Meta-analysis of combined therapy for adult hepatitis B virus-associated glomerulonephritis  

作　　者：Xiao-Yong Zheng Ri-Bao Wei Li Tang Ping Li Xiao-Dong Zheng 

机构地区：[1]Department of Nephrology, General Hospital of Chinese PLA, Beijing 100853, China [2]Department of Ophthalmology, Ehime University School of Medicine, Ehime 791-0295, Japan

出　　处：《World Journal of Gastroenterology》2012年第8期821-832,共12页世界胃肠病学杂志（英文版）

基　　金：Supported by National Natural Science Foundation, No. 81072914;Major Project Foundation of National Science and Technology, No. 2010ZX9102-204;Traditional Chinese Medicine Research Grant for Military Organization, No. 10ZYZ255

摘　　要：AIM: To investigate the efficacy and safety of combined antiviral and immunosuppressant therapy in adult hepatitis B virus-associated glomerulonephritis (HBVGN) patients. METHODS: A computerized literature search was carried out in the PubMed database, Embase, the Cochrane Library, Chinese BioMedical Literature on disc, Chinese Medical Current Contents, Chinese National Knowledge Infrastructure, Wanfang and VIP (Chinese Technological Journal of Database) to collect articles between June 1980 and December 2010 on therapy with immunosuppressants, e.g., glucorticosteroids, mycophenolate mofetil and leflunomide, combined with antivirals, e.g., interferon, lamivudine, entecavir and adefovir dipivoxil, in adult HBV-GN patients. The primary outcomes were remission of proteinuria, clearanceof HBV e-antigen, and elevation of serum albumin. The secondary outcomes were blood levels of alanine aminotransferase, serum creatinine, and HBV-DNA titer. Meta-analysis was performed using Review Manager 5.1. Fixed or random effect models were employed to combine the results after a heterogeneity test. The effects of the combined therapy were analyzed for different doses of glucorticosteroid and different types of HBV-GN. RESULTS: Twelve clinical trials with 317 patients were included. A significantly higher incidence of HBV-GN was found in male patients (relative risk = 2.40, 95% CI: 1.98-2.93). Combined therapy reduced the proteinuria significantly with a mean difference of 4.19 (95% CI: 3.86-4.53) and increased the serum albumin concentration significantly with a mean difference of -11.95 (95% CI: -12.97-10.93) without significant alterations of liver function (mean difference: 4.62, 95% CI: -2.55-11.79) and renal function (mean difference: 10.29, 95% CI: 0.14-20.45). No signif icant activation of HBV-DNA replication occurred (mean difference: 0.12, 95% CI: -0.37-0.62). There was no significant difference between the high dose glucorticosteroid group and the low dose glucorticosteroid group in terms of proteinuria remission (P = 0AIM： To investigate the efficacy and safety of combined antiviral and immunosuppressant therapy in adult hepatitis B virus-associated glomerulonephritis （HBVGN） patients. METHODS： A computerized literature search was carried out in the PubMed database, Embase, the Cochrane Library, Chinese BioMedical Literature on disc, Chinese Medical Current Contents, Chinese National Knowledge Infrastructure, Wanfang and VIP （Chinese Technological Journal of Database） to collect articles between June 1980 and December 2010 on therapy with immunosuppressants, e.g., glucorticosteroids, mycophenolate mofetil and leflunomide, combined with antivirals, e.g., interferon, lamivudine, entecavir and adefovir dipivoxil, in adult HBV-GN patients. The primary outcomes were remission of proteinuria, clearanceof HBV e-antigen, and elevation of serum albumin. The secondary outcomes were blood levels of alanine aminotransferase, serum creatinine, and HBV-DNA titer. Meta-analysis was performed using Review Manager 5.1. Fixed or random effect models were employed to combine the results after a heterogeneity test. The effects of the combined therapy were analyzed for different doses of glucorticosteroid and different types of HBV-GN. RESULTS： Twelve clinical trials with 317 patients were included. A significantly higher incidence of HBV-GN was found in male patients （relative risk = 2.40, 95% CI： 1.98-2.93）. Combined therapy reduced the proteinuria significantly with a mean difference of 4.19 （95% CI： 3.86-4.53） and increased the serum albumin concentration significantly with a mean difference of -11.95 （95% CI： -12.97-10.93） without significant alterations of liver function （mean difference： 4.62, 95% CI： -2.55-11.79） and renal function （mean difference： 10.29, 95% CI： 0.14-20.45）. No signif icant activation of HBV-DNA replication occurred （mean difference： 0.12, 95% CI： -0.37-0.62）. There was no significant difference between the high dose glucorticosteroid group and the low dose glucorti

关 键 词：META-ANALYSIS Hepatitis B virus-associatedglomerulonephritis GLUCOCORTICOIDS IMMUNOSUPPRESSANT Antiviral drug 

分 类 号：S858.26[农业科学—临床兽医学] Q78[农业科学—兽医学]