Pediatric resident, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Pediatric Rheumatology, Imam Hossein Children,s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Curr Rheumatol Rev. 2024;20(1):57-64. doi: 10.2174/1573397119666230825163008.
Henoch-Schönlein purpura (IgA vasculitis) is the most common childhood vasculitis, one of its complications is renal involvement. However, several treatment regimens have been proposed to improve renal function in the long term, but which drug regimen can be most effective is still controversial.
This study was a systematic review. In order to find evidence related to the purpose of this study, databases including Google Scholar, Web of Science, ProQuest and Medline via PubMed, and Scopus were searched with the appropriate keywords. QUADAS-2 (a Quality Assessment tools for Diagnostic Accuracy Studies) checklist was also used to evaluate the quality of studies. Based on the keywords used in reviewing the information sources of scientific articles, in the first stage, 86 studies were included in the review. Taking into account characteristics such as lack of homogeneity with the objectives of the present study, finally, 11 studies were selected for analysis and final evaluation.
A total of 11 studies, including 722 patients in the age range of 5.5 to 9.9 years with HSP were included in the study. The follow-up period of the patients varied from 6 months to 16 years in terms of examining the treatment process. In terms of study type, 7 studies were conducted as prospective or retrospective (non-interventional) cohorts and 4 studies as randomized clinical trials. The treatment regimen of injectable methylprednisolone followed by oral prednisolone resulted in a long-term recovery of 79.2% (95% confidence interval between 0.66% and 88.2%); however, the need for additional immunosuppressive in two studies was mentioned as 38% and 46.1%, respectively. In the therapeutic regimen of oral methylprednisolone alone, a significant improvement in long-term renal function was achieved in comparison with placebo. Administration of injectable methylprednisolone followed by cyclosporine A had the highest effectiveness in terms of improving renal function in the long term.
Regimes based on the administration of prednisolone (either oral or injectable, either as a single drug or as a combination) lead to long-term improvement of renal function in patients with HSP, but the use of other immunosuppressive drugs such as cyclosporine A, of course, with optimizing the drug dose can lead to a significant improvement in the clinical performance.
过敏性紫癜（IgA 血管炎）是儿童最常见的血管炎之一，其并发症之一是肾脏受累。然而，已经提出了几种治疗方案来改善长期肾功能，但哪种药物方案最有效仍存在争议。
这是一项系统评价研究。为了找到与本研究目的相关的证据，我们使用了适当的关键词，在包括 Google Scholar、Web of Science、ProQuest 和 Medline via PubMed 以及 Scopus 在内的数据库中进行了搜索。我们还使用了 QUADAS-2（诊断准确性研究的质量评估工具）检查表来评估研究的质量。根据审查科学文章信息来源时使用的关键词，在第一阶段，有 86 项研究被纳入了综述。考虑到与本研究目标缺乏同质性等特征，最终有 11 项研究被纳入分析和最终评估。
共有 11 项研究，包括 722 名年龄在 5.5 至 9.9 岁的 HSP 患者，被纳入了研究。根据检查治疗过程的不同，患者的随访时间从 6 个月到 16 年不等。就研究类型而言，有 7 项研究为前瞻性或回顾性（非干预性）队列研究，4 项研究为随机临床试验。静脉注射甲基强的松龙后继以口服强的松龙的治疗方案导致 79.2%（95%置信区间在 0.66%和 88.2%之间）的长期恢复；然而，有两项研究分别提到需要额外使用 38%和 46.1%的免疫抑制剂。在单独使用口服甲基强的松龙的治疗方案中，与安慰剂相比，长期肾功能显著改善。静脉注射甲基强的松龙后继以环孢素 A 的治疗方案在改善长期肾功能方面效果最佳。
基于泼尼松龙（无论是口服还是静脉注射，无论是单一药物还是联合使用）的治疗方案可改善 HSP 患者的长期肾功能，但使用其他免疫抑制剂，如环孢素 A，当然，通过优化药物剂量，也可以显著改善临床疗效。
