拉米夫定耐药株两种治疗策略的效果比较(拉米夫定和阿德福韦酯联用与恩替卡韦单用)

Comparison of efficacy between two treatment strategies in lamivudine-refractory patients with chronic hepatitis B:lamivudine plus adefovir dipivoxil versus entecavir

目的比较拉米夫定联合阿德福韦酯与恩替卡韦单用两种治疗策略对拉米夫定耐药慢性乙型肝炎患者的效果。方法检索2010年7月以前在PUBMED,EMBASE,CNKI等全文数据库公开发表的有关拉米夫定(剂量100 mg/d)联合阿德福韦酯(剂量10 mg/d)与恩替卡韦单用(剂量1 mg/d)治疗拉米夫定耐药慢性乙型肝炎患者(疗程≥48周)的随机对照临床研究。采用χ2检验分析研究间的异质性,以相对危险度为疗效分析统计量进行合并分析并绘制森林图。疗效判定指标包括血清HBV DNA检测不到(阴转)、血清ALT复常、血清HBeAg抗体转换。结果拉米夫定联合阿德福韦酯的治疗方式与恩替卡韦单用对拉米夫定耐药株的疗效差异无统计学意义(P>0.05),两者的48周血清HBV DNA阴转率、血清ALT复常率和血清HBeAg抗体转换率比较的P值分别为0.25,0.61和0.33。结论拉米夫定联合阿德福韦酯与恩替卡韦单用对拉米夫定耐药慢性乙型肝炎患者的疗效相似。

Objective To evaluate the efficacy between lamivudine plus adefovir dipivoxil and entecavir mono-therapy in lamivudine-refractory patients with chronic hepatitis B.Methods Chinese and English articles published in PUBMED,EMBASE,CNKI before July 2010 about comparison of efficacy between lamivudine plus adefovir dipivoxil and entecavir mono-therapy in lamivudine-refractory patients with chronic hepatitis B were searched.The dosages of lamivudine,adefovir dipivoxil and entecavir were respectively 100 mg/d,10mg/d and 1mg/d,and continuing time all last over 48 weeks.Heterogeneity was examined by Chi-square（χ2） test,the relative risk was calculated and forest-plot was drawn.The evaluated index contained the rates of undetected serum HBV DNA,serum ALT normalization,and HBeAg seroconversion.Results There were no statistic significances on the rates of undetected serum HBV DNA（P=0.25）,serum ALT normalization（P=0.61）,and HBeAg seroconversion（P=0.33） at week 48 between the lamivudine plus adefovir dipivoxil group and the entecavir mono-therapy group.Conclusion Efficacy between lamivudine plus adefovir dipivoxil and entecavir mono-therapy for lamivudine-refractory patients with chronic hepatitis B was similar.