目的： Meta分析药物治疗对乙型肝炎病毒相关性肾炎（HBV-GN）的有效性。方法计算机检索Cochrane图书馆、MEDLINE、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、万方数据库等中外生物医学数据库，收集有关HBV-GN药物治疗的临床试验，检索日期自1980年1月至2012年7月。按Cochrane系统评价方法，评价所纳入研究的文献质量，提取有效数据后采RevMan 5.0和STATA 10.0软件进行Meta分析。结果共纳入9项研究，共计331例患者，抗病毒治疗的疗效分析共纳入6项研究，其中3项用干扰素进行治疗，2项用拉米夫定进行治疗，1项用恩替卡韦进行治疗，共纳入患者236例（抗病毒治疗组122例、对照组114例）。Meta分析结果显示，抗病毒治疗组蛋白尿的缓解率[RR =1.37，95%CI（1.16，1.60），P =0.0001]和HBeAg清除率[RR =3.28，95%CI（2.18，4.94），P ＜0.00001]均明显高于对照组，且蛋白尿的缓解与HBeAg清除呈明显的正相关（Kappa =0.352，P =0.003）；对儿童亚组进行分析显示：血清HBeAg清除率与对照组比较差异有统计学意义[RR =9.86，95%CI（3.42，28.41），P =0.03]。糖皮质激素或免疫抑制剂联合抗病毒治疗的疗效分析共纳入3项研究，进行Meta分析显示，激素或免疫抑制剂联合抗病毒治疗组蛋白尿的缓解率[RR =2.34，95%CI（1.31，4.16），P=0.04]和HBeAg清除率[RR=0.98，95%CI（0.30-3.25），P=0.97]与对照组比较差异均无统计学意义。结论本研究显示抗病毒（干扰素和拉米夫定）治疗HBV-GN能有效缓解蛋白尿，提高HBeAg清除率，且尿蛋白的缓解与HBeAg的清除呈明显的正相关，并在一定程度上延缓肾功能恶化。激素或免疫抑制剂联合抗病毒治疗在HBV-GN中的作用不显著。%Objectives To assess the efifcacy of drug therapy on hepatitis B virus associated glomerulonephritis (HBV-GN) by a systematic review and meta-analysis of clinical trials. Methods Electronic databases including Pubmed, Cochrane library, EMBASE, MEDLINE, CBM, CNKI and VIP were searched for prospective controlled trials which assessed the efifcacy of drug therapy on HBV-GN in adult or pediatric patients from Jan. 1980 to July. 2012. Study selection and meta-analysis were conducted according to the Cochrane handbook for systematic reviews. Data were extracted from these trials by three reviewers independently and analyzed by Revman 5.0 and stata 10.0 software. Results Nine trials with a total of 331 patients were included;among them, six trials were speciifed as the anti-viral therapy group, three studies were about interferon, two about lamividine and one about entecavir. It was found by the meta-analysis that, compared with the controls, anti-viral therapy could signiifcantly elevate the remission rate of proteinuria (RR=1.37, 95%CI 1.16-1.60, P=0.0001) and the clearance rate of HBeAg (RR=3.28, 95%CI 2.18-4.94, P<0.00001). Futhermore, Kappa analysis showed positive correlation between proteinuria remission and HBeAg clearance after anti-viral therapy (Kappa = 0.352, P = 0.003). Another three trials were specified as the combined therapy (antivirals and immunosuppressants) group. Meta-analysis showed there was no signiifcant difference between the combined treatment group and the controls in the remission rate of proteinuria (RR=2.34, 95%CI 1.31, 4.16, P=0.04) and the clearance rate of HBeAg (RR=0.98, 95%CI 0.30-3.25, P=0.97). Conclusions This study showed the antiviral therapy (including interferon , lamivudine, entecavir) in HBV-GN is effective on remission of proteinuria and HBeAg clearance, the combined treatment could not conduct such effort in this study. For further research on combined treatment, more trials should be performed in the clinical.
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