摘要
目的评价免疫抑制剂联合核苷类似物治疗乙型肝炎病毒相关性肾炎(HBV-GN)的有效性和安全性。方法计算机检索中国知网,维普网,万方数据库,中国生物医学数据库,PubMed,Embase,the Cochrane Library,SCI等八大数据库,全面收集免疫抑制剂联合核苷类似物治疗HBV-GN的临床研究,检索的时限从2009年1月1日至2016年12月31日。由两名研究者根据纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan5.3软件进行Meta分析。结果纳入13篇研究,共包括HBV-GN患者606例。Meta分析结果:(1)试验组24小时尿蛋白定量低于对照组;(2)试验组血清白蛋白、客观有效率、完全缓解率高于对照组;(3)试验组与对照组ALT变化及HBV-DNA转阴率比较差异无统计学意义。结论免疫抑制剂联合核苷类似物治疗HBV-GN比单独用核苷类似物治疗客观有效率、完全缓解率更高,能有效降低蛋白尿,改善肝肾功能,不影响肝功能,不会导致乙型肝炎病毒复制。
Objective To evaluate the efficacy and safety of immunosuppressant combined with nucleoside analogues therapy in adult hepatitis B virusassociated glomerulonephritis （HBV-GN） patients. Methods We searched the Cochrane Library, PubMed, Embase, SCI, Chinese BioMedical database, CNKI, VIP and Wanfang of Database from Jan 1,2009 to Dec 31,2016 to screen the clinical trials of immunosuppressant combined with nucleoside analogues therapy in adult HBV-GN patients. Two researchers critically screened literatures by incorporating and exclusion criteria, extracted relevant data,then independently assessed by methodological quality. Rev Man 5.3 software was used for metaanalysis. Results A total of 13 cohort studies involving 606 adult HBV-GN patients were finally included. The results of metaanalysis showed that the combining therapy group was better than the control group in reducing 24 hour urinary protein quantity;the combining therapy group was better than the control group in increasing serum albumin, the complete remission rate and the objective response rate; the two groups showed no significant difference in alanine aminotransferase and negative conversion ratio of HBV-DNA. Conclusion Compared with single nucleoside analogues therapy, immunosuppressant combined with nucleoside analogues therapy can increase the objective response rate and complete remission rate, more effectively reduce 24 hours urinary protein quantity and protect hepatorenal function,keep hepatic function intact and no replication of HBV-DNA in adult HBV-GN patients.
出处
《临床荟萃》
CAS
2017年第7期613-617,共5页
Clinical Focus
