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