Preliminary Evaluation Of Multiple Targets Trerapy For Refractory Nephrotic Syndrome

Objective:To evaluate the efficacy and safety of hormone combined tacrolimus(TAC)and mycophenolate mofetil(MMF)multiple targets in treatment of refractory nephrotic syndrome.Methods:Databases such as PubMed,Cochrane Library,EMbase,CNKI,WanFang,VIP Data were electronically searched for comprehensively collecting the randomized controlled trials of multiple targets for refractory nephrotic syndrome from inception to October,2018.Formulate the including and excluding criteria,two reviewers independently screened studies,extracted data and evaluated the methodological quality of the included studies.Then RevMan 5.3 software was used for meta-analysis.Results:8 domestic RCTs studies of total number 592 were eventually included according to inclusion and exclusion criteria.Meta‐analysis showed that multiple target group could significantly higher than the control group in complete remission rate[OR=2.21,95%CI(1.52,3.19),P<0.0001] and total remission rate[OR=3.57,95%CI(2.29,5.57),P<0.00001].Compared with control group,multiple target therapy group could significantly increase serum albumin[MD=6.84,95%CI(6.03,7.64),P<0.00001],reduce 24 hour urine protein[MD=-0.77,95%CI(-1.06,-0.48),P<0.00001].In terms of safety,there was no significant difference between the two groups in pulmonary infection,gastrointestinal discomfort,hyperglycemia,leukocyte reduction,and liver dysfunction.Conclusions: Hormone combined with TAC and MMF multi-target therapy can improve the complete remission rate and total remission rate of refractory nephrotic syndrome,and the multi-target therapy has more obvious increase in plasma protein and more obvious decrease in 24-hour urine protein,with good overall safety.However,large-scale and high quality RCTs are needed to confirm the conclusions.