| Objective:In this study,Meta analysis was used to compare Glucocorticoid(GC)combined with Mycophenolate Mofetil(MMF)and GC combined with Cyclophosphamide(CTX)to treat children with Henoch-Schonlein purpura nephritis(HSPN),and compare the safety of the two groups of drugs.Methods:Use a computer to search the Chinese literature database: China National Knowledge Internet(CNKI),Wan Fang database,China Biology Medicine disc(CBM),VIP;English literature database: PubMed,Cochrane Library,Embase,Web of Science.The search period is from the establishment of the database to November2019.All articles on Randomized Controlled trials(RCTS)of GC combined with MMF(GC+MMF)versus GC combined with CTX(GC+CTX)in the treatment of HSPN in children were collected.Filter literature based on inclusion and exclusion criteria.Use Excel to collect the data of the literature,and use Cochrane handbook5.1.0 to evaluate the quality of the selected literature.Statistical analysis of the included literature data using RevMan5.2 statistical software.And calculate the combined effect of each research indicator and its 95% confidence interval(95% CI).Use STATA15.0 software to draw a funnel chart to investigate whether there is publication bias.Results:A total of 404 articles,371 articles in Chinese and 33 articles in English were retrieved from the database.14 articles were finally included in this study.14 articles were all RCTS.No description was made on their allocation concealment method,and no blind method was implemented.One of the articles had a loss of follow-up,did not selectively report research results and other sources of bias.All baseline data included in the literature are comparable.The main outcome indicators of the meta analysis show: At 6-month follow-up,the treatment effect of GC+MMF group wasmore significant than that of GC+CTX group [RR=1.13,95% CI(1.07,1.19),P<0.001];At 9-month follow-up,the GC+MMF group was more effective than the GC+CTX group [RR=1.21,95%CI(1.10,1.34),P= 0.0001<0.001];At 12-month follow-up,the GC+MMF group had more advantages than the GC+CTX group in remission [RR=1.17,95%CI(1.09,1.25),P<0.001];In the treatment of children with grade III-V renal biopsy,the GC+MMF group had better treatment effects than the GC+CTX group [RR=1.13,95% CI(1.06,1.20),P<0.001];For the patients with large urine protein content,the GC+MMF group was better than the GC+CTX group,the former had better efficacy [RR=1.18,95%CI(1.11,1.24),P<0.001].The meta analysis secondary outcome indicators show: Compared with GC+CTX group,GC+MMF group had the predominant urinary protein relief [MD= ? 0.35,95%CI(? 0.42,?0.29),P<0.001],the serum albumin increased more significantly after treatment[MD=1.22,95%CI(0.19,2.24),P=0.02];Among the secondary outcome indicators,although the GC+MMF group had a significant decrease in creatinine level,but the heterogeneity between the two groups is too large.Considering the inconsistency with the follow-up time of blood test after treatment and the small sample size,the results of Meta analysis may be affected.In terms of safety,the Meta analysis showed that the GC+MMF group had fewer adverse reactions [RR=0.34,95%CI(0.27,0.44),P<0.001].Conclusion:According to the results of this meta-analysis,compared with GC combined with CTX,GC combined with MMF has a better therapeutic effect on HSPN in children.From safety considerations,the adverse reactions of GC combined with MMF are relatively few. |
PDF Full Text Request