阿德福韦酯单用或联合拉米夫定治疗拉米夫定耐药慢性乙型肝炎的Meta分析  

A META-ANALYSIS OF ADEFOVIR DIPIVOXIL ALONE OR IN COMBINATION WITH LAMIVUDINE IN PATIENTS WITH LAMIVUDINE-REFRACTORY CHRONIC HEPATITIS B

作　　者：肖亮[1] 谢江平[1] 张晓君[1] 李瑞东[1] 刘芳[1] 倪之嘉[1] 傅宏[1] 施晓敏[1] 郭闻渊[1] 王正昕[1] 马钧[1] 丁国善[1] 傅志仁[1] 

机构地区：[1]上海长征医院器官移植科,上海200003

出　　处：《肝胆外科杂志》2009年第6期418-424,共7页Journal of Hepatobiliary Surgery

摘　　要：目的评价阿德福韦酯（Adefovir dipivoxil，AD）单独或联合拉米夫定（Lamivudine，LAM）对拉米夫定耐药的慢性乙型肝炎患者的疗效差异。方法根据纳入标准，摘录7篇随机对照试验（RCT）的研究结果，用RevMan4．2软件进行分析。结果与单用AD（10mg／d）相比，AD（10mg／d）＋LAM（100mg／d）能更显著地提高HBV—DNA、HBeAg转阴率，HBeAg血清学转换率和ALT复常率：RR（95％CI，P）分别为1．39（1．26～1．54，〈0．00001），2．28（1．58～3．30，〈0．0001），2．58（1．61～4．14，〈0．0001），1．29（1．17～1.42，〈0．00001）；显著降低病毒学突破发生率和耐AD基因突变发生率：RR（95％CI，P）分别为0．10（0．03～0．34，0．0002）和0．12（0．02～0．95，0．04）；而两组药物副作用发生率的差异无统计学意义（RR：0．94，95％C10．75～1．17，P=0．57）。结论采用AD＋LAM联合治疗LAM耐药的慢性乙肝患者，较之单用AD，能更显著地提高HBV-DNA、HBeAg转阴率、血清学转换率和ALT复常率，降低病毒学突破发生率和耐AD基因突变发生率，且不增加药物副作用，值得临床推广。Objective To evaluate the efficacy and safety of adefovir dipivoxil alone or in combination with lamivudine in patients with lamivudine-refractory chronic hepatitis B. Methods Acccording to the including criteria, seven randomized controlled trials of this topic were enrolled. The results of the trials were reviewed and analysed by using software Revman 4. 2. Results Patients in the AD（ 10 mg/d） ＋ LAM （100 mg/d）group enjoyed significantly higher negative conversion ratios of HBV-DNA, HBeAg and ALT, and positive seroconversion of HBeAg：the RR （95 % CI, P） were 1.39 （ 1.26 - 1.54, 〈 0. 00001 ）, 2. 28 （ 1.58 - 3.30, 〈 0. 0001 ）, 2. 58 （ 1.61 - 4. 14, 〈 0. 0001 ） and 1.29 （ 1.17 - 1.42, 〈 0. 00001 ） respectively. Moreover, AD ＋ LAM could significantly lower the rates of virological breakthroughs and genotypic AD resistance, the RR （95 % CI, P） were 0. 10 （0. 03 -0. 34,0. 0002） and 0. 12 （0.02 - 0. 95, 0. 04）, while the incidence of drug side-effects reached no significant statistical difference （ RR = 0. 94,95 % CI 0. 75 -1.17, P = 0.57）. Conclusion Compared with AD alone,in combination with LAM can significantly improve the negative seroconversion ratio of HBV-DNA. HBeAg, and positive seroconversion ratio to HBeAb, improve the liver function, lower the rates of virological breakthroughs and genotypic AD resistance without rasing the incidence of drug sideeffects.

关 键 词：阿德福韦酯 拉米夫定 病毒性肝炎 META分析 

分 类 号：R373.21[医药卫生—病原生物学]