拉米夫定治疗乙型肝炎病毒相关性肝衰竭疗效的Meta分析

Efficacy of lamivudine in treatment on HBV-related liver failure:Meta analysis study

目的系统评价拉米夫定治疗乙型肝炎病毒(HBV)相关性肝衰竭的疗效。方法检索1989年1月至2007年7月有关在常规内科治疗的基础上加用拉米夫定后对患者病死率、总胆红素(TBIL)及凝血酶原活动度(PTA)影响的文献,应用Meta分析的方法以比值比(OR)或加权平均数(WMD)为效应量进行合并分析。结果上述研究指标纳入研究文献分别为13、10篇和10篇,合并效应量及95%可信限(95%CI)分别为0.29(95%CI:0.21,0.40)、-0.88(95%CI:-1.27,-0.48)和0.60(95%CI:0.42,0.78)。结论与常规内科治疗组比较,加用拉米夫定可以显著降低肝衰竭患者的病死率,改善患者的TBIL和PTA水平。

Objective To evaluate the therapeutic effect of lamivudine in the treatment of HBV-related liver failure. Methods We collected the literature on lamivudine used to treat liver failure in randomized control trail or clinical control trial studies from January 1989 to July 2007. All these clinical trials were carried out by comparing lamivudine treatment with routine medical treatment for liver failure. The literature must concern about mortality, total bilirubin （TBIL） or prothrombin activity （PTA）. Odds ratio （OR） was applied to evaluate the effect of glucocorticoid to improve ease fatality. Weighted mean differences （WMD） was applied to evaluate the effect of lamivudine to improve TBIL and PTA. Results There were only 13 literatures obtained, among them all about mortality, and 10 about TBIL and PTA. Effective index was 0.29 （95% CI： 0. 21, 0.40）, -0. 88 （95% CI： - 1.27, -0.48） and 0.60 （95% CI： 0.42, 0.78） respectively for the 3 indexes. Conclusion Combination with lamivudine is more effective in treatment liver failure than only routine medical treatment.