The Effectiveness And Safety Of Glucocorticoid Combined With Nucleotide Analogues In The Treatment Of Hepatitis B Virus-Associated Glomerulonephritis:A Meta-Analysis

Background and Aim:There are an estimated 400 million HBV infections worldwide,of which about3% are secondary to hepatitis B virus-associated glomerulonephritis(HBV-GN)[1].Approximately 30% of adult HBV-GN patients may progress to renal failure,and up to 10% of these patients will require maintenance hemodialysis [2].Therefore,the diagnosis and treatment of HBV-GN is of great importance.However,whether glucocorticoid can be used to treat HBV-GN is still controversial.To evaluate the efficacy and safety of glucocorticoid combined with nucleoside analogues(NAs)for HBV-GN.Methods:Retrieval of Cochrane Library,Pub Med,Medline,Embase,CNKI,wip,wanfang database and China biomedical database: literature from January 2000 to December2018,no language restrictions.Retrieve the title or keywords contained“hepatitis B virus-associated glomerulonephritis”?“HBV-GN”?“glucocorticoids”?“prednisone”?“prednisolone”?“Methylprednisolone”?“Prednisone acetate”related literature.Results:A total of 679 adult HBV-GN patients were enrolled in 11 eligible clinical studies.Compared with the control group before and after treatment,24 h urine protein quantitative reduction was more significant(MD=-1.24,95% CI [-1.54,-0.94],P < 0.00001).The increase of ALB was more obvious(MD=3.98,95% CI [2.59,5.37],P < 0.00001).There was no significant difference in ALT(MD=1.21,95% CI[-0.47,2.88],P =0.16).There was no significant difference in AST(MD=-0.02,95%CI [-0.39,0.34],P =0.90).Scr changes were not statistically significant(MD=-1.48,95% CI [-9.18,6.21],P =0.71).There was no significant difference in HBV-DNA replication(RR=1.05,95% CI [0.93,1.19],P =0.46).There was no significant difference in HBe Ag transformation(RR=1.24,95% CI [0.89,1.73],P =0.20).The complete response rate was higher(RR=1.45,95% CI [1.20,1.75],P = 0.0001).There was no significant difference in partial response rate(RR=1.12,95% CI [0.93,1.35],P = 0.25).The total effective rate was higher(RR=1.27,95% CI [1.18,1.38],P<0.00001).There was no significant difference in the incidence of adverse reactions(RR=1.72,95%CI [0.80,3.73],P=0.17).Conclusion:For adult HBV-GN patients,glucocorticoid combined with NAs is more effective than antivirus therapy with NAs alone,and does not increase the risk of adverse reactions.