摘要：
Objective To evaluate the efficiency and safety of corticosteroid therapy for IgA nephropathy.Methods Pubmed,Medline/embase,and Te Cochrane Library databases were searched for randomized controlled trials (RCTs) of hormone therapy for IgA nephropathy from database establishment to September 2017.According to the Cochrane system evaluation method,two reviewers independently screened the literature,extracted data,evaluated the quality of the included studies and cross-checked them according to inclusion and exclusion criteria.The Cochrane bias risk method was used to evaluate the quality of the included studies.The fixed effect model was used to assess the risk of serum creatinine change and progression to end-stage renal disease (ESRD).The random-effect models were used to assess 24-hour urinary protein quantification and the incidence of adverse events leading to drug withdrawal or hospitalization.The data were pooled using RevMan 5.3 software.The quadratic variables were odds ratio (OR) and the continuous variables were mean difference (MD).The odds ratio was used as the effect variable for the two variables,and the mean variance was used as the effect variable for the continuous variable data.Results A total of 9 RCTs were enrolled.Meta-analysis showed that compared with the control group,the steroid treatment group could slow down the increase of serum creatinine by more than 50％ in IgA nephropathy patients (OR =0.15,95％ CI:0.04-0.53,P =0.003) and delay the progression to ESRD (OR =0.38,95％ CI:0.16-0.87,P =0.02),but there was no significant difference in the level of serum creatinine (MD =-0.03,95％ CI:-0.29-0.24,P =0.85),the 24 hour urinary protein quantification (MD =-0.55,95％ CI:-1.42-0.31,P =0.21),and the incidence of adverse reactions (OR =1.68,95％ CI:0.69-4.11,P =0.26).Conclusions The meta analysis showed that there was no significant difference in the safety of steroid treated IgA nephropathy compared with the control group,and may be beneficial to the long-term prognosis of patients with IgA nephropathy.%目的 系统评价激素治疗IgA肾病的有效性及安全性.方法 计算机检索Pubmed、Medline/embase和Te Cochrane Library数据库,检索时限均为从建库至2017年9月,查找激素治疗IgA肾病的随机对照试验.按照Cochrane系统评价方法,由两名评价者根据纳入与排除标准独立筛选文献、提取资料、评价纳入研究质量并交叉核对.采用Cochrane偏倚风险方法评价纳入研究质量.采用固定效应模型评估血肌酐变化、进展至终末期肾病(ESRD)的风险,采用随机效应模型评估24h尿蛋白定量以及导致停药或住院的不良事件发生率等指标,数据合并采用RevMan 5.3软件.二次变量采用比值比(OR)为效应量,连续变量资料采用均数差(MD)为效应量.结果 最终纳入9个随机对照试验.Meta分析结果显示:与对照组相比,激素组可以减缓IgA肾病患者血肌酐升高50％以上(OR =0.15,95％ CI:0.04 ～0.53,P=0.003)、延缓进展至ESRD(OR =0.38,95％ CI:0.16 ～0.87,P=0.02);但在血肌酐升高水平(MD=-0.03,95％ CI:-0.29～0.24,P=0.85)、24 h尿蛋白定量(MD=-0.55,95％ CI:-1.42～0.31,P=0.21)、不良反应发生率(OR=1.68,95％ CI:0.69 ～4.11,P=0.26)等方面差异无统计学意义.结论 本项meta分析表明激素治疗IgA肾病与对照组相比安全性无明显差异,且可能对IgA肾病患者的长期预后有益.
