Meta-analysis: Anti-viral Therapy Of Hepatitis B Virus-associated Glomerulonephritis

Objective:Hepatitis B virus-associated glomerulonephritis(HBV-GN) is one of the common secondary glomerular diseases and the extrahepatic manifestations of hepatitis B virus in China. It is not very clear about the pathogenesy,and there is not standard therapeutic regimen. Traditional glucocorticosteroid and immunosuppressive agents are not recommended as the first-line drugs by most academic experts because of the risk of inducing viral replication, whereas the anti-viral drugs of hepatitis B virus are used for the disease gradually.The aim of this Meta-analysis was to evaluate the efficacy of anti-viral drugs for HBV-GN and give clinical evidence and guidance for the treatment.Methods:Medical databases including PubMed,EMBASE,Cochrane Library,Ovid full-text database and CNKI were searched in two languages(English and Chinese) till December of 2008,Two investigators independently identified literatures according to eligibility and exclusion criteria,then assessed quality by the Sackett assessment,and extracted data.The primary outcome was clinical response(remission of proteinuria),the secondary outcome was virological response(clearance of HBeAg).Identify the differences between trials and controls according to clinical and virological response by software STATA 10.1 and RevMan 4.2.In addition,other unavailable data were reviewed and described.Results:Five studies(4 in English,1 in Chinese) including 200 patients met the predefined criteria,one of which was randomized controlled trial and others were cohort studies.Three studies were about interferon,one about lamivudine and 1 about entecavir.It was found by the meta-analysis that,compared with the controls,anti-viral therapy could significantly elevate the remission rate of proteinuria[93%vs 60%,RR=1.52,95%CI:1.12-2.07,P=0.007]and the clearance rate of HBeAg[63.9%vs 16.48%,RR=3.68,95%CI:1.35-10.05,P=0.01]. Furthermore,chi square test showed a link between proteinuria remission and HBeAg clearance(P<0.01).Conclusions:This study showed the efficacy of anti-viral therapy(including interferon, lamivudine,entecavir) in HBV-GN.The efficacy was obvious in remission of proteinuria, clearance of HBeAg and delay of renal function deterioration.Moreover,chi square test showed a link between proteinuria remission and HBeAg clearance.There were some shortcomings in the Meta-analysis due to lack of high-quality randomized controlled trials(RCTs).Thus, multi-central and large-sale RCTs are still needed to draw final and more persuasive conclusions.