糖皮质激素治疗IgA肾病蛋白尿的meta分析

Glucocorticoid in treatment of proteinuria in IgA patients with nephropathy:a meta analysis

目的通过meta分析探讨糖皮质激素对IgA肾病蛋白尿的疗效。方法检索Science Direct、EBSCO、Wiley、PubMed、CBMdisc、CNKI等数据文献库,收集1995-2013年国内外公开发表的以糖皮质激素作为随机对照试验治疗IgA肾病相关文献。采用固定效应模型计算标准化均数差(SMD)及95%置信区间(95%CI)。用Revman5.0软件从总体疗效、不同蛋白尿程度、不同疗程、不同肌酐值水平及联合ACEI等亚组进行Meta分析。结果共纳入9篇文献,包括256例激素组和273例对照组进行meta分析,结果显示:①糖皮质激素治疗IgA肾病蛋白尿的总体疗效优于对照组(P=0.000 01);②蛋白尿大于1.5 g/d和小于1.5 g/d的IgA肾病患者,糖皮质激素治疗蛋白尿的疗效均优于对照组(P<0.01);③对于血肌酐小于1.5mg/dl的IgA肾病患者,糖皮质激素治疗蛋白尿的疗效优于对照组(P<0.01);④糖皮质激素短程治疗(<1年)和长程治疗(≥1年)对于蛋白尿的疗效均优于对照组(P<0.01);⑤激素联合ACEI类药物对于蛋白尿的疗效更为显著(P<0.01)。结论糖皮质激素治疗IgA肾病蛋白尿总体疗效确切,对于不同程度蛋白尿的IgA肾病,激素治疗均有效,考虑不同疗程对于蛋白尿的疗效无明显影响,建议可适当缩短激素治疗疗程。激素联合ACEI较单纯应用ACEI类药物能更有效降低蛋白尿。

Abstract： Objective To explore the effect of glucocorticoid on proteinuria induced by IgA nephropathy.Methods Databases including Science Direct,EBSCO,Wiley,PubMed,CBMdisc,CNKI academic literature database,were searched from 1995 to 2011 to collect randomized controlled trials （RCTs） on glucocorticoid for IgA nephropathy.Standardized mean difference （SMD） with 95%confidence interval （95% CI） was calculated using fix effects models.Then Revman5.0 software was used to perform meta analysis in the overall effect,the degree of proteinuria,treatment cycle,creatinine levels and the effect of combined ACEI subgroup.Results A total of 9 articles were enrolled including 256 cases of glucocorticoid group and 273 cases of control group.①The overall efficacy in glucocorticoid group on proteinuria was better than in control group（P =0.000 01）.②The efficacy in glucocorticoid patients with proteinuria higher than 1.5 g/d or lower than 1.5 g/d was superior to the controls（P 〈 0.01）.③The efficacy of glucocorticoid treatment on proteinuria in IgA nephropathy serum creatinine level 〈 1.5 mg/dl was better than the controls（P 〈 0.01）.④ The curative effect for proteinuria with glucocorticoid short-range treatment （〈 1 year） and long-term （≥ 1 year） was superior to that of the controls （P 〈0.01）.⑤The efficacy of cormbined glucocorticoid with ACEI drugs on proteinuria was even more significant （P 〈 0.01）.Conclusion The overall efficacy of glucocorticoid treatment for proteinuria caused by IgA nephropathy is exact.Glucocorticoid treatment is effective for different degrees of proteinuria.Considering no significandy different effect of different glucocorticoid treatment cycles,the treatment cycle can be shortened appropriately.Combined glucocorticoid and ACEI drugs is more effective for lowering proteinuria than ACEI drugs alone.