儿童过敏性紫癜早期应用糖皮质激素预防肾损害Meta分析

Corticosteroid preventing renal involvement of henoch-schonlein purpura in early stage: a meta-analysis

目的 应用Meta分析方法对国内、外已发表和未发表的有关儿童过敏性紫癜（HSP）早期应用糖皮质激素（GC）预防肾损害的RCT进行综合定量分析，为GC早期应用降低儿童HSP肾损害的发生率提供参考依据。方法 以过敏性紫癜（Henoch—Schonlein purpura／HSP），紫癜性肾炎（Anaphylactoid purpura），紫癜肾炎（Henoeh—Schonlein purpura nephritis／HSPN），糖皮质激素（glueocorticoid，steroid），泼尼松（predonisone），甲泼尼龙（methypredonisolone），地塞米松（dexamethasone）等为主题词，通过电子检索MEDLINE（1963～2006．3）、OVID数据库（1993～2006．3）、Springer数据库（1994～2006．3）和中国期刊全文数据库（1994～2006．3）等，同时辅以手丁检索包括会议资料和学位论文。尽可能全面地收集GC早期应用治疗儿童HSP的RCT，对符合要求的文献进行质量评估，用Rev Man4．2软件对结果进行合并统计分析，计算治疗组相对于对照组的肾损害危除的优势比（odds ratio，OR），评价GC早期应用是否能预防儿童HSP肾损害。结果 本次评价中共纳入4篇RCT。总样本量为359例，其中GC治疗组178例，出现肾损害15例；对照组181例，出现肾损害36例，差异有统计学意义。GC早期应用有利于减少肾损害的发生，合并OR=0．36，95％CI：0．19～0．69。结论 与对照组相比，GC早期应用仅显示有能够预防儿童HSP肾损害的趋势。HSP一经诊断，或最迟不超过出现症状后3周内，口服泼尼松1～2mg·kg^-1·d^-1，疗程为2～3周，能够减少肾损害的发生率。可靠结论尚需大样本、多中心、设计良好的RCT进一步验证。

Objective Searching all studies that have been published or unpublished worldwide with regards to the effectiveness of the early administration of corticosteroids for reducing risk to develop renal involvement in patients with HSP by means of Meta-analysis, in order to provide some evidences for using corticosteroids to deal with HSP and lower the renal involvement incidence. Methods MEDLINE （ 1963 - 2006. 3 ）, OVID （ 1993 - 2006.3 ）, Springer （ 1994 - 2006.3 ）, CNKI database （ 1994 - 2006. 3） were searched by using the terms Henoch-Schonlein purpura/HSP , anaphylactoid purpura, Henoch- Schonlein purpura nephritis/ HSPN, glucocorticoid, steroid, prednisone, methypredonisolone, dexamethasone, etc. for human clinical trials, including unpublished documents from scientific meetings and thesis, and the similar documents listed in the references of the documents above. To evaluate strictly all the studies that have been searched according to Jadad Standard and adopted the studies in high quality that can be analyzed by means of Meta-analysis, Review Manager 4. 2 software was used to analyze the data input. To calculate the odds ratio for renal involvement during the period from initial episode to the end of followup between treatment with corticosteroids and control. Results Totally 4 studies containing 359 cases were analyzed. The cumulative cases in treatment group were 178, 15 of them were developed renal involvement, while in control, cumulative cases were 181,36 were developed renal involvement ,there was a significant difference between treatment group and control statistically. The pooled OR was 0. 36, with a 95% confidence interval （0. 19 -0. 69）. Conclusions Corticosteroids should be used in＇early stage of HSP. Early administration of corticosteroids tends to benefit patients for reducing risk to develop renal involvement as compared with control. 1 -2 mg.kg i d i of prednisone po. for two to three weeks is suitable the moment HSP being diagnosed, while large scale, multicentre, well-designed experiments should be adopted to further confirm the conclusions.