对儿童性综合征进行皮质类固醇治疗
Deirdre Hahn1, Susan M Samuel2, Narelle S Willis3,4
1Department of Nephrology, The Children's Hospital at Westmead, Westmead, Australia.
The Cochrane database of systematic reviews
|August 22, 2024
概括
对于患有类固醇敏感性脏综合征 (SSNS) 的儿童来说,延长普雷迪尼松治疗超过两到三个月没有额外的好处. 较短的持续时间和较低的剂量同样有效,可以减少不良事件.
科学领域:
- 儿科脏病学 儿科脏病学
- 临床药理学 临床药理学
- 基于证据的医学基于证据的医学.
背景情况:
- 性综合征会导致蛋白质泄漏,导致血液蛋白质不足和水.
- 虽然皮质类固醇是有效的,但80%的儿童出现复发,长期使用有显著的不良影响.
- 本综述更新了关于对患有类固醇敏感性脏综合征 (SSNS) 的儿童使用皮质类固醇治疗方案的证据.
研究的目的:
- 评估不同类型的皮质类固醇治疗方案对患有类固醇敏感性脏综合征 (SSNS) 的儿童的益处和危害.
- 评估初始SSNS发作和复发SSNS的儿童的治疗方法.
主要方法:
- 儿童 (1-18岁) 随机对照试验 (RCT) 的系统审查和元分析.
- 搜索了科克伦脏和移植注册表,CENTRAL,MEDLINE,EMBASE和临床试验注册表.
- 使用随机效应模型分析数据,将结果表达为风险比率 (RR) 和平均差异 (MD) 与95%置信区间 (CI).
- 使用推评估,开发和评价 (GRADE) 方法评估证据确定性.
主要成果:
- 对于最初的SSNS发作,在延长前尼松治疗超过2至3个月时,复发率没有显著差异 (高确定性证据).
- 在不同的普得尼松持续时间之间,复发率或不良事件的差异很小或不存在 (2vs3+个月,3vs5-7个月).
- 在复发性SSNS中进行的小型研究没有显示较低的诱导剂量或更短的持续时间的疗效差异;需要进行更大的研究.
结论:
- 对于第一个SSNS发作,延长前尼松疗法超过2-3个月,没有额外的益处.
- 目前的证据表明,更短的持续时间和更低的剂量可能对复发性SSNS有效.
- 需要进一步的大型,精心设计的研究来证实感染期间关于普得尼松策略的发现.
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