HCV相关肝移植前后抗病毒治疗疗效和安全性荟萃分析

Meta-analysis of the efficacy and safety of antiviral therapy before and after liver transplantation related to hepatitis C virus

目的比较分析干扰素(IFN)、聚乙二醇干扰素(PEG-IFN)单药或其分别联合利巴韦林治疗丙型肝炎病毒(HCV)感染相关肝移植患者的疗效和安全性。方法通过计算机检索1990年1月1日至2011年8月31日在PubMed、荷兰医学文摘、Ovid,万方和中国知网期刊全文数据库、维普中文期刊数据库等发表的有关丙型肝炎相关肝移植患者抗HCV治疗疗效和安全性的相关研究,并对肝移植前、后抗HCV治疗结束时病毒学应答(EDVR)率、持续病毒学应答(SRV)率和不良事件发生率进行比较研究。共纳入11项研究,296例患者,均接受IFN、PEG-IFN单药或其分别联合利巴韦林抗HCV治疗。结果其中移植前抗HCV治疗患者167例,移植后抗HCV治疗患者129例,两个时期患者抗HCV治疗获得的EDVR率比较,差异无统计学意义(45.0%、45.2%,χ2=0.029 3,P>0.05),但SRV率比较,差异有统计学意义(20.0%、31.8%,χ2=5.549 2,P<0.05),而不良事件发生率比较,差异无统计学意义(47.5%、41.7%,χ2=1.193 6,P>0.05)。结论肝移植前、后进行抗HCV感染均能获得一定的病毒学应答率,移植后抗HCV治疗可能比移植前进行抗HCV治疗获得更高的SRV率。

Objective To analyze and compare the efficacy and safety of single drug of interferon （IFN）, pegylated in- terferons （PEG-IFN） or combined with ribavirin respectively in the treatment of infections with hepatitis C virus （HCV） infection. Methods Data about efficacy and safety of HCV patients with antiviral therapy published on Pubmed,Excerpta Medica Database （EMBASE）, Ovid,Wanfang database, CNKI,VIP and so on from January 1,1990 to August 31,2011 by computer re- trieval. Totally 11 items were enrolled in the study with 296 patients, and all patients were treated with single drug of IFN and PEG-IFN ,or combined with ribavirin respectively. Results 167 patients were with anti-HCV therapy before liver transplanta- tion ,while 129 patients were with anti-HCV therapy after liver transplantation. The virological response rate after anti-HCV ther- apy between the two periods had no statistically significant difference （45.0%vs.45.2% ,X~=0.029 3 ,P〉0.05 ）, but the sustained vi- rological response rate between the two groups had statistically significant difference （20.0% vs. 31.8% ,Xa=5.549 2, P〈O.05 ）. The occurrence rate of adverse events between the two periods had statistically significant difference （47.5% vs.41.7% ,xa=l. 193 6, P〉 0.05）. Conclusion Anti-HCV infection before and after liver transplantation can benefit certain virological response rate,and sustained virological response rate with antiviral therapy after transplantation is higher than that before transplantation.