血液灌流治疗儿童过敏性紫癜疗效的Meta分析

Effects of hemoperfusion on treatment of childhood Henoch-Schonlein purpura:a Meta-analysis

目的评价血液灌流治疗儿童过敏性紫癜的疗效。方法检索PubMed、Ovid、web of Science、Embase、Cochrane Library、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)和万方数据库,并辅以手工检索,检索时间均从建库至2015年6月30日公开发表的血液灌流治疗儿童过敏性紫癜的随机对照试验或临床对照实验,筛选符合标准的研究,应用Jadad评分法进行质量评价,使用Rev Man 5.0软件进行Meta分析。结果共7篇文献纳入研究,其中随机对照试验(RCT)6篇,临床对照试验(CCT)1篇,研究对象共416例,其中血液灌流组216例,对照组200例。Meta分析结果显示,血液灌流组与对照组缩短皮疹持续时间,其合并加权均数差(WMD)=-1.13(95%CI:-1.38^-0.87,P<0.00001);缩短腹痛持续时间,其合并WMD=-1.23(95%CI:-1.46^-0.99,P<0.00001);缩短关节肿痛持续时间,其合并WMD=-0.91(95%IC:-1.13^-0.70,P<0.00001)。结论血液灌流联合药物等支持治疗能有效缓解儿童过敏性紫癜的临床症状,但其疗效需要大样本、多中心、设计良好的RCT进一步验证。

Objective To systematically evaluate the effects of hemoperfusion （ HP） on treatment of childhood Henoch-Sch？nlein purpura （HSP）.Methods Assisted with handwork, a comprehensive search was performed in web databases , including PubMed, Ovid, Web of Science, Embase Cochrane Library, Chinese Biological Medicine Database （CMB）, National Knowledge Infrastructure （CNKI） of China, Chongqing VIP Database and Wanfang Database from the very beginning till June 30, 2015.Literatures of randomized controlled trials （RCT） or clinical controlled trials （CCT） about HSP treated with HP were evaluated according to Jadad Standard and Meta -analysis was performed using Review Manager 5.0 software.Results Six RCT and one CCT were included in this study with 416 cases, of which 216 cases were in HP group and 200 cases were in control group.The weighted mean difference （WMD） of duration of skin lesions was -1.13 （95%CI： -1.38--0.87, P〈0.00001）, the WMD of duration of abdominal pain was -1.23 （95%CI：-1.46 --0.99,P〈0.00001）, and that of duration of joint pains was -0.91 （95%CI：-1.13--0.70,P〈0.00001）.Conclusion The supportive therapy combining HP and drugs can relieve clinical symptoms of childhood HSP effectively , but large scale , multi-centered and well-designed RCTs are needed to further confirm the conclusion .