拉米夫定联合阿德福韦酯治疗失代偿期肝硬化的Meta分析

Meta-analysis of Lamivudine Combined with Adefovir for Treatment of Decompensated Liver Cirrhosis

目的系统评价拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化的疗效和安全性。方法检索提取此两药联合治疗失代偿期肝硬化的随机对照临床研究;采用RevMan 5.0软件进行Meta分析。结果有7项随机对照临床试验(583例患者)符合入选标准;与单药组比较,初始联合组有较高的丙氨酸氨基转移酶复常率、乙型肝炎病毒DNA转阴率和HBeAg转阴率,有较低的病毒学突破发生率,可改善Child-Pugh评分;未见明显不良反应。结论对于失代偿期肝硬化患者,初始联合安全,可以提高疗效,减少病毒学突破发生。

Objective To systematically evaluate the efficacy and safety of lamivudine combined with adefovir in treatment of the patients with decompensated liver cirrhosis caused by HBV.Methods Literatures about randomized controlled trials（RCTs） of lamivudine and adefovir combination therapy were retrieved from databases.RevMan 5.0 software was used for Meta-analysis.Results 7 RCTs with 583 patients were included in the study.Meta-analysis showed that ALT normalization rate,HBV DNA negative rate and the HBeAg loss rate in patients treated with combinative therapy were higher than that in monotherapeutic patients,and the Child-Pugh score was improved significantly in the combinative group.The rate of virologic breakthrough in the monotherapeutic patients was significantly higher than that in the combinative group;no serious adverse events were reported.Conclusion Combinative therapy with lamivudine and adefovir in the decompensated liver cirrhosis patients is proved to be safe,which can inhibit HBV replication better and has a lower virologic breakthrough rate.