抗病毒药物联合安络化纤丸治疗乙型肝炎肝硬化疗效 Meta 分析

Therapeutic efficacy of antiviral drugs combined with Anluohuaxian Pill in treatment of hepatitis B-related cirrhosis: a meta-analysis

目的系统评价抗病毒药物联合安络化纤丸治疗乙型肝炎肝硬化的疗效。方法计算机检索PubMed、the Cochrane Library、中国期刊全文数据库、中国科技期刊数据库(维普)和万方数字化期刊全文数据库,全面收集抗病毒药物联合安络化纤丸治疗乙型肝炎肝硬化的随机对照试验(randomized controlled trials,RCTs)。检索时限从1989年1月至2013年1月。由5名研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入6篇RCTs,纳入研究对象543例,其中联合用药组294例,普通用药组249例。Meta分析结果显示,抗病毒药物联合安络化纤丸治疗乙型肝炎肝硬化可明显降低患者的透明质酸水平[MD=-77.09,95%可信区间(confidence interval,CI)(-86.21,-67.97),P<0.00001]、层黏连蛋白水平[MD=-35.37,95%CI(-41.11,-29.62),P<0.000 01]和Ⅲ型前胶原水平[MD=-56.49,95%C(I-63.13,-49.85),P<0.000 01]。结论现有证据显示,在使用常规的护肝药物及抗病毒药物的基础上联合安络化纤丸可以明显改善肝纤维化指标。受纳入研究数量和质量所限,上述结论尚须开展更多大样本、高质量的RCTs加以验证。

Objective To systematically evaluate the efficacy of antiviral drugs combined with A nluohuaxian Pill in treatment of hepatitis B-related cirrhosis. Methods Randomized controlled trials （RCTs） on antiviral drugs plus A nluohuaxian Pill in treat- ment of hepatitis B-related cirrhosis from Jan. 1989 to Jan. 2013 were retrieved through databases including PubMed, the Cochrane Library, Chinese Journal Full-Text Database, VIP Database for Chinese Technical Periodicals and Wanfang Digital Journal Full- text Database. Five reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included RCTs. Then, a meta-analysis was performed using RevMan 5.0 software. Results Six RCTs were included, involving 543 cases of hepatitis B-related cirrhosis （the combination group： n=294; the conventional medication group： n=249）. The results of the meta-analysis showed that as compared with the conventional medication, antiviral drugs plus Anluohuaxian Pill significantly decreased the levels of HA [MD=-77.09, 95%CI （-86.21, -67.97）,P〈0.000 01], LN [MD=-35.37, 95%C1 （--41.11, -29.62）, P〈0.000 01] and PCIII[MD =-56.49, 95%CI （-63.13, -49.85）, P〈0.000 01]. Conclusions The meta-analysis shows that in addition to the use of conventional liver-protecting drugs, antiviral drugs plus A nluohuaxian Pill can significantly improve the indexes of liver fibrosis. However, due to the limitation of quantity and quality of the included RCTs, this conclusion should be fur- ther confirmed by RCTs of larger sample and higher quality.