激素联合免疫抑制剂治疗儿童原发性IgA肾病有效性和安全性的Meta分析

Efficacy and safety of steroid combined with immunosuppressants in the treatment of primary IgA nephropathy in children: a Meta analysis

摘要:

目的 系统评价激素联合免疫抑制剂治疗儿童原发性IgA肾病的有效性和安全性。方法 检索中英文电子数据库，纳入对比激素联合免疫抑制剂和单用激素治疗儿童原发性IgA肾病的有效性、安全性的研究。结局指标为尿蛋白缓解率、尿蛋白定量、不良反应发生率、估算肾小球滤过率和肾功能损害发生率。使用Review Manager 5.3软件进行数据分析。结果 最终纳入7项研究，包括381例患儿（基线平均尿蛋白定量为中到大量水平）。Meta分析结果显示，激素联合免疫抑制剂组比单用激素治疗组达到更高的尿蛋白缓解率（RR=1.36，95% CI：1.19~1.55，P < 0.001），更低的尿蛋白定量（SMD=-0.82，95% CI：-1.23~-0.41，P < 0.001）；两组不良反应发生率差异无统计学意义（RR=1.28，95% CI：0.92~1.77，P=0.14）。结论 现有证据显示，对于伴有中到大量蛋白尿的原发性IgA肾病儿童，与单用激素治疗相比，激素联合免疫抑制剂治疗的疗效更佳，且不增加不良反应的发生。

Abstract:

Objective To systematically evaluate the efficacy and safety of steroid combined with immunosuppressants in the treatment of primary IgA nephropathy in children. Methods English and Chinese electronic databases were searched to include the studies on the efficacy and safety of steroid combined with immunosuppressants versus steroid alone in the treatment of primary IgA nephropathy in children. Outcome measures included proteinuria remission rate, urinary protein quantification, incidence of adverse events, estimated glomerular filtration rate, and incidence of renal dysfunction. Review Manager 5.3 software was used for data analysis. Results A total of 7 studies with 381 children were included. The children had moderate to severe proteinuria. The Meta analysis showed that compared with the steroid alone group, the steroid combined with immunosuppressants group achieved a significantly higher rate of proteinuria remission (RR=1.36, 95% CI: 1.19-1.55, P < 0.001) and significantly lower urinary protein quantification (SMD=-0.82, 95% CI: -1.23 to -0.41, P < 0.001). There was no significant difference in the incidence rate of adverse events between the two groups (RR=1.28, 95% CI: 0.92-1.77, P=0.14). Conclusions The current evidence shows that for children with primary IgA nephropathy who have moderate to severe proteinuria, steroid combined with immunosuppressants has a better effect than steroid alone and does not increase the incidence rate of adverse events.