A Meta-analysis Of Cyclophosphamide Therapy For Henoch-sch(o|¨)nlein Purpura Nephritis In Children

Objective Henoch-Sch nlein purpura nephritis (HSPN) is one of the mostcommon secondary glomerulonephritis in children, but there are no accepted andspecific treatment protocols home and abroad. To assess the efficacy and safety ofcyclophosphamide(CTX) therapy for HSPN in children.Methods Cochrane Library, ACP Journal Club, PubMed, OVID, EBSCO,CNKI, Wanfang Data and VIP Database were searched for studies, conferencematerials and dissertations concerning CTX therapy for HSPN in children withoutlanguage restriction as completely as possible. Formulate the including and excludingcriteria as well as the efficacy judgement criteria. According to Oxford Centre forEvidence-based Medicine-Level of Evidence and the criterias and quality evaluationstandards of Cochrane Handbook5.1.0, articles were screened and evaluated with bytwo researchers respectively. Review Manager5.2software was used formeta-analysis.Results A total of423papers were included, containing176Englisharticles and247Chinese 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 werelack of information about allocation concealment，withdrawal and loss of subject,selectively reporting and other bias, but all used established diagnostic criteria. Weassessed the efficacy of GC plus CTX group (149cases) vs GC alone (134cases) byanalysing8RCTs (Ib).The results were as follows:(1) The remission rate of CTXplus GC group was higher than that of GC group(RR=1.58,95%CI:1.36,1.85);(2)The24h 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 CTXplus GC group was lower than that of GC group(RR=0.34，95%CI:0.12,0.96),gastrointestinal reaction incidence of CTX plus GC group was higher than that of GCgroup(RR=3.76，95%CI:1.86,7.63), but there was no significant difference inrespiratory infection, leukopenia, hemorrhagic cystitis, alopecie and hepaticdysfunction between two groups.Conclusions Compared to GC, the remission rate in CTX plus GC group washigher and this treatment was more effective in reducing proteinuria and elevatingalbumin. The efficacy of GC combined with CTX pulse therapy for severe HSPN wassuperior to that of GC alone. CTX can reduce the rate of hormone side effects, andrespiratory infection, leukopenia, hemorrhagic cystitis, alopecie and hepaticdysfunction rarely occur apart from gastrointestinal reaction compared to GC alone.So it was very safe. Nevertheless, multicentral and large-scale RCT studies are neededto confirm the conclusions．...