针对IgA脏病的非免疫抑制治疗
David J Tunnicliffe1, Sharon Reid2, Jonathan C Craig3,4
1Sydney School of Public Health, University of Sydney, Sydney, Australia.
The Cochrane database of systematic reviews
|February 1, 2024
概括
这次审查发现,氨酸 - ангиотензин系统 (RAS) 的抑制可能会降低IgA腎病症 (IgAN) 患者的蛋白尿症. 虽然桃体切除术可以改善一些人的蛋白尿和血尿,但其他非免疫抑制治疗的证据仍然不足.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- IgA病 (IgAN) 是导致功能衰竭的首要原因,在25年内影响20%至40%的患者.
- 非免疫抑制治疗对于通过控制血压和减少蛋白尿来控制IgAN至关重要,同时避免免疫抑制风险.
- 对于IgAN管理的现有临床试验数据通常受到小样本大小和短时间的限制,导致相互矛盾的证据.
研究的目的:
- 评估成人和儿童IgA脏病 (IgAN) 的非免疫抑制疗法的疗效和安全性.
- 系统地审查所有非免疫抑制干预措施,包括抗高血压剂,抗凝固剂,饮食改变,桃体切除术和草药.
主要方法:
- 在科克兰脏和移植研究登记册中进行全面搜索,直到2023年12月.
- 包括随机对照试验 (RCT) 和准RCT,涉及成人和患有活检证明的Igan的儿童.
- 数据提取和质量评估由两位独立审查员进行,并使用随机效应模型和GRADE进行元分析,以确保证据的确定性.
主要成果:
- 雷宁-血管酶系统 (RAS) 的抑制可能会减少蛋白尿 (中等确定性),但对功能衰竭或血清肌素翻倍 (低确定性) 的影响很小.
- 桃体切除术可能会增加日本Igan患者蛋白尿和微观血的缓解率 (确定性低),但概括性不清楚.
- 其他干预措施,如抗凝剂,鱼油和传统中医药,与安慰剂相比,其益处很小,但与标准护理相比没有明显的优势.
结论:
- 抗高血压疗法,特别是RAS抑制剂,似乎是对Igan最有益的非免疫抑制治疗方法,益处可能超过危害.
- 桃体切除术对Igan的疗效的证据有限,主要基于日本人群;由于不一致的发现和潜在的危害,其建议是不确定的.
- 对于大多数其他非免疫抑制治疗方法,缺乏可靠的RCT证据,需要进一步研究以确定其在IGAN管理中的有效性和安全性.
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