评价来氟米特联合中小剂量糖皮质激素治疗慢性进展性IgA肾病的疗效及安全性。

用PubMed、Cochrane图书馆和中国知网全文数据库(CNKI)、中文科技期刊维普数据库(VIP)、万方数据库检索来氟米特联合中小剂量糖皮质激素治疗慢性进展性IgA肾病的随机对照试验(RCTs)，按照Cochrane中工具对符合标准的文献进行质量评价和Meta分析。

共检索出53篇文献，其中中文文献39篇，英文文献14篇，通过查重去除18篇，通过阅读题名及文献摘要去除综述、会议论文及回顾性分析15篇，通过阅读全文去除非RCTs及质量差的文献，最终纳入7篇RCTs，385例患者。

(1)来氟米特联合中小剂量糖皮质激素与常规应用糖皮质激素相比，能降低患者24 h尿蛋白定量，改善肾小球滤过率，并且不会增加患者近期不良反应；(2)与环磷酰胺联合糖皮质激素相比，疗效相当，但可明显减少患者不良反应的发生率。

To evaluate the efficacy and safety of leflunomide combined with low or moderate doses of glucocorticoids in the treatment of chronic progressive IgA nephropathy.

Randomized controlled trials (RCTs) of leflunomide combined with low or moderate doses of glucocorticoids in the treatment of chronic progressive IgA nephropathy were searched for by PubMed, Cochrane Library, China National Knowledge Internet Full Text Database (CNKI), Chinese Science and Technology Journals VIP Database (VIP), and Wanfang Database. And quality evaluation and meta-analysis were performed on eligible literatures according to the Cochrane tools.

A total of 53 literatures were retrieved, including 39 Chinese literatures and 14 English literatures. 18 literatures were removed through duplicate checking. 15 literatures were removed including reviews, conference papers, and retrospective analysis articles. 13 literatures were removed including the non-RCTs and literatures of poor quality. Eventually, 7 RCTs were enrolled with altogether 385 patients.

Compared with the conventional glucocorticoids treatment, leflunomide combined with low or moderate doses of glucocorticoids reduced the 24-hour urine protein quantitation, improved the glomerular filtration rate, and did not increase the patients′ recent adverse reactions. And compared with the treatment of cyclophosphamide plus glucocorticoids, leflunomide combined with low or moderate doses of glucocorticoids had similar efficacy, and significantly reduced the incidence of adverse reactions.