恩替卡韦治疗HBV相关性肝衰竭短期疗效的荟萃分析  

Short-term efficacy of entecavir in treatment of HBV-related liver failure: a Meta analysis

作　　者：臧卫波[1] 甄真[1] 

机构地区：[1]河北医科大学第三医院感染科,石家庄050051

出　　处：《中华临床感染病杂志》2013年第3期166-171,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：河北省医学适用技术跟踪项目

摘　　要：目的 系统评价恩替卡韦治疗HBV相关性肝衰竭的短期疗效.方法 检索2005年3月至2012年9月在Embase、PubMed、BIOSIS Previews、HMIC、中国知网全文数据库(CNKI)、万方数据库、维普数据库和中国生物医学文献数据库等公开发表的涉及恩替卡韦治疗肝衰竭的临床研究文献,研究类型为随机对照试验.应用RevMan 5.0软件对文献进行荟萃分析,根据异质性差异采用固定效应模型或随机效应模型,以风险比(RR)或加权平均数(WMD)对效应量进行综合分析,应用漏斗图、失安全系数对判定指标进行敏感性和发表偏倚分析.结果 共选出10篇中、英文文献,共计790例病例纳入研究.荟萃分析结果显示:恩替卡韦治疗组患者的病死率、总胆红素(TBil)和丙氨酸转氨酶(ALT)水平显著低于对照组(病死率:RR=0.68,95％可信区间(CI)为0.56～0.81,Z=4.21,P＜0.01;TBil和ALT:WMD=-133.97和-99.81,95％ CI为-185.15 ～-82.78和-187.37 ～-12.24,Z =5.13和2.23,P＜0.01).恩替卡韦治疗组HBV DNA转阴率、血浆凝血酶原活动度(PTA)和白蛋白(Alb)水平明显高于对照组(HBV DNA转阴率:RR=5.21,95％ CI为3.66～7.42,Z =9.15,P＜0.01;PTA和Alb:WMD=21.49和3.81,95％ CI为19.32 ～ 23.67和1.24 ～ 6.37,Z=19.37和2.91,P＜0.01).结论 与常规内科治疗相比,加用恩替卡韦可以降低肝衰竭患者的病死率、ALT和TBil水平,提高PTA、Alb水平和HBV DNA转阴率.Objective To evaluate the short-term therapeutic effect of entecavir in treatment of HBV-related liver failure.Methods Randomized controlled trails on treatment of HBV-related liver failure with entecavir were searched in Embase,PubMed,BIOSIS Previews,HMIC,CNKI,Wanfang data,cqvip and SinoMed from March 2005 to September 2012.Meta-analysis was performed by using RevMan 5.0 software.Fixed effects model or random effect model was used according to heterogeneity differences.To evaluate the effect of entecavir,risk ratio (RR) was applied to assess the improvement of mortality rate and HBV DNA negative conversion rate,and weighted men differences (WMD) was applied to assess the changes of alanine aminotransferase (ALT),total bilirubin (TBil),albumin (Alb) and plasma thromboplastin antecedent (PTA) levels.Funnel plots and fail-safe number were used for sensitivitypublication bias analysis.Results Totally 10 eligible literatures with 790 patients were included in this analysis.Compared with the controls,the mortality rate (RR =0.68,95％ CI =0.56 to 0.81,Z =4.21,P＜0.01),TBil (WMD=-133.97,95％CI=-185.15 to-82.78,Z=5.13,P＜0.01) and ALT (WMD =-99.81,95％ CI =-187.37 to-12.24,Z =2.23,P ＜ 0.01) levels were lower in entecavir group,while HBV DNA negative conversion rate (RR =5.21,95％ CI =3.66 to 7.42,Z =9.15,P ＜0.01),PTA(WMD=21.49,95％CI=19.32 to 23.67,Z=19.37,P＜0.01) and Alb (WMD=3.81,95％CI=1.24 to 6.37,Z=2.91,P＜0.01) were higher in the entecavir group.Conclusion Entecavir can significantly reduce mortality rate,ALT and TBil levels,improve PTA,Alb levels and increase HBV DNA negative conversion rate for patients with HBV-related liver failure.

关 键 词：肝炎病毒 乙型 肝功能衰竭 恩替卡韦 荟萃分析 

分 类 号：R512.62[医药卫生—内科学]