干扰素-α联合利巴韦林治疗丙型肝炎相关性混合型冷球蛋白血症的meta分析

Treatment of hepatitis C virus-associated mixed cryoglobulinemia with interferon-α and ribavirin:a meta analysis

目的探讨干扰素-α(IFN-α)联合利巴韦林治疗丙型肝炎相关性混合型冷球蛋白血症的有效性和安全性。方法全面检索了PubMed、OVID、Springer、CCTR(Cochrane Controlled Trails Rwgister)、万方、维普等全文数据库,对符合纳入标准的7篇文献共计169例患者进行了meta分析。结果治疗前与治疗结束丙氨酸氨基转移酶(ALT)的演变具有同质性(P=0.18;I2=41%),可用固定效应模型分析;治疗前与随访结束时ALT的演变也具有同质性(P=0.14;I2=50%),可用固定效应模型分析;治疗前后冷沉比容的演变也具有同质性(P=0.23,I2=31%),用固定效应模型分析。合并分析显示:治疗前与治疗结束ALT平均降低了104.2 IU/L(95%CI 76.25-132.60,P<0.000 01);治疗前与随访结束时ALT平均降低了40.04 IU/L(95%CI 26.28-53.80,P<0.000 01);治疗前与治疗结束时冷沉比容平均降低了3.17%(95%CI 2.21-3.99,P<0.000 01)。结论现有的临床证据表明,IFN-α联合利巴韦林治疗丙型肝炎相关性混合型冷球蛋白血症通过降低血清ALT水平可明显改善肝功能,同时对冷沉比容也有一定的降低作用,但还需要多中心、大规模的随机双盲对照试验来进一步验证和支持。

Abstract： Objective To assess the efficacy of interferon-α （IFN-α） and ribavirin in treatment of hepatitis C virus-associated mixed cryoglobulinemia.Methods A thorough literature on interferon-α （IFN-α） and ribavirin in treatment of hepatitis C virus-associated mixed cryoglobulinemia was searched among PubMed,OVID,Springer,CCTR （Cochrane Controlled Trails Register）,Wanfang,VIP full text database,et al.A meta analysis was performed on a total of 169 patients involved in 7 articles which met the inclusion criteria.Results Test for heterogeneity showed that the evolution of alanine aminotransferase （ALT） had homogeneity between the pretreatment and the end of treatment （P =0.18;I2 =41%）,which allowed to use the fixed effect model analysis.And the evolution of ALT had homogeneity between the pretreatment and the end of follow-up （P =0.14 ;I2 =50%）,which allowed to use the fixed effect model analysis.The evolution of cryocrit also had homogeneity between the pretreatment and the end of treatment,so the fixed effect model analysis was applied.Incorporation analysis showed that ALT reduced by an average of 104.2 IU/L （95% CI 76.25-132.60,P 〈 0.000 01）from the pretreatment to the end of treatment.And ALT reduced by an average of 40.04 IU/L （95 % CI 26.28-53.80,P 〈 0.000 01）from the pretreatment to the end of follow-up.Cryocrit reduced by an average of 3.17% （95% CI 2.21-3.99,P 〈 0.000 01） from the pretreatment to the end of treatment.Conclusion The clinical evidences available indicate that IFN-α and ribavirin for hepatitis C virus-associated mixed cryoglobulinemia can significantly improve the liver function by reducing serum alanine amino transferase （ALT） levels,and can also reduce the cryocrit.But it needs the multi-centre and large-scale randomized double blind clinical trials to further demonstrate and support the conclusion.