恩替卡韦与拉米夫定治疗HBV相关性肝衰竭患者疗效Meta分析  

Efficacy of entecavir and lamivudine in the treatment of patients with hepatitis B virus-related liver failure:a Meta analysis

作　　者：张冬琴[1] 张海月[1] 吴吉圆 王鲁文 龚作炯[1] 

机构地区：[1]武汉大学人民医院感染病科,武汉市430060

出　　处：《实用肝脏病杂志》2014年第6期606-610,共5页Journal of Practical Hepatology

摘　　要：目的系统评价恩替卡韦(ETV)和拉米夫定(LAM)治疗乙型肝炎病毒(HBV)相关性肝衰竭患者的疗效。方法应用计算机检索PUBMED、MEDLINE、EMBASE、CNKI、VIP、中国生物医学文献数据库(CBM)和万方数据库,查找所有比较恩替卡韦和拉米夫定治疗重型乙型肝炎、HBV相关性肝衰竭的随机对照试验(RCT),检索时间均为建库至2014年4月1日。同时手工检索纳入文献的参考文献。按纳入和排除标准,由2人独立进行RCT的筛选、资料提取和质量评价,采用Rev Man5.2软件进行Meta分析。结果纳入14个研究,共1383例患者(ETV组622例,LAM组761例)。结果显示,在治疗HBV相关性肝衰竭12 w和24 w,ETV能更有效地降低血清ALT及总胆红素水平,差异具有统计学意义(z=3.24或z=2.26,P<0.02;z=1.92或z=2.23,P<0.03);在治疗12 w时,相比LAM治疗,ETV显著提高PTA水平,差异具有统计学意义(z=2.09,P=0.04),但在24 w时,两组无明显差异(z=1.76,P=0.08);在治疗12 w和24 w时,ETV组HBe Ag血清学转阴率分别为18.2%和49.5%,与LAM组相比均无显著性差异(13.6%和52.1%);在治疗12 w和24 w时,ETV组HBV DNA转阴率分别为37.5%和77.5%,显著高于LAM组的23.0%(P=0.04)和52.0%(P=0.002);在治疗12 w和24 w时,ETV组患者的病死率分别为8.2%和12.8%,显著低于LAM组的18.6%(P=0.02)和19.6%(P=0.0001)。结论恩替卡韦比拉米夫定能更有效改善HBV相关性肝衰竭患者的肝功能,抑制病毒复制,并且降低患者的病死率。Objective To systematically review the efficacy of entecavir （ETV） and lamivudine （LAM） for the treatment of patients with hepatitis B virus （HBV）-related liver failure. Methods We searched PUBMED, MEDLINE,EMBASE,CNKI,VIP,Chinese Biomedical Literature Database （CBM） and Wanfang database for randomized controlled trials （RCT） comparing entecavir and lamivudine in the treatment of severe hepatitis B or HBV-related liver failure up to April 1,2014. According to the inclusion and exclusion criteria, screening of RCT articles,data extraction and quality assessment were completed by two invastigators independently. The meta-analysis was performed by using the RevMan 5.2 software. Results Fourteen studies involving 1383 patients were enrolled （622 cases in ETV group and 761 in LAM group）. The results of meta-analysis showed that at 12 w and 24 w,ETV was more effective in reducing serum ALT and total bilirubin levels than LAM and the differences were statistically significant （z=3.24 and z=2.26,P〈0.02;z=1.92 and =2.23,P〈0.03）;ETV significantly elevated PTA levels than LAM at 12 w （z=2.09,P=0.04）,but not at 24 w （z=1.76,P=0.08）;At 12 w and 24 w, there were no statistical differences between ETV and LAM in HBeAg seroconversion （18.2% vs. 13.6%,P=0.68;or 49.5% vs. 52.1%,P=0.93）;At 12 w and 24 w,HBV DNA loss were 37.5% and 77.5% in ETV group, significantly higher than those in LAM group （23.0% and 52.0%,respectively,P〈0.05）;The mortalities in ETV group were 8.2% and 12.8% at 12 w and 24 w,significantly lower than in LAM group （18.6% and 19.6%, respectively,P =0.05）. Conclusions Entecavir is more effective in improving liver function,inhibiting viral replication and reducing mortality in patients with HBV-related liver failure when compared with LAM.

关 键 词：肝衰竭 慢性乙型肝炎 恩替卡韦 拉米夫定 Meta分析 

分 类 号：R512.62[医药卫生—内科学] R575.3[医药卫生—临床医学]