Corticosteroid Therapy in IgA Nephropathy
Corticosteroid Therapy in IgA Nephropathy
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DOI：
10.1681/asn.2011111112
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发表时间：
2012-06-01
影响因子：
13.6
通讯作者：
Wang, Haiyan
中科院分区：
文献类型：
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作者：
Lv, Jicheng;Xu, Damin;Wang, Haiyan
类固醇治疗伊加肾病的获益和风险仍不确定。我们系统性检索了MEDLINE、EMBASE和科克伦图书馆中1966年至2011年3月发表的关于糖皮质激素治疗伊加肾病的随机对照试验。我们确定了9项相关试验，其中包括536例尿蛋白排泄>1 g/d且肾功能正常的患者。这些患者中有46例（8.6%）发生肾衰竭事件，定义为血清肌酐加倍/GFR或ESRD减半。总体而言，类固醇治疗与肾衰竭风险降低（相对风险，0.32 [95%置信区间[CI]，0.15-0.67]; P=0.002）和蛋白尿减少（加权平均差异，-0.46 g/d [95% CI，-0.63至-0.29 g/d]）相关，这些结局无异质性证据。亚组分析表明，剂量改变了类固醇的肾脏保护作用（异质性P =0.030）：相对高剂量和短期治疗（泼尼松>30 mg/d或高剂量静脉内甲基强的松龙脉冲持续时间
The benefits and risks of steroids for the treatment of IgA nephropathy remain uncertain. We systematically searched MEDLINE, EMBASE, and the Cochrane Library for randomized, controlled trials of corticosteroid therapy for IgA nephropathy published between 1966 and March 2011. We identified nine relevant trials that included 536 patients who had urinary protein excretion >1 g/d and normal renal function. Forty-six (8.6%) of these patients developed a kidney failure event, defined as doubling of the serum creatinine/halving of the GFR or ESRD. Overall, steroid therapy was associated with a lower risk for kidney failure (relative risk, 0.32 [95% confidence interval [Cl], 0.15-0.67]; P=0.002) and a reduction in proteinuria (weighted mean difference, -0.46 g/d [95% Cl, -0.63 to -0.29 g/d]), with no evidence of heterogeneity in these outcomes. Subgroup analysis suggested that the dose modifies the effect of steroids for renal protection (P for heterogeneity=0.030): Relatively high-dose and short-term therapy (prednisone >30 mg/d or high-dose pulse intravenous methylprednisolone with duration