Abstract: Objective To evaluate the efficacy and safety of entecavir in treatment of patients with hepatitis B virus （HBV）-related acute-on-chronic liver failure. Methods All randomized controlled trials comparing the efficacy of entecavir versus lamivudine in patients with HBV-related acute-on-chronic liver failure published in January 2006 to September 2014 were collected by searching PubMed，Cochrane Library，CBMdisc，Chinese National Knowledge Infrastructure（CNKI），Chinese VIP database and WanFang database. The quality assessment of literatures and the extraction of information were accomplished by two independent reviewers. Statistical analyses were performed with RevMan 5.1 software. Results Seven eligible trials including 823 patients were included. According to the results of meta-analysis，the mortality rates of patients in entecavir groups were significantly lower than that of patients in lamivudine groups when the treatment lasted for more than 6 months [RR=0.75，95%CI （0.60，0.95），P<0.05]；the negative conversion rates of serum HBV DNA in patients of entecavir groups were significantly higher than that of patients in lamivudine groups when the treatment lasted for 2 to 3 months and more than 6 months[RR=1.47，95%CI（1.29，1.68），P<0.05;RR=1.48，95%CI（1.30，1.67），P<0.05]，and the virological breakthrough rate of patients in entecavir groups was significantly lower as compared to that of patients in lamivudine groups [RR=0.07，95%CI（0.01，0.54），P<0.05]. No serious adverse events were observed in the entecavir groups. Conclusion Entecavir leads to lower long-term mortality rate and virological breakthrough rate than lamivudine in patients with HBV-related acute-on-chronic liver failure，providing a better option for the long-term antiviral therapy.

Key words: Hepatitis B, Liver failure, Entecavir, Meta-analysis