糖皮质激素治疗IgA肾病疗效的Meta分析

A meta analysis of effects on IgA nephropathy by glucocorticoids treatment

目的研究糖皮质激素治疗IgA肾病的疗效和安全性。方法通过PubMed/Medline、Embase、Sci、万方数据库(CNKI)等文献库收集了近20年关于糖皮质激素治疗IgA肾病的随机对照试验,共有9篇文献(包括536例观察对象),按照纳入标准进入荟萃分析,通过采用Rev Man 4.2软件进行Meta分析,研究糖皮质激素治疗IgA肾病伴有中到大量蛋白尿的疗效和安全性。结果安慰剂组与激素治疗组比较,激素治疗组降低了血肌酐成倍增长或发展至终末期肾病的风险[OR,0.32(95%CI,0.15～0.6)]7;P<0.05],同时降低蛋白尿[WMF,-0.46 g/d(95%CI,-0.63～-0.29 g/d;P<0.01]。其中激素治疗组有48个患者发生副作用,对照组有23个患者发生不良反应。结论对伴有中到大量蛋白尿的患者,糖皮质激素治疗可降低蛋白尿、改善患者远期预后;激素治疗增加了不良事件发生的风险但无统计学意义。

Objective To investigate the benefits and risks of the glucocorticoids treatment on IgA nephropathy. Methods Da- ta were collected about the glucocorticoids treatment on IgA nephropathy over last twenty years though PubMed/Medline, EMBASE, SCI and CNKI. Nine articles （ including 536 participants） of them were included into the meta - analysis according to inclusion criteria. The meta analysis was carried on these studies by using the Cochrane Collaboration~ RevMan 4.2 software. Results Glucocorticoids therapy was associated with a lower risk for kidney failure （ relative risk, 0.32 [ 95 % confidence interval （ CI）, 0.15 - O. 67 ] ; P = O. 002 ） and a reduction in proteinuria （ the mean difference, - O. 46 g/d [ 95% CI, - 0.63 to - 0.29 g/d ] ;P 〈 0.01 ）. Conclusion Glucocorti- coids treatment on IgA nephropathy may reduce the risk for renal failure but also decrease the amount of proteinuria. The glucocorticoids therapy increases the risk of the adverse events, but there is no statistical significance.