雷公藤总苷和糖皮质激素治疗紫癜性肾炎的Meta分析

Meta Analysis of Henoch-Schonlein Purpura Nephritis Treated with Tripterygium Glycosides and Glucocorticoid

目的评价雷公藤总苷(TG)和糖皮质激素(GC)治疗紫癜性肾炎(HSPN)的疗效,为临床上合理用药、提高治愈率和降低复发率提供指导。方法检索PubMed、Cochrane、清华同方、重庆维普数据库,时间为该数据库建立至2009年12月31日,全面收集有关TG和GC治疗HSPN的文献。制定文献纳入及排除标准,由2名研究者分别独立筛选文献,并对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。应用Revman4.2.8软件进行Meta分析,计数资料采用优势比(OR)及其95%CI表示,计量资料采用加权均数差(WMD)及其95%CI表示。结果共检索到HSPN相关文献62篇,其中51篇文献不符合纳入标准予以排除。其中1篇文献将治疗组分为TG组、GC组和TG联合GC组。TG联合GC组与GC组治疗有效率、24 h尿蛋白总量、血浆蛋白、血肌酐、治疗复发率比较差异均有统计学意义(Pa<0.05);而不良反应比较差异无统计学意义(P>0.05)。在单用TG和单用GC的文献分析中,二者有效率比较差异有统计学意义(P=0.000 8)。结论单用TG或联合GC在治疗HSPN效果上均优于单用GC。

Objective To evaluate the effects of tripterygium glycosides（TG） and glucocorticoid（GC） on Henoch-Schonlein purpura nephritis（HSPN） by a Meta-analysis so as to guide the rational drug administration and improve the curative rate and reduce the recurrence of purpuric nephritis.Methods A computerized literature review on PubMed,Cochrane Library,CNKI and VIP database from the establishment of these data to 31,Dec.2009 was conducted and all the related articles were collected.According to inclusion and exclusion criteria,the articles were evaluated by 2 evaluators.The quality of the articles was assessed according to the criteria of Shekelle et al.Data were calculated by Revman 4.2.8 software.When the data were dichotomous,the pooled value of the odds ratios（OR）and 95% confidence interval（CI）were calculated.When the data were continuous,the overall effect was calculated by using the weighted mean difference（WMD）and 95% CI.Results Sixty-two articles up to the criterion were identified in the search;51 articles didn′t meet the selection criteria and were excluded.A literature included 3 groups,which were group of combinition TG with GC,TG group and GC group.Comparison between combination TG with GC group and sole GC group,the differences of effective rate,24-hour urine total protein,plasma protein,serum creatinine and recurrence rate had statistical significance（Pa0.05）;but the rate of adverse reaction didn′t（P0.05）.In comparison of sole TG group with sole GC group,there was markedly statistical significance for the effective rate（P=0.000 8）.Conclusion The therapy for HSPN by sole TG or the combination TG with GC can get a better result than by GC alone in clinical application.