恩替卡韦与拉米夫定治疗乙型肝炎病毒相关肝衰竭生存率Meta分析

Survival Meta analysis for Entecavir versus Lamivudine therapy for patients with HBV-related liver failure

目的通过Meta分析系统评价恩替卡韦和拉米夫定对HBV相关肝衰竭生存率的影响。方法检索2007年至2015年公开发表的中、英文相关文献，严格按照文献纳入、排除标准筛选。采用RevMan5．2版统计软件进行Meta分析，应用森林图对治疗4周、12周、24周、48周生存率进行分析。结果纳入恩替卡韦和拉米夫定治疗HBV相关肝衰竭有关生存率的中、英文文献18篇，共计1837例病例纳入研究，其中12篇为队列研究，6篇为randomizedcontrolledtrial（RCT）研究。Meta分析结果显示：恩替卡韦组4周、12周、24周、48周HBVDNA阴转率均高于拉米夫定组（4周：RR=1．52，Z=4．11，P〈0．01；12周：RR=1．26，Z=3．85，P〈0．01；24周：RR=1．26，Z=5．16，P〈0．01；48周：RR=1．22，Z=3．41，P〈0．01）。恩替卡韦组4周、12周和24周生存率与拉米夫定组均无差异（4周：RR=0．97，Z=0．55，P=0．58；12周：RR=1．01，Z=0．15，P=0．88；24周：RR=1．02，Z=0．56，P=0．57），而48周生存率高于拉米夫定组（48周：RR值为1．18，Z=2．84，P〈0．01）。结论恩替卡韦治疗HBV相关肝衰竭抗HBV疗效及改善远期生存率优于拉米夫定，更适合HBV相关肝功能衰竭的长期治疗。

Objective To evaluate the short-term and long-term survival rate for Entecavir versus Lamivudine in the treatment of patients with HBV-related liver failure through Meta-analysis. Methods Relevant literature published from 2007 to 2015 in Chinese or English were searched, papers fully matching the inclusion criteria were brought into the study. RavMan 5.2 statistical software was utilized for Meta- analysis. The survival rate of 4- week, 12- week,24-week, 48-week were analyzed by forest plot. Results Total 1837 patients from 18 controlled clinical trials reported in Chinese and English were recruited in this study, which involving survival rate for Entecavir versus Lamivudine in the treatment of patients with HBV- related liver failure. Among them 12 papers were cohort and 6 were RCT（ Randomized Controlled Trial） study. Meta analysis show： HBV DNA undetectable rate of 4-week, 12-week,24-week and 48- week in Entecavir group were higher than that in Lamivudine group （4-week ： RR = 1.52, Z = 4. 11, P 〈 0. 01 ; 12- week：RR = l.26,Z =3.85, P 〈0. 01;24-week：RR = 1.26,Z =5.16, P 〈0. 01;48-week：RR = 1.22,Z = 3.41, P 〈 0. 01 ） , survival rate of four-week, twelve-week, twenty four-week had no significant differences between Entecavir and Lamivudine group（ 4-week ：RR = 0.97, Z = 0.55, P = 0.58 ; 12-week：RR = 1.01, Z = 0. 15 ,P = 0. 88 ; 24-week： RR = 1.02, Z = 0. 56, P = 0.57 ） , fourty eight-week survival rate in Entecavir group was higher than that in Lamivudine group （ 48-week ： RR = 1. 18, Z = 2.84, P 〈 0. 01 ）. Conclusions The data indicated that Entecavir was more effective in the management of HBV levels and better improve the long-term prognosis of patients with HBV-associated liver failure than Lamivudine, which might be more suitable for long-term treatment to patients with HBV-related liver failure.