优生与遗传杂志，2017，25（4）：14． ［18］Ling Yi, Huang Yuanhua, Chen Caixia, et al. Low dose Cyclosporin A treatment increases live birth rate of unexplained recurrent abortion  initial cohort study ［J］. Clinical and Experimental Obstetrics & Gynecology, 2017, 44 (2): 230235. ［19］Reggia R, Bazzani C, Andreoli L, et al. The efficacy and safety of cyclosporin a in pregnant patients with systemic autoimmune diseases ［J］. American Journal of Reproductive Immunology, 2016, 75 (6): 654660. ［20］付锦华，苏梅．联合环孢素A治疗难治性不明原因复发性流产6例 ［J］．中华临床医师杂志（电子版），2011，5（11）：33683370． ［21］吴娟，张冰璟．环孢素A治疗难治性免疫性复发性流产的临床效果分析 ［J］．北方药学，2016，13（2）：4445．

备注/Memo

备注/Memo:
四川大学“跨学科专业贯通式”人才培养专项项目（项目编号：SCUKG073）
更新日期/Last Update: 2020-05-25