CAJ | 학술논문

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。
목적： Meta분석약물치료대을형간염병독상관성신염（HBV-GN）적유효성。방법계산궤검색Cochrane도서관、MEDLINE、EMBASE、중국생물의학문헌수거고、중국기간전문수거고、만방수거고등중외생물의학수거고，수집유관HBV-GN약물치료적림상시험，검색일기자1980년1월지2012년7월。안Cochrane계통평개방법，평개소납입연구적문헌질량，제취유효수거후채RevMan 5.0화STATA 10.0연건진행Meta분석。결과공납입9항연구，공계331례환자，항병독치료적료효분석공납입6항연구，기중3항용간우소진행치료，2항용랍미부정진행치료，1항용은체잡위진행치료，공납입환자236례（항병독치료조122례、대조조114례）。Meta분석결과현시，항병독치료조단백뇨적완해솔[RR =1.37，95%CI（1.16，1.60），P =0.0001]화HBeAg청제솔[RR =3.28，95%CI（2.18，4.94），P ＜0.00001]균명현고우대조조，차단백뇨적완해여HBeAg청제정명현적정상관（Kappa =0.352，P =0.003）；대인동아조진행분석현시：혈청HBeAg청제솔여대조조비교차이유통계학의의[RR =9.86，95%CI（3.42，28.41），P =0.03]。당피질격소혹면역억제제연합항병독치료적료효분석공납입3항연구，진행Meta분석현시，격소혹면역억제제연합항병독치료조단백뇨적완해솔[RR =2.34，95%CI（1.31，4.16），P=0.04]화HBeAg청제솔[RR=0.98，95%CI（0.30-3.25），P=0.97]여대조조비교차이균무통계학의의。결론본연구현시항병독（간우소화랍미부정）치료HBV-GN능유효완해단백뇨，제고HBeAg청제솔，차뇨단백적완해여HBeAg적청제정명현적정상관，병재일정정도상연완신공능악화。격소혹면역억제제연합항병독치료재HBV-GN중적작용불현저。
Objectives To assess the efifcacy of drug therapy on hepatitis B virus associated glomerulonephritis (HBV-GN) by a systematic review and meta-analysis of clinical trials. Methods Electronic databases including Pubmed, Cochrane library, EMBASE, MEDLINE, CBM, CNKI and VIP were searched for prospective controlled trials which assessed the efifcacy of drug therapy on HBV-GN in adult or pediatric patients from Jan. 1980 to July. 2012. Study selection and meta-analysis were conducted according to the Cochrane handbook for systematic reviews. Data were extracted from these trials by three reviewers independently and analyzed by Revman 5.0 and stata 10.0 software. Results Nine trials with a total of 331 patients were included;among them, six trials were speciifed as the anti-viral therapy group, three studies were about interferon, two about lamividine and one about entecavir. It was found by the meta-analysis that, compared with the controls, anti-viral therapy could signiifcantly elevate the remission rate of proteinuria (RR=1.37, 95%CI 1.16-1.60, P=0.0001) and the clearance rate of HBeAg (RR=3.28, 95%CI 2.18-4.94, P<0.00001). Futhermore, Kappa analysis showed positive correlation between proteinuria remission and HBeAg clearance after anti-viral therapy (Kappa = 0.352, P = 0.003). Another three trials were specified as the combined therapy (antivirals and immunosuppressants) group. Meta-analysis showed there was no signiifcant difference between the combined treatment group and the controls in the remission rate of proteinuria (RR=2.34, 95%CI 1.31, 4.16, P=0.04) and the clearance rate of HBeAg (RR=0.98, 95%CI 0.30-3.25, P=0.97). Conclusions This study showed the antiviral therapy (including interferon , lamivudine, entecavir) in HBV-GN is effective on remission of proteinuria and HBeAg clearance, the combined treatment could not conduct such effort in this study. For further research on combined treatment, more trials should be performed in the clinical.