环磷酰胺联合糖皮质激素治疗儿童紫癜性肾炎有效性及安全性的Meta分析

目的:评价环磷酰胺联合糖皮质激素治疗儿童紫癜性肾炎的疗效及安全性。方法:电子计算机检索PubMed、EMBase、the Cochrane Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库、万方数据库和维普中文科技期刊数据库中有关环磷酰胺治疗儿童紫癜性肾炎的随机对照试验(RCT)研究,检索时限为建库至2018年10月。由两名研究者按纳入标准与排除标准独立筛选文献,提取资料并按照Cochrane系统评价方法进行文献质量评价,采用RevMan 5.3软件进行Meta分析。结果:共纳入15篇RCT文献,包括683例紫癜性肾炎患儿。Meta分析结果显示,环磷酰胺联合糖皮质激素组与单用激素组比较,在总体缓解率、24 h尿蛋白水平、血清白蛋白水平、血肌酐水平方面具有优势(P均<0.05),且能减少激素不良反应(P<0.01),但可增加胃肠道反应、白细胞减少的风险(P均<0.05)。两组患儿在呼吸道感染、血压升高及肝功能异常发生率等方面比较差异无统计学意义(P均>0.05)。结论:基于现有证据,环磷酰胺联合糖皮质激素治疗儿童紫癜性肾炎安全有效。

Meta-Analysis of Cyclophosphamide Combined with Glucocorticoid in the Treatment of Henoch-Schonlein Purpura Nephritis

Objective: To systematically evaluate the efficacy and safety of cyclophosphamide combined with glucocorticoid in the treatment of Henoch-Schönlein purpura nephritis. Methods: PubMed, EMBase, the Cochrane Library, CBM, CNKI, Wanfang database and VIP database were retrieved to collect the randomized controlled trial of cyclophosphamide combined with glucocorticoid in the treatment of Henoch-Schönlein purpura nephritis. The retrieval time was from the establishment of the database to Oct. 2018. Literature were independently screened by two investigators based on inclusion and exclusion criteria. Data were extracted and literature quality was evaluated according to the Cochrane systematic review method. Meta-analysis was performed by using RevMan 5.3 software. Results: Fifteen clinical studies with a total of 638 children were included. The results of the Meta-analysis showed that compared with the hormone group alone, the cyclophosphamide combined glucocorticoid group had advantages in overall remission rate, 24 h urine protein level, serum albumin level and blood creatinine level (P<0.05), and reducing side effects (P<0.01), but increasing the risk of gastrointestinal reactions and leukopenia (P<0.05). There was no significant difference between two groups in the incidence of respiratory tract infection, elevated blood pressure and liver dysfunction (P>0.05). Conclusion: Based on the available evidence, cyclophosphamide combined with glucocorticoids in the treatment of children with Henoch-Schönlein purpura nephritis is effective and safe.