富马酸丙酚替诺福韦与富马酸替诺福韦二吡呋酯对血脂影响的meta分析  

Effects of tenofovir alafenamide fumarate and tenofovir disoproxil fumarate on blood lipid:a meta‑analysis

作　　者：吴小艳[1] 于浩[2] 周洋 蔡晧东[2] 江宇泳[2] Wu Xiaoyan;Yu Hao;Zhou Yang;Cai Haodong;Jiang Yuyong(Department of Pharmacy,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Center of Integrated Traditional and Western Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院药剂科,北京100015 [2]首都医科大学附属北京地坛医院中西医结合中心,北京100015

出　　处：《药物不良反应杂志》2021年第11期584-591,共8页Adverse Drug Reactions Journal

基　　金：国家卫生计生委国家科技重大专项(2018ZX10725505)。

摘　　要：目的探讨富马酸丙酚替诺福韦(TAF)与富马酸替诺福韦二吡呋酯(TDF)对血脂的影响。方法检索有关数据库(截至2021年8月31日),收集采用TAF(试验组)和TDF(对照组)治疗乙型肝炎病毒(HBV)或人类免疫缺陷病毒(HIV)感染的随机对照试验(RCT)中血脂异常的数据。采用国际通用的Cochrane协作网偏倚风险评估工具进行方法学质量评价,采用RevMan 5.3软件进行meta分析,效应值为危险度(RR)及其95%置信区间(CI)。结果共纳入11项RCT,治疗乙型肝炎的研究4项(HBV亚组),治疗艾滋病的研究7项(HIV亚组),质量评价结果均为低偏倚风险。11项RCT共涉及患者11888例,试验组6273例,对照组5615例。meta分析结果显示,试验组≥3级的低密度脂蛋白胆固醇(LDL‑C)、总胆固醇(TC)和三酰甘油(TG)升高发生率均高于对照组,其中LDL‑C和TC的差异有统计学意义[LDL‑C:2.9%(157/5347)比0.8%(37/4727),RR=3.39,95%CI:2.35~4.89,P<0.001;TC:0.7%(36/4880)比0.1%(6/4397),RR=4.25,95%CI:1.91~9.45,P<0.001;TG:0.5%(16/3157)比0.3%(8/3102),RR=1.83,95%CI:0.81~4.15,P=0.140]。对2组患者治疗后血脂变化情况进行比较,结果显示试验组LDL‑C升高值(14.00 mg/dl)明显高于对照组(4.00 mg/dl),差异有统计学意义(P=0.004)。结论TAF可明显升高LDL‑C和TC水平。Objective To explore the effects of tenofovir alafenamide fumarate(TAF)and tenofovir disoproxil fumarate(TDF)on blood lipid.Methods The relevant databases(up to August 31,2021)were searched.The data of dyslipidemia in treatment of hepatitis B virus(HBV)or human immunodeficiency virus(HIV)infection with TAF(trial group)and TDF(control group)in randomized controlled trials(RCTs)were collected.Methodological quality was evaluated by bias risk assessment tool of Cochrane collaborative net‑work,and the meta‑analysis was conducted using RevMan 5.3 software.The effect value was the risk ratio(RR)and its 95%confidence interval(CI).Results A total of 11 RCTs were enrolled in the analysis,including 4 on the treatment of hepatitis B(HBV subgroup)and 7 on the treatment of AIDS(HIV subgroup),and the methodological quality evaluation results showed low risk of bias for all.Eleven thousand eight hundred and eighty‑eight patients were involved in the 11 RCTs,of which 6273 were in the trial group and 5615 in the control group.The results of meta‑analysis showed that the incidences of increased low density lipoprotein cholesterol(LDL‑C),total cholesterol(TC),and triglyceride(TG)with the severity of≥3 grade were higher in the trial group than those in the control group and the differences of incidences in LDL‑C and TC increase were significant between the 2 groups[LDL‑C:2.9%(157/5347)vs.0.8%(37/4727),RR=3.39,95%CI:2.35-4.89,P=0.001;TC:0.7%(36/4880)vs.0.1%(6/4397),RR=4.25,95%CI:1.91-9.45,P<0.001;TG:0.5%(16/3157)vs.0.3%(8/3102),RR=1.83,95%CI:0.81-4.15,P=0.140].The changes of blood lipid af‑ter treatment were compared and the results showed that the increase of LDL‑C was higher in the trial group(14.00 mg/dl)than that in the control group(4.00 mg/dl),and the difference was statistically significant(P=0.004).Conclusion TAF can significantly increase the levels of LDL‑C and TC in patients.

关 键 词：替诺福韦 血脂异常 乙型肝炎 HIV感染 

分 类 号：R512.62[医药卫生—内科学]