长期抗病毒治疗对慢性乙型肝炎疗效的Meta分析

Long-term Effect of Interferon and Nucleotide Analogues on Treating Chronic Hepatitis B:A Meta-Analysis of Randomized Controlled Trials

目的：系统评价长期抗病毒治疗[干扰素和核苷（酸）类药物]对防止慢性乙型肝炎（慢乙肝）进展到肝癌和死亡的疗效。方法：检索Pub Med、Cochrane图书馆、Web of Science、EMbase、CBM-disc和CNKI等数据库中关于抗病毒治疗治疗慢乙肝的随机对照研究（RCT）。截止时间设定为2014年11月。评价指标包括肝癌和死亡率。结果：纳入16篇RCT,共1 814名慢乙肝患者。Meta分析结果表明,抗病毒治疗可以降低肝癌发生率（OR=0.57,95%CI=0.35~0.92）和死亡发生率（OR=0.52,95%CI=0.34~0.80）。亚组分析结果表明核苷（酸）类药物比干扰素的效果更明显。各个Meta分析中不存在显著的异质性和发表偏倚。结论：长期抗病毒治疗对降低肝癌发生率和死亡率有显著疗效,核苷（酸）类药物效果可能比干扰素的效果更好。

Objective： To evaluate the long- term effect of antiviral therapy with nucleotide analogues and interferon for prevention of hepatocellular carcinoma（ HCC） and mortality in chronic hepatitis B through meta- analysis. Methods： A comprehensive literature search（ including Pub Med,CCTR,Web of Science,Embase,CBM- disc,and CNKI） was conducted dating until Augest 2014. Two researchers independently reviewed studies and abstracted data according to inclusion / exclusion criteria. HCC incidence and mortality were the outcome measures. Results： Data were obtained from 16 RCTs with 1 814 patients. The analysis found antiviral therapy could significantly decease the risk of HCC（ OR = 0. 57,95% CI = 0. 35 ~ 0. 92） and the risk of mortality（ OR = 0. 52,95% CI = 0. 34 ~ 0. 80）. Significant heterogeneity and potential publication bias did not exist.Conclusion： The long- term treatment of antiviral therapy on chronic hepatitis B can significantly decreased the risk of HCC and mortality and was worthy of clinical popularization.