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中国循证儿科杂志

中国循证儿科杂志 ›› 2022, Vol. 17 ›› Issue (1): 39-43.

• 论著 • 上一篇    下一篇

利妥昔单抗治疗抗髓鞘少突胶质细胞糖蛋白抗体相关疾病疗效的系统综述和Meta分析

李尚茹，常旭婷，武鹏霞，张捷，吴晔   


  1. 作者单位 北京大学第一医院儿科北京，100034

  • 收稿日期:2022-01-15 修回日期:2022-01-27 出版日期:2022-02-25 发布日期:2022-02-25
  • 通讯作者: 吴晔

Effectiveness of rituximab in the treatment of antimyelin oligodendrocyte glycoproteinantibody associated disorders: A systematic review and meta-analysis

LI Shangru, CHANG Xuting, WU Pengxia, ZHANG Jie, WU Ye    

  1. Department of Pediatrics，Peking University First Hospital，Beijing 100034，China
  • Received:2022-01-15 Revised:2022-01-27 Online:2022-02-25 Published:2022-02-25
  • Contact: WU Ye, email: dryewu@263.net

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摘要： 背景：儿童抗髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）临床表型多样，根据病程可分为单相性和多相性，约50%的患儿表现为多相性病程。多相性MOGAD反复发作会遗留不同程度的神经系统功能损害。预防多相性MOGAD复发的药物主要包括吗替麦考酚酯、利妥昔单抗、硫唑嘌呤以及每月维持静脉注射IVIG，但目前预防复发的治疗方案缺乏高质量的临床研究证据。 目的：通过系统评价/Meta分析探讨利妥昔单抗（RTX）治疗MOGAD的有效性。 设计：系统评价/Meta分析。 方法：检索中英文数据库（PubMed、Embase、Web of Science、Cochrane、万方数据库、中国知网数据库、维普数据库），筛选有关RTX治疗MOGAD的文献，检索时间为1997年1月1日至2021年6月1日。由2名研究者独立筛选文献，提取相关数据以及对纳入文献行风险偏倚评价，采用RevMan 5.3进行Meta分析。 主要结局指标：年复发率（ARR）、无复发率。 结果：共纳入13篇研究272例患者。Meta分析结果显示，RTX治疗MOGAD的无复发率为32.4％（95%CI：2.9%~47.9％，I2=52%，P=0.03），应用RTX治疗MOGAD后ARR平均变化为-1.44（95%CI：-1.67~-1.21，I2=71%，P=0.004）。 结论：RTX虽然可降低MOGAD患者的复发频率，但无复发率仅为32.4%，此结论有待更多高质量的研究加以验证。

关键词: 抗髓鞘少突胶质细胞糖蛋白抗体相关疾病, 免疫治疗, 利妥昔单抗, Meta分析

Abstract: Background: Pediatric antimyelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) has a variety of clinical manifestations, which can be divided into monophasic and polyphasic courses according to the course of disease, of which about 50% children present with a polyphasic course. Recurrent episodes of polyphasic MOGAD lead to varying degrees of neurological impairment. The main prophylactic drugs for relapse of multiphasic MOGAD include mecophenolate mofetil（MMF）, rituximab (RTX), azathioprine (AZA) and intravenous gamma globulin (IVIG) on a monthly basis. However, there is a lack of highquality clinical evidence for the prophylactic treatment. Objective: To investigate the effectiveness of rituximab in the treatment of MOGAD through a systematic review and metaanalysis. Design: Systematic review/metaanalysis. Methods: Literature on rituximab in the treatment of MOGAD was searched in the databases of Pubmed，Embase，Web of Science，Cochrane，Wanfang Data，CKNI and VIP from Jan 1st, 1997 to June 1st, 2021. After two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies, the metaanalysis was performed using RevMan 5.3. Main outcome measures: Annualized relapse rate and relapsefree rate. Results: Thirteen studies (272 patients) were included. Metaanalysis showed that the relapsefree rate of patients of MOGAD who received rituximab treatment was 32.4%（95%CI:2.9%47.9％，I2=52%，P=0.03）, and the annualized relapse rate changes -1.44（95%CI: -1.67-1.21，I2=71%，P=0.004）. Conclusion: Rituximab reduced the frequency of relapse in some MOGAD patients, but the relapsefree rate was only32.4%. The results of this study need to be verified by more highquality studies.

Key words: Anti-myelin oligodendrocyte glycoprotein-antibody associated disease, Immunotherapy, Rituximab, Meta-analysis