拉米夫定对乳腺癌化疗患者乙肝病毒再激活预防疗效的系统评价  

Prevention of lamivudine on hepatitis B virus reactivation in breast cancer patient receiving chemotherapy:a meta analysis

作　　者：童师雯[1] 盛云建[1] 殷文伟[1] 胡怀东[1] 

机构地区：[1]重庆医科大学附属第二医院临床营养科,重庆400016

出　　处：《西部医学》2014年第1期27-33,共7页Medical Journal of West China

基　　金：国家自然科学基金面上项目(81171560)

摘　　要：目的拉米夫定已被推荐作为乙肝表面抗原阳性接受化学治疗和免疫抑制剂治疗患者阻止HBV再激活的预防用药。但是有关乙肝表面抗原阳性乳腺癌患者接受拉米夫定预防用药的资料相对较少。本研究在于评价拉米夫定对乙肝表面抗原阳性乳腺癌化学治疗患者预防HBV再激活的疗效,为临床决策提供更高级别的循证医学证据。方法计算机检索Medline/Pubmed、EMBAS、Web of Knowledge数据库和Cochrane图书馆(The Cochrane Library)中所有有关拉米夫定对乙肝表面抗原阳性的乳腺癌化学治疗患者预防作用的研究文献。根据文献纳入及排除标准筛选文献,并对文献进行质量评价。采用以相对危险度(Relative risks,RR)及95%可信区间(Confidence Interval,CI)表示作为分析疗效的统计量,对HBV再激活引起的肝炎、HBV再激活导致的化学治疗终止和HBV再激活导致化学治疗延迟的发生率进行分析。采用Cochrane协作网推荐的Revman 5.0软件进行统计分析。各研究合并先前进行临床异质性检验,若无统计学异质性,采用固定效应模型分析;如存在统计学异质性,采用随机效应模型进行分析。结果①共计纳入6篇研究文献,入选619例研究对象,其中232例采用拉米夫定预防治疗(预防组),387例未采用拉米夫定预防用药治疗(对照组)。②对于预防HBV再激活引起的肝炎,meta分析显示拉米夫定预防治疗组明显低于未预防组(RR=0.17,95%CI:0.08-0.36,P<0.00001)。③HBV再激活导致的化学治疗终止发生率(RR=0.28,95%CI:0.09-0.88,P=0.03)在拉米夫定预防用药组低于未预防用药组。④HBV再激活导致的延迟化学治疗发生率(RR=0.43,95%CI:0.2-0.94,P=0.03)在拉米夫定预防用药组低于未预防用药组。结论乙肝表面抗原阳性的乳腺癌化学治疗患者,在化学治疗前使用拉米夫定预防用药能降低HBV的再激活。因纳入研究数量有限,且包含了非随机对照试验。尚需更多的�Objective Lamivudine has been recommended as prophylaxis for the reactivation of hepatitis B virus （HBV） infection in patients undergoing chemotherapy. However, information on breast cancer patients in particular has been lacking. The purpose of this metaanalysis was to assess the overall efficacy of lamivudine prophylaxis compared to untreated patients with hepatitis B S-antigen （HBsAg） seropositive breast cancer who had undergone chemotherapy. Methods Studies that compared the efficacy of treatment with lamivudine prophylaxis versus no prophylaxis in HBsAg seropositive breast cancer patients were identified through Medline, Cochrane, Embase and Web of Knowledge databas- es. The search was designed using ＂lamivudine＂, ＂breast cancer＂, ＂hepatitis B virus＂ . We obtained full articles and ab- stracts for all potentially relevant trials, and the reference lists from retrieved documents were also searched. Relative risks （RRs） of HBV reactivation, premature termination of chemotherapy for HBV reactivation and delay of chemothera- py for HBV reactivation were studied. Meta-analysis was performed using fixed effect or random-effect methods, depen- ding on the absence or presence of significant heterogeneity. Statistical heterogeneity between trials was evaluated by the chi-square and I-square （I2） tests, with significance set at P〈0. 10. In the absence of statistically significant heterogenei- ty, the fixed-effect method was used to combine the results. When heterogeneity was confirmed （P〈0. 10）, the random-effect method was used. The overall effect was tested using z scores calculated by Fisher^s z~ transformation, with sig- nificance set at P〈0. 05. Data analysis was carried out with the use of Review Manager Software 50（Cochrane Collabora- tion, Oxford, United Kingdom）. Results Six studies involving 619 patients were analyzed. The rates of hepatitis due to HBV reactivation in patients with lamivudine prophylaxis were significantly lower than those with no prophylaxis （RR=

关 键 词：乙型肝炎病毒 乳腺癌 化学治疗 系统评价 

分 类 号：R512.62[医药卫生—内科学]