恩替卡韦联合IFN-α治疗慢性乙肝的系统评价

Combination of Entecavir and IFN-α for Chronic Hepatitis B: A Systematic Review

目的系统评价恩替卡韦联合IFN-α与单用恩替卡韦治疗慢性乙肝的疗效。方法计算机检索PubMed、EMbase、The Cochrane Library(2013年第12期)、Web of Science、CBM、CNKI、WanFang Data和VIP,查找恩替卡韦联合IFN-α治疗慢性乙肝的随机对照试验(RCT),检索时限均为从建库至2013年12月。由2位评价者按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2.5软件进行Meta分析。结果最终纳入7个RCT,共计543例患者。Meta分析结果显示:与单用恩替卡韦相比,联合IFN-α治疗24周后,明显提高了慢性乙肝患者的血清HBV-DNA阴转率[OR=2.93,95%CI 1.79,4.79),P<0.0001]、HBeAg转换率[OR=2.36,95%CI(1.35,4.14),P=0.003]和ALT复常率[OR=2.73,95%CI(1.73,4.32),P<0.0001];两组不良反应无明显差异。结论当前证据显示,恩替卡韦联合IFN-α治疗慢性乙肝优于单用恩替卡韦,但受纳入研究的质量和数量所限,上述结论尚需开展更多高质量的研究加以验证。

Objective To systematically review the combination of entecavir and interferon-a （IFN-α） in treating hepatitis B compared to entecavir alone. Methods PubMed, EMbase, The Cochrane Library （Issue 12, 2013）, Web of Sci- ence, CBM, CNKI, WanFang Data and VIP were searched for the randomized controlled trials （RCTs） on entecavir and interferon-α （IFN-α） in treating hepatitis B from inception to December 2013. Two reviewers independently screened lit- erature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2.5. Results A total of 7 RCTs were finally included involving 543 cases. The results of meta-analysis revealed that, compared to entecavir alone, 24-week combined therapy was more effec- tive in improving negative conversion rates of serttrn HBV-DNA （OR=2.93, 95%CI 1.79 to 4.79, P〈0.000 1）, conversion rates of HBeAg （OR=2.36, 95%CI 1.35 to 4.14, P=0.003）, and recovery rates of ALT （OR=2.73, 95%CI 1.73 to 4.32, P〈0.000 1）. No statistical significance was found in terms of side effects. Condusion Current evidence shows that combination of entecavir and IFN-α is more effective than entecavir alone in treating hepatitis B. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.