糖皮质激素联合硫唑嘌呤治疗重症儿童IgA肾病的Meta分析

Glucocorticoid plus azathioprine for treatment of severe childhood IgA nephropathy: a Meta-analysis

目的运用Meta分析方法评价糖皮质激素联合硫唑嘌呤治疗重症儿童Ig A肾病的疗效和安全性。方法检索数据库包括:中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库、Cochrane图书馆、Pub Med和Embase数据库,检索时间均为从建库至2014年1月31日。检索有关糖皮质激素联合硫唑嘌呤治疗重症儿童Ig A肾病的随机对照研究。对纳入研究进行质量分析和资料提取,采用Rev Man 5.0软件进行数据分析。结果共纳入3项完全随机对照试验研究(226例患儿)。Meta分析结果显示:糖皮质激素联合硫唑嘌呤与其他药物治疗比较,可以有效降低肾小球硬化、血清Ig A水平、24 h尿蛋白定量、血尿及肾小球系膜Ig A抗体强度(P<0.05),但不能改善两组血清肌酐清除率、肾小球囊粘连及肾小球新月体的发生率(P>0.05)。结论糖皮质激素联合硫唑嘌呤与其他药物治疗比较可以有效降低肾小球硬化、血清Ig A水平、24 h尿蛋白定量、血尿及肾小球系膜Ig A抗体强度,延缓患儿疾病的进展。

Objective To explore the effect and safety of glucocorticoid plus azathioprine for treatment of severe childhood IgA nephropathy using Meta-analysis method. Methods We searched the databases including CNKI, CBMDisc, VIP, Cochrane Library, PubMed and Embase to collect randomized controlled trials （RCTs） on glucocorticoid plus azathioprine for treatment of severe childhood IgA nephropathy from the date of initiation establishment of the databases to 31 January, 2014. Quality analysis and data extraction were performed in the selected studies. RevMan 5.0 software was used for date analysis. Results Three RCTs involving 226 participants were included. The result of Meta-analysis showed that glucocorticoid plus azathioprine might contribute to the decrease of glomerular sclerosis, serum IgA level ,24-hour urinary protein excretion, hematuria and intensity of messangial IgA compared with other drugs（ P 〈 0.05 ）, but could not improve serum ereatinine clearance, the incidences of glomerular capsular adhesion and crescent （ P 〉 0.05 ）. Conclusion Compared with other drugs, glucocorticoid plus azathioprine can improve glomendar sclerosis, serum IgA level, 24-hour urinary protein excretion, hematuria and intensity of mesangial IgA effectively,which might slow the progression of severe childhood IgA nephropathy.