环磷酰胺治疗儿童紫癜性肾炎的Meta分析  

A meta-analysis of cyclophosphamide therapy for Henoch-Schonlein purpura nephritis in children

作　　者：孙智才[1] 杨华彬[1] 曾海丽[1] 

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心肾内科,510120

出　　处：《中华临床医师杂志（电子版）》2014年第4期95-99,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：广东省科技厅基金项目(200883090)

摘　　要：目的运用循证医学方法评价环磷酰胺(CTX)治疗儿童紫癜性肾炎(HSPN)的疗效和安全性。方法检索Cochrane Library、ACP Journal Club、PubMed、OVID、EBSCO、中国期刊全文数据库(CNKI)、万方数据库和维普中文期刊数据库以及手工检索会议资料和学位论文,尽可能获取所有CTX治疗儿童HSPN的文献。制定严格的纳入和排除标准,依据Cochrane手册5.1.0质量评价标准对文献进行质量评价。采用Review Manager 5.2软件进行Meta分析。结果共检索文献423篇,英文176篇,中文247篇。依据纳入及排除标准最终纳入分析的随机对照试验(RCT)文献8篇。8篇RCT文献均未对随机分组方法作详细描述,均未采用分配隐藏,未采用盲法,未提及退出和失访,亦未提及选择性报告研究结果和其他偏倚,但都采用了公认的诊断方法,基线资料具有可比性。Meta分析结果显示:(1)CTX/激素(GC)联合组临床缓解率显著高于单用GC组:RR值为1.58(95%CI:1.36,1.85),差异有统计学意义;(2)CTX/GC联合组治疗后尿蛋白定量和血清白蛋白量均优于单用GC组,MD值分别为:-2.04(95%CI:-2.92,-1.71)和7.61(95%CI:4.69,10.52),差异均有统计学意义;(3)不良反应发生率:CTX/GC联合组的激素不良反应低于单用GC组,但急性胃肠道反应发生率较高,差异均有统计学意义,而两组患儿的呼吸道感染、白细胞减少、出血性膀胱炎、肝功能损害和脱发发生率差异均无统计学意义。结论 GC联合CTX治疗儿童HSPN比单用GC治疗临床缓解率高,降低蛋白尿和升高血清白蛋白效果更明显,对重症HSPN患儿疗效优于单用GC治疗。除急性胃肠道反应发生率较激素高外,呼吸道感染、白细胞减少、出血性膀胱炎、肝功能损害和脱发等不良反应少,安全性好,但确切疗效仍需要大量前瞻性研究进一步证实。Objective To assess the efficacy and safety of cyclophosphamide（CTX） therapy for Henoch- Schnlein purpura nephritis（HSPN） in children. Methods Cochrane Library, ACP Journal Club, PubMed, OVID, EBSCO, CNKI, Wanfang Data and VIP Database were searched for studies, conference materials and dissertations concerning CTX therapy for HSPN in children without language restriction as completely as possible. Formulate the including and excluding criteria as well as the efficacy judgement criteria. According to the criterias and quality evaluation standards of Cochrane Handbook 5.1.0, articles were screened and evaluated with by two researchers respectively. Review Manager 5.2 software was used for meta-analysis. Results A total of 423 papers were included, containing 176 English articles and 247 Chinese articles. According to the including and excluding criteria, eight RCTs were enrolled for meta-analysis. Eight RCTs all didn＇t describe the method of random allocation and didn＇t use double blind method. All of them were lack of information about allocation concealment, withdrawal and loss of subject, selectively reporting and other bias, but all used established diagnostic criteria. The results were as follows：（1）The remission rate of CTX plus GC group was higher than that of GC group（RR=1.58, 95% CI：1.36,1.85）;（2）The 24 h urine protein of CTX plus GC group was lower than that of GC group（MD=-2.04, 95% CI：-2.92,-1.71）, and albumin was higher than that of GC group（MD=7.61, 95% CI：4.69, 10.52）;（3）Adverse effects： Hormone side effects incidence of CTX plus GC group was lower than that of GC group, gastrointestinal reaction incidence of CTX plus GC group was higher than that of GC group, but there was no significant difference in respiratory infection, leukopenia, hemorrhagic cystitis, alopecia and hepatic dysfunction between two groups. Conclusions Compared to GC, the remission rate in CTX plus GC group was higher and this treatment was more effective in reducing proteinuria an

关 键 词：环磷酰胺 儿童 META分析 紫癜性肾炎 

分 类 号：R726.9[医药卫生—儿科]