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目的 Meta分析药物治疗对乙型肝炎病毒相关性肾炎(HBV-GN)的有效性。方法计算机检索Cochrane图书馆、MEDLINE、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、万方数据库等中外生物医学数据库,收集有关HBV-GN药物治疗的临床试验,检索日期自1980年1月至2012年7月。按Cochrane系统评价方法,评价所纳入研究的文献质量,提取有效数据后采RevMan 5.0和STATA 10.0软件进行Meta分析。结果共纳入9项研究,共计331例患者,抗病毒治疗的疗效分析共纳入6项研究,其中3项用干扰素进行治疗,2项用拉米夫定进行治疗,1项用恩替卡韦进行治疗,共纳入患者236例(抗病毒治疗组122例、对照组114例)。Meta分析结果显示,抗病毒治疗组蛋白尿的缓解率[RR=1.37,95%CI(1.16,1.60),P=0.0001]和HBeAg清除率[RR=3.28,95%CI(2.18,4.94),P<0.00001]均明显高于对照组,且蛋白尿的缓解与HBeAg清除呈明显的正相关(Kappa=0.352,P=0.003);对儿童亚组进行分析显示:血清HBeAg清除率与对照组比较差异有统计学意义[RR=9.86,95%CI(3.42,28.41),P=0.03]。糖皮质激素或免疫抑制剂联合抗病毒治疗的疗效分析共纳入3项研究,进行Meta分析显示,激素或免疫抑制剂联合抗病毒治疗组蛋白尿的缓解率[RR=2.34,95%CI(1.31,4.16),P=0.04]和HBeAg清除率[RR=0.98,95%CI(0.30-3.25),P=0.97]与对照组比较差异均无统计学意义。结论本研究显示抗病毒(干扰素和拉米夫定)治疗HBV-GN能有效缓解蛋白尿,提高HBeAg清除率,且尿蛋白的缓解与HBeAg的清除呈明显的正相关,并在一定程度上延缓肾功能恶化。激素或免疫抑制剂联合抗病毒治疗在HBV-GN中的作用不显著。
Objective Meta analysis of drug treatment of hepatitis B virus-associated nephritis (HBV-GN) effectiveness. Methods The Chinese and foreign biomedical databases such as Cochrane Library, MEDLINE, EMBASE, China Biomedical Literature Database, Chinese Journal Full-text Database and Wanfang Database were searched by computer. The clinical trials of HBV-GN drug therapy were collected. The search date was from January 1980 to July 2012. According to the Cochrane systematic review method, the quality of the literature included in the study was evaluated. Valid data were extracted and then analyzed by RevMan 5.0 and STATA 10.0 software for meta-analysis. Results A total of 9 studies were enrolled in a total of 331 patients. A total of 6 studies were included in the analysis of efficacy of antiviral therapy, 3 of which were treated with interferon, 2 were treated with lamivudine, 1 was treated with entecavir, A total of 236 patients were enrolled (122 in the antiviral group and 114 in the control group). Meta-analysis showed that the remission rate of proteinuria [RR = 1.37, 95% CI (1.16,1.60), P = 0.0001] and HBeAg clearance [RR = 3.28,95% CI P <0.00001] were significantly higher than the control group, and proteinuria and HBeAg eradication was significantly positively correlated (Kappa = 0.352, P = 0.003); analysis of children’s subgroup showed: serum HBeAg clearance compared with the control group The difference was statistically significant [RR = 9.86, 95% CI (3.42, 28.41), P = 0.03]. Efficacy of glucocorticoid or immunosuppressant in combination with antiviral therapy A total of 3 studies were included in the meta-analysis. The response rate of proteinuria to hormones or immunosuppressive agents in combination with antiviral therapy [RR = 2.34,95% CI (1.31 , 4.16), P = 0.04] and HBeAg clearance [RR = 0.98,95% CI (0.30-3.25), P = 0.97]. There was no significant difference between the two groups. Conclusions This study shows that antiviral (interferon and lamivudine) treatment of HBV-GN can effectively relieve proteinuria and improve the rate of HBeAg clearance, and urinary protein remission and HBeAg clearance was significantly positively correlated, and to some extent Delayed renal function deterioration. The effect of hormones or immunosuppressive agents in combination with antiviral therapy in HBV-GN was insignificant.