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儿童过敏性紫癜性肾炎药物治疗的Meta分析 预览 被引量:54

A meta-analysis of drug therapy for Henoch-Schonlein purpura nephritis in children
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摘要 目的儿童过敏性紫癜性肾炎(HSPN)是儿科常见的继发性肾小球疾病,多发于欧洲及亚洲地区,目前尚无统一治疗方案。应用Meta分析方法评价儿童HSPN药物治疗的疗效,为临床治疗及开展相关研究提供参考和帮助。方法检索Medline、PubMed、EMBASE、CBM、中国期刊网等数据库、学术会议资料和学位论文等,全面收集有关儿童HSPN药物治疗的文献。制定文献纳入及排除标准,并通过查阅文献制定效应指标的评价标准。由2名研究者分别独立筛选文献,符合纳入标准的文献按Shekelle等建议的标准进行文献质量评估,对照性研究按Juni量表进行质量评价。应用ReviewManager4.2软件进行Meta分析,计算治疗组与对照组的治愈率及有效率的危险率差(RD)及其95%CI,对不能进行Meta分析的文献进行描述性分析,客观评价各种药物治疗方案的疗效。结果共检索到HSPH相关中、外文文献1948篇,从中筛选出儿童HSPN药物治疗的相关文献64篇,其中多中心RCT研究(Ⅰa级)1篇,单中心RCT研究(Ⅰb级)6篇,单中心对照研究(Ⅱa级)10篇,无对照的临床病例观察(Ⅱb级)34篇,病例报道(Ⅲ级)13篇。在各种药物治疗方案中应用最多的是激素联合免疫抑制剂的治疗,共纳入163例患儿,其中对照组87例,治疗组76例,治疗前除对照组16例、治疗组14例患儿有轻微肾脏损伤(B级临床状态)外,其余均有肾病水平蛋白尿(C级临床状态)。治疗组采用激素联合免疫抑制剂治疗,对照组单用激素治疗,Meta分析结果显示治疗组较对照组治愈率及有效率均高(治愈率比较的RD=-0.39,95%CI:-0.53~-0.25,有效率比较的RD:-0.43,95%CI:-0.66~-0.20),差异有统计学意义。进一步对激素联合静脉冲击环磷酰胺(CTX)的疗效进行单独分析,共纳入106例患儿,其中对照组57例,治疗组49例, Objective To assess the efficacy of drug therapy for Henoch-Schionlein purpura nephritis (HSPN) in children. Methods Medical electronic databases and other sources were searched without language restriction. According to including and excluding cretria, articles were evaluated ( Shekelle PG, et al). Randomized control trials (RCTs) were assessed according to the Juni assessment. Software Rev Man 4. 2 was used to assess control trials, and other studies were reviewed and descrbied. Results Sixty-four papers were included out of 1948 papers. There were 1 article in grade Ⅰ a, 6 in grade Ⅰ b, 10 in grade Ⅱ a, 34 in grade Ⅱ b, and 13 in grade Ⅲ. We assessed the efficacy of steroids combined with immunosuppressants (76 cases) vs steroids alone (87 cases) by analyzing 1 RCT ( Ⅰ b) and 4 control trials ( Ⅱ a). There were significant differences in cure rate ( RD = - 0.39, 95% CI: -0.53 ~-0.25) and effective power (RD = -0.43, 95%CI: -0.66 ~-0.20). The efficacies of steroids combined with cyclophosphamide (CTX) pulse therapy (57 cases) vs steroids alone (49 cases) were revealed significant differences in cure rate (RD= -0.48, 95% CI: -0.74~-0.23) and effective power (RD = -0.60, 95% CI: -0.81~ -0.40). CTX used alone was not effective compared to supported therapy from a RCT. Steroids combined with other drugs were confined to non- randomized control trials, so efficacy was difficult to evaluate, Conclusions Drug therapy for HSPN in children is still lack of consistent and common regimens. Steroids combined with immunosuppressants were effective for severe HSPN in children, in which steroids combined with CTX were the most effective; CTX used alone was not effective compared to supported therapy. Nevertheless, muhicentre and large-scale RCTs are still needed. In addition, other drug regimens were limited to non-randomized control trials and difficult to evaluate.
作者 赵丹 王君 李惠芳 张燕舞 丁洁 于力 ZHAO Dan, WANG Jun, LI Hui-fang, ZHANG Yan-wu, DING Jie, YU Li (1.Department of Pediatrics, Peking University First Hospital, Beijing 100034, China; 2. Library of Peking University First Hospital, Beijing 100034, China; 3. Department of Pediatrics, Guangzhou First Municipal People's Hospital, Guangzhou 510180, China)
出处 《中国循证儿科杂志》 CSCD 2007年第2期 88-101,共14页 Chinese JOurnal of Evidence Based Pediatrics
基金 致谢:感谢北京大学循证医学中心詹思延教授对我们的研究工作给予的悉心指导和帮助!
关键词 儿童 过敏性紫癜 肾炎 META分析 药物治疗 Children Henoch-Schtonlein purpura Nephritis Meta-analysis Drug therapy
作者简介 现为广州医学院附属广州市第一人民医院儿科研究生。 通讯作者丁洁,E-mail:djne_5855@126.com; 通讯作者于力,E-mail:yuli828@yeah.net
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