恩替卡韦与拉米夫定治疗HBV相关性肝衰竭患者疗效Meta分析

doi:10.3969/j.issn.1672-5069.2014.06.012

摘要/Abstract

摘要： 目的系统评价恩替卡韦（ETV）和拉米夫定（LAM）治疗乙型肝炎病毒（HBV）相关性肝衰竭患者的疗效。方法应用计算机检索PUBMED、MEDLINE、EMBASE、CNKI、VIP、中国生物医学文献数据库（CBM）和万方数据库,查找所有比较恩替卡韦和拉米夫定治疗重型乙型肝炎、HBV相关性肝衰竭的随机对照试验（RCT）,检索时间均为建库至2014年4月1日。同时手工检索纳入文献的参考文献。按纳入和排除标准,由2人独立进行RCT的筛选、资料提取和质量评价,采用RevMan5.2软件进行Meta分析。结果纳入14个研究,共1383例患者（ETV组622例,LAM组761例）。结果显示,在治疗HBV相关性肝衰竭12 w和24 w,ETV能更有效地降低血清ALT及总胆红素水平,差异具有统计学意义（z=3.24或z=2.26,P<0.02;z=1.92或z=2.23,P<0.03）;在治疗12 w时,相比LAM治疗,ETV显著提高PTA水平,差异具有统计学意义（z=2.09,P=0.04）,但在24 w时,两组无明显差异（z=1.76,P=0.08）;在治疗12 w和24 w时,ETV组HBeAg血清学转阴率分别为18.2%和49.5%,与LAM组相比均无显著性差异（13.6%和52.1%）;在治疗12 w和24 w时,ETV组HBV DNA转阴率分别为37.5%和77.5%,显著高于LAM组的23.0%（P=0.04）和52.0%（P=0.002）;在治疗12 w和24 w时,ETV组患者的病死率分别为8.2%和12.8%,显著低于LAM组的18.6%（P=0.02）和19.6%（P=0.0001）。结论恩替卡韦比拉米夫定能更有效改善HBV相关性肝衰竭患者的肝功能,抑制病毒复制,并且降低患者的病死率。

关键词: 肝衰竭, 慢性乙型肝炎, 恩替卡韦, 拉米夫定, Meta分析

Abstract: Objective To systematically review the efficacy of entecavir （ETV） and lamivudine （LAM） for the treatment of patients with hepatitis B virus（HBV）-related liver failure. Methods We searched PUBMED, MEDLINE,EMBASE,CNKI,VIP,Chinese Biomedical Literature Database（CBM） and Wanfang database for randomized controlled trials（RCT） comparing entecavir and lamivudine in the treatment of severe hepatitis B or HBV-related liver failure up to April 1,2014. According to the inclusion and exclusion criteria, screening of RCT articles,data extraction and quality assessment were completed by two invastigators independently. The meta-analysis was performed by using the RevMan 5.2 software. Results Fourteen studies involving 1383 patients were enrolled（622 cases in ETV group and 761 in LAM group）. The results of meta-analysis showed that at 12 w and 24 w,ETV was more effective in reducing serum ALT and total bilirubin levels than LAM and the differences were statistically significant（z=3.24 and z=2.26,P<0.02;z=1.92 and =2.23,P<0.03）;ETV significantly elevated PTA levels than LAM at 12 w （z=2.09,P=0.04）,but not at 24 w （z=1.76,P=0.08）;At 12 w and 24 w,there were no statistical differences between ETV and LAM in HBeAg seroconversion （18.2% vs. 13.6%,P=0.68;or 49.5% vs. 52.1%,P=0.93）;At 12 w and 24 w,HBV DNA loss were 37.5% and 77.5% in ETV group, significantly higher than those in LAM group（23.0% and 52.0%,respectively,P<0.05）;The mortalities in ETV group were 8.2% and 12.8% at 12 w and 24 w,significantly lower than in LAM group（18.6% and 19.6%, respectively,P=0.05）. ConclusionsEntecavir is more effective in improving liver function,inhibiting viral replication and reducing mortality in patients with HBV-related liver failure when compared with LAM.

Key words: Liver Failure, Chronic hepatitis B, Entecavir, Lamivudine, Meta-analysis

张冬琴, 张海月, 吴吉圆, 王鲁文, 龚作炯. 恩替卡韦与拉米夫定治疗HBV相关性肝衰竭患者疗效Meta分析[J]. 实用肝脏病杂志, 2014, 17(6): 606-611.

Zhang Dongqin, Zhang Haiyue, Wu Jiyuan. Efficacy of entecavir and lamivudine in the treatment of patients with hepatitis B virus-related liver failure:a Meta analysis[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2014, 17(6): 606-611.

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