Department of Nephrology, The Affiliated Changzhou NO.2 People's Hospital of Nanjing Medical University, Jiangsu, China.
Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Medicine (Baltimore). 2024 Jul 26;103(30):e39059. doi: 10.1097/MD.0000000000039059.
The objective of this meta-analysis was to compare the efficacy and safety between glucocorticoids combined with mycophenolate mofetil (MMF) versus glucocorticoids combined with cyclophosphamide (CTX) for henoch schonlein purpura nephritis (HSPN) in children.
Databases including PubMed, EMbase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database were searched from the inception to April 5th, 2024. Eligible studies comparing glucocorticoids combined with MMF versus glucocorticoids combined with CTX for HSPN in children were included. Data were analyzed using Review Manager Version 5.3.
Ten studies were included in the meta-analysis. Six randomized controlled trials (RCTs) and 4 non-randomized studies involving 675 patients were identified. Compared with CTX therapeutic schedule, MMF therapeutic schedule had a higher complete remission (CR) within the 6 months (OR 1.61, 95%CI 1.16-2.22, P = .004) and CR within the 12 months (OR 1.73, 95%CI 1.00-2.97, P = .05). However, there was no significant difference between MMF and CTX therapeutic schedule concerning total remission (TR) within the 6 months (OR 1.54, 95%CI 0.82-2.92, P = .18) and TR within the 12 months (OR 2.08, 95%CI 0.86-5.01, P = .10). In addition, incidences of gastrointestinal discomfort (OR 0.33, 95%CI 0.19-0.56, P < .0001), liver function injury (OR 0.28, 95%CI 0.09-0.87, P = .03), myelosuppression (OR 0.15, 95%CI 0.06-0.41, P = .0001), alopecia (OR 0.25, 95%CI 0.07-0.91, P = .03) in MMF therapeutic schedule were all lower than CTX therapeutic schedule. There was no statistically significant difference between the 2 therapeutic schedules concerning infection (OR 0.90, 95%CI 0.50-1.61, P = .72), rash (OR 0.38, 95%CI 0.07-2.04, P = .26).
Glucocorticoids combined with MMF had a higher CR and lower incidence of adverse effects compared with glucocorticoids combined with CTX in the treatment of HSPN in children.
本荟萃分析旨在比较糖皮质激素联合吗替麦考酚酯（MMF）与糖皮质激素联合环磷酰胺（CTX）治疗儿童过敏性紫癜肾炎（HSPN）的疗效和安全性。
检索PubMed、EMbase、Cochrane 图书馆、中国知网和万方数据库，纳入比较糖皮质激素联合 MMF 与糖皮质激素联合 CTX 治疗儿童 HSPN 的研究。使用 Review Manager Version 5.3 进行数据分析。
共纳入 10 项研究，包括 6 项随机对照试验（RCT）和 4 项非随机研究，共 675 例患者。与 CTX 治疗方案相比，MMF 治疗方案在 6 个月内完全缓解（CR）（OR 1.61，95%CI 1.16-2.22，P=0.004）和 12 个月内 CR（OR 1.73，95%CI 1.00-2.97，P=0.05）的比例更高。然而，在 6 个月内总缓解（TR）（OR 1.54，95%CI 0.82-2.92，P=0.18）和 12 个月内 TR（OR 2.08，95%CI 0.86-5.01，P=0.10）方面，MMF 和 CTX 治疗方案之间无显著差异。此外，MMF 治疗方案的胃肠道不适（OR 0.33，95%CI 0.19-0.56，P<0.0001）、肝功能损伤（OR 0.28，95%CI 0.09-0.87，P=0.03）、骨髓抑制（OR 0.15，95%CI 0.06-0.41，P=0.0001）和脱发（OR 0.25，95%CI 0.07-0.91，P=0.03）的发生率均低于 CTX 治疗方案。在感染（OR 0.90，95%CI 0.50-1.61，P=0.72）和皮疹（OR 0.38，95%CI 0.07-2.04，P=0.26）方面，两种治疗方案之间无统计学差异。
与糖皮质激素联合 CTX 相比，糖皮质激素联合 MMF 治疗儿童 HSPN 可提高 CR 率，降低不良反应发生率。
