不同剂量干扰素α治疗慢性丙型肝炎疗效与安全性的系统评价

Effectiveness and Safety of Different Doses of Interferon Alfa in the Treatment of Chronic Hepatitis C:A Systematic Review

目的系统评价不同剂量干扰素α治疗慢性丙型肝炎的疗效与安全性。方法计算机检索MEDLINE、EMbase、CENTRAL、CBM、CNKI、VIP和WanFang Data,查找有关不同剂量干扰素α治疗慢性丙型肝炎的随机对照试验,检索时限截至2012年8月。由2位研究者根据纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.0软件进行Meta分析。结果最终纳入13个RCT,共1 442例患者。Meta分析结果显示:①干扰素α3 MU组与1 MU组治疗慢性丙型肝炎的完全应答率差异无统计学意义[RR=0.83,95%CI(0.52,1.32),P=0.43],而两组持续应答率差异有统计学意义[RR=1.89,95%CI(1.00,3.59),P=0.05];②干扰素α3 MU组与6MU组以及10 MU组治疗慢性丙型肝炎的完全应答率和持续应答率差异均无统计学意义。结论干扰素α(治疗剂量3 MU,1周3次)治疗慢性丙型肝炎有效,但目前尚无证据确定是否存在剂量依赖效应。在使用干扰素α治疗慢性丙型肝炎时,应根据患者的耐受性和经济情况等实施个体化给药以有效控制慢性丙型肝炎。

Objective To evaluate the effectiveness and safety of different doses of interferon alfa （INF-α） in the treatment of chronic hepatitis C （CHC）. Methods Such databases as MEDLINE, EMbase, CENTRAL, CBM, CNKI, VIP and WanFang Data were searched to collect the randomized controlled trials （RCTs） on different doses of INF-α in the treatment of CHC published before August, 2012. According to the inclusion and exclusion criteria, two reviewers inde- pendently screened literature, extracted data and evaluated the quality of the included studies, and then meta-analysis was performed using RevMan 5.0 software. Results A total of 13 RCTs involving 1 442 patients were included. The results of meta-analysis on different doses of INF-ct showed that, a） There was no significant difference in the complete response rate between the 3 MU dose group and the 1 MU dose group （RR=0.83, 95%CI 0.52 to 1.32, P=0.43）, but there was significant difference in the sustained response rate between those 2 groups （RR= 1.89, 95%CI 1.00 to 3.59, P=0.05）; and b） No significant differences were found in the complete response rate among the 3 MU dose group, the 6 MU dose group, and the 1 MU dose group. Conclusion INF-α in dose of 3 MU, 3 times daily, is effective in treating CHC, but it would not rule out that higher dose takes more effective action. When INF-α is used to treat CHC, an individualized medication should be applied according to patients＇ tolerance and economic status.