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Rheumatol Int. 2012 Mar;32(3):645-53. doi: 10.1007/s00296-010-1697-6. Epub 2010 Dec 4.
Scleroderma renal crisis (SRC) has been associated with the use of corticosteroids (CS) in retrospective studies. Using an evidence-based approach, we undertook a systematic review of the literature to identify prospective studies in which scleroderma patients were administered CS to ascertain the risk of SRC in those patients. A comprehensive search was conducted using Medline, EMBASE, the Cochrane Library, and Web of Science. All original prospective clinical studies were eligible if they enrolled SSc patients newly treated with CS. Selected studies were reviewed, and data extraction was systematically performed for the dose and duration of the CS intervention as well as the occurrence of SRC. Twenty-six studies with a total of 500 SSc patients commencing new CS therapy were included in the systematic review. Ten definite cases of SRC, equivalent to a rate of 2%, were identified. In the subset of early diffuse patients, the rate of SRC was 4%. All 10 definite cases of SRC occurred in patients who received medium- to high-dose CS therapy. Seven cases occurred in the setting of stem cell transplant. CS are associated with SRC, although this may be due to confounding by disease severity and/or co-intervention. Great caution must continue to be exerted when initiating such therapy, especially in high doses and in the early diffuse subset of SSc patients.
硬皮病肾危象（SRC）与皮质类固醇（CS）的使用有关，在回顾性研究中已经得到证实。本研究采用循证医学方法，对文献进行了系统评价，以确定对接受 CS 治疗的硬皮病患者进行前瞻性研究，从而明确此类患者发生 SRC 的风险。通过 Medline、EMBASE、Cochrane 图书馆和 Web of Science 进行了全面检索。如果前瞻性临床研究纳入了新接受 CS 治疗的 SSc 患者，则符合入选标准。对入选研究进行了综述，并对 CS 干预的剂量和持续时间以及 SRC 的发生情况进行了系统的数据提取。系统评价共纳入了 26 项研究，共 500 例 SSc 患者接受了新的 CS 治疗。确定了 10 例明确的 SRC 病例，发生率为 2%。在早期弥漫性患者亚组中，SRC 的发生率为 4%。所有 10 例明确的 SRC 均发生在接受中高剂量 CS 治疗的患者中。7 例发生在干细胞移植的背景下。CS 与 SRC 相关，但这可能是由于疾病严重程度和/或合并干预的混杂因素所致。在开始此类治疗时，特别是在高剂量和早期弥漫性 SSc 患者中，必须继续保持高度谨慎。
