不同方式治疗中重度过敏性紫癜肾炎有效性与安全性的网状Meta分析

Efficacy and safety of different treatments for moderate to severe Henoch-Schönlein purpura nephritis:a network meta-analysis

目的评价不同方式治疗中重度过敏性紫癜肾炎(HSPN)的有效性和安全性。方法检索中国知网、维普网、万方数据、中国生物医学文献服务系统、PubMed、OVID、Web of Science、Embase、the Cochrane Library,收集单用糖皮质激素(GC),环磷酰胺、霉酚酸酯、雷公藤多苷、来氟米特、咪唑立宾、他克莫司、环孢素A、血液灌流、扁桃体切除联合GC,以及双重血浆置换联合GC与环磷酰胺、双重血浆置换联合GC与霉酚酸酯共12种干预措施治疗中重度HSPN的随机对照试验(RCT)和队列研究,检索时限为建库至2024年3月。筛选文献、提取资料、评价文献质量后,采用Stata 16.0软件进行网状Meta分析。结果共纳入28篇文献,RCT和队列研究均为14篇,共计1746例患者。网状Meta分析结果显示,总缓解率方面,他克莫司联合GC最优的概率最大,其次为雷公藤多苷联合GC、双重血浆置换联合GC与霉酚酸酯;完全缓解率方面,来氟米特联合GC最优的概率最大,其次为咪唑立宾联合GC、双重血浆置换联合GC与环磷酰胺;降低24 h尿蛋白定量方面,咪唑立宾联合GC最优的概率最大,其次为双重血浆置换联合GC与霉酚酸酯、来氟米特联合GC;安全性方面,他克莫司联合GC最优的概率最大,其次为环孢素A联合GC、来氟米特联合GC。结论相较于其他治疗方式,他克莫司联合GC治疗中重度HSPN的疗效和安全性均较好。

OBJECTIVE To assess the efficacy and safety of different treatment modalities for moderate to severe Henoch-Schönlein purpura nephritis(HSPN).METHODS Literature searches were conducted in the CNKI,VIP,Wanfang Data,SinoMed,PubMed,OVID,Web of Science,Embase,and the Cochrane Library to collect randomized controlled trials(RCTs)and cohort studies on the treatment of moderate to severe HSPN with 12 intervention measures:monotherapy with glucocorticoid(GC),as well as cyclophosphamide,mycophenolate mofetil(MMF),Tripterygium wilfordii multiglucoside(TWM),leflunomide,mizoribine,tacrolimus,cyclosporin A,hemoperfusion,tonsillectomy combined with GC,and double filtration plasmapheresis(DFPP)combined with GC and cyclophosphamide or mycophenolate mofetil.The search period was from the inception of the databases to March 2024.After literature screening,data extraction,and quality assessment,a network metaanalysis was performed using Stata 16.0 software.RESULTS A total of 28 articles were included,with 14 RCTs and 14 cohort studies,involving 1746 patients.The network meta-analysis results showed the combination of tacrolimus and GC had the highest probability of being the best in overall remission rate,followed by the combination of TWM and GC,and DFPP combined with GC and MMF.The combination of leflunomide and GC had the highest probability of being the best in complete remission rate,followed by the combination of mizoribine and GC,and DFPP combined with GC and cyclophosphamide.The combination of mizoribine and GC had the highest probability of being the best in terms of reducing 24-hour urinary protein quantification,followed by DFPP combined with GC and MMF,and the combination of leflunomide and GC.Moreover,the combination of tacrolimus and GC had the highest probability of being the best in safety,followed by the combination of cyclosporin A and GC,and the combination of leflunomide and GC.CONCLUSIONS Compared to other treatment methods,the combination therapy of tacrolimus and GC shows better efficacy and safety in the treatment of moderate to severe HSPN.