中药联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎的系统评价  

Traditional Chinese Medicine Combined with Adefovirin in Treatment of HBeAg-negative Chronic Hepatitis B: A Systematic Review

作　　者：王彬[1] 马利[1] 龙远雄 李瀚旻[2] 

机构地区：[1]湖北中医药大学信息工程学院,湖北武汉430065 [2]湖北省中医院肝病研究所,湖北武汉430065

出　　处：《湖北中医药大学学报》2015年第4期111-115,共5页Journal of Hubei University of Chinese Medicine

基　　金：国家自然科学基金(81373513;30271562);国家科技部重大基础研究项目("973"项目;2002CCC00300);国家中医临床研究基地(湖北)重点病种研究项目(JDZX2012054);国家"十二五"重大专项(2012ZX10005005-001-015);国家中医药管理局国家中医临床研究基地(湖北)重点病种研究项目(JDZX2012054);湖北省自然科学基金重点项目(2011CDB463);高等学校博士学科点专项科研基金项目(20124230110001);武汉市科技局科技攻关武汉市重大科技产业化专项项目(201260523199)

摘　　要：目的系统评价中药联合阿德福韦酯(ADV)治疗HBeAg阴性慢性乙型肝炎的有效性和安全性。方法计算机检索中国知网、重庆维普、万方、Pub Med和Cochrane 5大数据库,全面搜集中药联合阿德福韦酯治疗HBeAg阴性慢性乙型肝炎的相关文献。由两名研究者共同制定纳入、排除标准,严格筛选纳入文献,并逐个进行方法学质量评级和资料提取,采用Review Manager 5.2软件进行Meta分析。结果最终纳入8个随机对照试验文献(RCT),共计HBeAg阴性慢性乙型肝炎患者584例,其中试验组303例,对照组281例。文献的方法学质量评价均为C级。Meta分析结果显示:中药联合ADV组的HBV DNA转阴率优于单用ADV组(RR=1.24,95%CI(1.06,1.45));中药联合ADV组治疗后AST水平低于单用ADV组(WMD=-19.22,95%CI(-21.09,-17.36));中药联合ADV组治疗后TBIL水平低于单用ADV组(WMD=-3.65,95%CI(-5.17,-2.14));两组差异均具有统计学意义。结论中药联合ADV治疗HBeAg阴性慢性乙型肝炎在抗病毒和改善肝功能方面可能优于单用ADV,尚未发生严重不良反应,其循证医学证据还需后续研究纳入大样本、高质量临床研究进一步证实。Objective To evaluate the efficacy and safety of Traditional Chinese Medicine combined with adefovir（ADV） in treatment of HBeAg - negative chronic hepatitis B. Methods Five databases such as CNKI, VIP, Wanfang, PubMed and the Coehrane were searched to collect relevant literature on adefovir dipivoxil combined with Chinese herbal medicine in treatment of HBeAg - negative chronic hepatitis B. Two researchers jointly developed inclusion and exclusion criteria and screened included literatures which were methodological quality rated and information extracted one by one rigorously. To make META analysis using Review Manager 5.2 software . Results A total of eight RCTs were included eventually,involving 584 cases of HBeAg - negative chronic hepatitis B patients, of which 303 cases of test group and 281cases of control group. Methodological quality of all were C - level . Meta - analysis showed that ： HBV DNA negative rate of TCM joint ADV group was higher than alone ADV group （RR = 1.24,95% CI （1.06,1.45） ） ;AST levels of ADV combined TCM group below alone ADV group （WMD = - 19.22,95% CI （ - 21.09, - 17.36） ） ; TBIL level of ADV combined TCM group was lower than with ADV group （WMD = -3.65,95% CI （ -5.17, -2.14）） ;Differences between the experimental and control groups above analysis were statistically significant. Conclusion TCM combined with ADV in treatment of HBeAg - negative chronic hepatitis B in antiviral and improving liver function might be superior to single -use ADV, and serious adverse reactions had not yet occurred. Its evidence based medicine needs a follow study included a large samples, high quality clinical study to further confirmed.

关 键 词：慢性乙型肝炎 HBEAG阴性 中药 阿德福韦酯 系统评价 

分 类 号：R259[医药卫生—中西医结合]