恩替卡韦治疗乙型肝炎肝硬化失代偿期的Meta分析

Meta-analysis: treatment of entecavir in patients with decompensated hepatitis B virus cirrhosis

目的比较恩替卡韦、拉米夫定、阿德福韦酯治疗乙型肝炎肝硬化失代偿期的疗效。方法计算机检索PubMed、MEDLINE、EBSCO、CNKI、万方数据库、重庆维普等,并追查所有纳入的参考文献。检索年限均从建库到2013年3月。纳入恩替卡韦与拉米夫定或阿德福韦酯比较治疗乙型肝炎肝硬化失代偿期的随机对照试验。采用Jadad评分法评价纳入研究的方法学质量,并用Cochrane协作网提供的RevMan 5.0软件进行Meta分析,并对不同疗程进行亚组分析。结果纳入8个随机对照试验(n=708),Meta分析结果显示:恩替卡韦治疗乙型肝炎肝硬化失代偿期24周HBV DNA转阴率略高于拉米夫定组,差异无统计学意义(P>0.05),但明显高于阿德福韦酯组,差异有统计学意义(P<0.00001);48周恩替卡韦组HBV DNA转阴率明显高于拉米夫定组和阿德福韦酯组,差异有统计学意义(P<0.00001)。48周恩替卡韦组HBeAg血清转换率与拉米夫定组和阿德福韦酯组差异无统计学意义(P>0.05)。结论长期的恩替卡韦治疗乙型肝炎肝硬化失代偿期疗效明显优于拉米夫定和阿德福韦酯。

Objective To assess the curative efficacy of entecavir, lamivudine and adefovir dipivoxil in patients with decompensated hepatitis B virus cirrhosis. Methods PubMed, MEDLINE, EBSCO, CNKI, WanFang and Weipu were searched from the beginning to Mar. 2013, and the references of eligible studies were manually screened. Randomized controlled trials comparing entecavir with lamivudine and adefovir dipivoxil in patients with decompensated hepatitis B virus cirrhosis were eligible for inclusion. Jadad score method was adopted to evaluate the methodological quality of ineluded studies. Meta-analysis was conducted by RevMan 5.0 software supplied by the Cochrane Collaboration. Subgroup analyses were used in treatment and observation course. Results Eight randomized controlled trials were included （n = 708 ） , Meta-analysis showed that HBV DNA negative conversion rate of the entecavir group at 24-week was slightly higher than that of the lamivudine group, the difference was not statistically significant （P 〉 0.05 ）. HBV DNA negative conversion rate of the enteeavir group at 48-week was significantly higher than that of the lamivudine group and the adefovir dipivoxil group （P 〈 0. 00001 ）. The difference in HBeAg seroconversion at 48-week was not statistically significant in entecavir, lamivudine and adefovir dipivoxil in patients with decompensated hepatitis B virus cirrhosis （P 〉 0.05 ）. Conclusion Long-term entecavir treatment in patients with decompensated hepatitis B virus cirrhosis were significantly better than lamivudine and adefovir dipivoxil.