替比夫定联合阿德福韦酯治疗慢性耐药型乙型肝炎的Meta分析  

Telbivudine combined with adefovir dipivoxil in the treatment of chronic hepatitis B with drug resistance: a Meta-analysis

作　　者：杜兴[1] 康莊 马成[2] 

机构地区：[1]重庆医科大学第一临床学院,重庆400016 [2]湖北中医药大学临床学院,武汉430000

出　　处：《中国当代医药》2014年第32期71-74,共4页China Modern Medicine

摘　　要：目的系统评价替比夫定联合阿德福韦酯治疗慢性耐药型乙型肝炎的疗效及安全性。方法计算机检索Pub Med、EMBASE、CNKI、VIP、CBM、Cochrane图书馆和万方数据库,检索时间截止到2014年4月,纳入相关随机对照试验(RCT)并评价质量,提取有效数据进行Meta分析。结果有6项随机对照临床试验符合入选标准,Meta分析结果显示,和单用替比夫定相比,联合用药治疗阿德福韦酯耐药的慢性乙型肝炎,在治疗12周和24周时均有较高的HBV-DNA转阴率、HBe Ag转阴率和丙氨酸氨基转移酶(ALT)复常率(P<0.05)。对替比夫定耐药的慢性乙型肝炎患者,联合用药和单用阿德福韦酯相比,在治疗48周时有较高的HBV-DNA转阴率和ALT复常率(P<0.05),但两者的HBe Ag转阴率差异无统计学意义(P>0.05)。联合用药治疗和单药治疗均未见严重不良反应。结论基于当前临床证据,替比夫定联合阿德福韦酯治疗慢性耐药型乙型肝炎具有较高的疗效和安全性。Objective To assess the efficacy and safety of telbivudine combined with adefovir dipivoxil in the treatment of chronic hepatitis B with drug-resistance. Methods The Pubmed,EMBASE,CNKI,VIP,CBM,Cochrane Library and WanFang Data were searched until up to April 2014 for relevant randomized controlled trials.The Meta-analysis and evaluation on methodology quality were performed for the included studies. Results Six randomized controlled trials met the inclusion criteria.Meta-analysis found that,the combination therapy was superior to telbivudine alone in ade-fovir dipivoxil-resistant patients in aspects of HBV-DNA negative rates,HBeAg negative rates and ALT recovery rates after 12 and 24 weeks treatment （P〈0.05）.In telbivudine-resistant patients,higher HBV-DNA negative rates and ALT recovery rates were with the combination therapy after 48 weeks treatment （P〈0.05）,but there was no significant differ-ence in HBeAg negative rates （P〉0.05）.Neither of them was found with severe adverse reactions. Conclusion Based on the current clinical evidence,telbivudine combined with adefovir dipivoxil shows higher clinical efficacy and safety in the treatment of chronic hepatitis B with drug-resistance.

关 键 词：慢性乙型肝炎 替比夫定 阿德福韦酯 耐药 META分析 

分 类 号：R512.62[医药卫生—内科学]