【摘要】 目的评价糖皮质激素对过敏性紫癜患儿肾损害的预防作用。方法检索Cochrane图书馆、MEDLINE、EMBASE、CBM等资料库,收集有关糖皮质激素对过敏性紫癜患儿肾损害预防作用的随机对照研究后进行Meta分析。结果3个随机对照研究符合纳入标准。显示治疗组肾损害的发生率为7．0％(11／158),对照组肾损害的发生率为19．9％(30／151)(RR=0．35,95％CI:0．19-0．65);治疗组未出现明显的不良反应。结论过敏性紫癜患儿早期接受泼尼松治疗可显著减少肾脏损害的发生,且无明显不良反应。但本项分析的试验数较少,且存在研究结果方向的不一致,故仍需要进行大样本、前瞻性、随机对照研究来进一步明确。目前建议糖皮质激素应有选择地早期应用于存在肾脏受累危险因素的高危患儿,以预防肾脏损害。更多还原

【Abstract】 Objectives Henoch-Scholein purpura (HSP) is the most common systemic small vessel vasculitis in children. The long-term morbidity and mortality of HSP are predominantly attributable to renal involvement. During the last three decades there were many studies reported the early use of corticosteroids in HSP children without renal involvement; but the question of whether early treatment with corticosteroids reduces the risk of subsequent renal involvement in HSP remains unknown. So it is necessary to use evidence-based medicine to investigate whether early corticosteroid administration could reduce the rate of renal complications in children with HSP. Methods Cochrane library, MEDLINE, EMBASE and CBM were searched and the randomized controlled clinical trials were selected and analyzed with Meta-analysis. Eligible patients were younger than 16 years of age and without renal involvement before the treatment. Results Three randomized controlled clinical trials were selected and the results showed that the incidence of renal involvement in the treatment group and in the controlled group were 7.0 % (11/158) and 19.9 % (30/151) (RR = 0.35, 95 % CI: 0.19 ~ 0.65); respectively. No serious side effects were reported in the treatment group. Conclusions Early corticosteroid administration could reduce the rate of renal complications in children with HSP without obvious serious side effects. But in this analysis the number of studies were not enough to obtain the reliable results. Moreover the results in the selected studies were different. So the prospective randomized controlled clinical trials with large samples are needed. By now it is recommended that corticosteroids should be used selectively in the patients with high risk factors of renal involvement.更多还原