肝动脉化疗栓塞术联合抗病毒治疗乙肝相关肝癌疗效的Meta分析

Meta-analysis of efficacy of antivirus therapy combined with hepatic arterial chemoembolization in the treatment of hepatitis B virus-associated hepatocellular carcinoma

目的从近期疗效和远期疗效以及对乙肝病毒、肝功能、甲胎蛋白的作用这几方面,系统评价以恩替卡韦抗病毒治疗联合肝动脉化疗栓塞术(TACE)对乙肝相关性肝癌的疗效。方法通过计算机于多个中外数据库检索恩替卡韦联合TACE治疗乙肝相关性肝癌的RCT(中文?)文献,截止日期为2018年7月1日,通过筛选最终纳入中文文献16篇,包括TACE联合恩替卡韦抗病毒(实验组)734例和单独TACE(对照组)696例,对其进行质量评价,并使用Stata 11进行Meta分析。结果 Meta分析显示实验组在ALT下降(P=0.011)、HBV DNA定量减少(P=0.000)、AFP变化(P=0.006)、1年生存率(P=0.001)及2年生存率(P=0.004)均优于对照组(P<0.05)。即联合恩替卡韦抗病毒治疗对TACE术后乙肝病毒有抑制作用,改善肝功能、抑制甲胎蛋白水平,并提高其近期疗效、远期生存情况。结论 HBV再激活是乙肝相关性肝癌治疗后复发的重要危险因素,多次TACE治疗能引起HBV再激活,故有必要联合抗病毒治疗以预防,降低HBV再激活发生率。联合恩替卡韦抗病毒治疗乙肝相关性肝癌可提高TACE的疗效,值得在临床中推广应用。

Objective To systematically evaluate the efficacy of antivirus therapy combined with hepatic arterialchemoembolization(TACE) in hepatitis B virus(HBV)-associated hepatocellular carcinoma(HCC) by META analysis, takingentecavir as an example,from the aspects of short-term and long-term efficacy as well as the effects on hepatitis B virus, liverfunction and alpha fetoprotein. Methods Randomized controlled clinical trials(RCTs) of entecavir combined with TACE intreatment of HBV-associated HCC were selected in Chinese and foreign databases. The deadline was July 1, 2018. SixteenChinese literatures,734 cases in the experimental group and 696 cases in the control group, were finally included throughscreening and quality evaluation, and meta analyzed by Stata 11. Results The results of META analysis showed that ALTchanges(P=0.011), HBV DNA changes(P=0.000), AFP changes(P=0.006), 1-year survival rate(P=0.001) and 2-yearsurvival rate(P=0.004) were better in the experimental group than in the control group, and P<0.05. That is, combined withentecavir could inhibit the HBV after TACE, improve the liver function, inhibit the level of AFP, and improve its short-termefficacy and long-term survival. Conclusion HBV reactivation is an important risk factor for HBV-associated liver cancerrecurrence after treatment. Multiple TACE treatments can cause HBV reactivation, so it is necessary to combine with antiviraltherapy to prevent and reduce the incidence of HBV reactivation.Combined with entecavir in the treatment of hepatocellularcarcinoma associated with hepatitis B can improve the efficacy of TACE and is worthy of clinical application.