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不同抗病毒策略治疗慢性乙型肝炎低病毒血症临床疗效的Meta分析

Meta analysis of clinical efficacy of different antiviral strategies in the treatment of chronic hepatitis B with low level viremia
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摘要 目的:运用Meta分析方法评价不同抗病毒策略治疗慢性乙型肝炎经治后低病毒血症(LLV)的临床疗效。方法:检索PubMed、Embase、Web of Science、中国知网(CNKI)、万方知识服务平台(WanFang Data)文献数据库,选取符合纳入标准的治疗慢性乙型肝炎LLV的临床研究文献,使用Rev Man 5.4.1软件进行统计学分析。结果:本研究纳入8篇文献,涉及1 150例患者,经Meta分析后提示与维持原核苷类药物(NAs)治疗相比,换用新NAs的治疗方案可以获得更高的HBV DNA阴转率[RR=5.49,95%CI(3.73,8.08),P<0.01]以及HBeAg清除率[RR=2.77,95%CI(1.33,5.77),P=0.006];含有长效干扰素(PEG-IFN)治疗方法可以获得更高的HBsAg清除率(9/241)[RR=8.29,95%CI(1.01,68.33)],P=0.05];不同治疗策略谷丙转氨酶(ALT)复常率差异无统计学意义(P>0.05)。在含有PEG-IFN治疗策略组中,治疗相关不良事件发生率更高[RR=6.42,95%CI(1.69,24.36),P<0.05]。结论:不同抗病毒策略安全性均较高,换用新NAs治疗可以提高LLV患者HBV DNA阴转率和HBeAg消除率。 Objective:Meta analysis was used to evaluate the clinical efficacy of different antiviral strategies for the treatment of treated chronic hepatitis B with low-level viremia(LLV).Methods:The literature databases of PubMed,Embase,Web of Science,CNKI and WanFang Data were searched,and the clinical research literatures on the treatment of chronic hepatitis B hypoviremia LLV were selected and statistically analyzed by RevMan5.4.1 software.Results:This study included 8 literatures involving 1150 patients.Meta analysis suggested that compared with maintaining pronucleoside drugs(NAs),the new NAs treatment regimen could achieve higher HBVDNA negative conversion rate[RR=5.49,95%CI(3.73,8.08),P<0.01]and higher HBeAg clearance rate[RR=2.77,95%CI(1.33,5.77),P=0.006].Treatment with long-acting interferon(PEG-IFN)could achieve higher HBsAg clearance rate(9/241)[RR=8.29,95%CI(1.01,68.33),P=0.05],and there was no significant difference in ALT normalization rate among different treatment strategies(P>0.05).The incidence of treatment-related adverse events was higher in the group with PEG-IFN treatment strategy[RR=6.42,95%CI(1.69,24.36),P<0.05].Conclusion:The safety of different antiviral strategies was high,switching to new NAs treatment can increase the negative conversion rate of HBVDNA and HBeAg clearance rate in patients with LLV,and the treatment regimen containing PEG-IFN can increase the dearamce rate of HBsAg.
作者 冯雨薇 戴丹 刘黎明 张建军 FENG Yuwei;DAI Dan;LIU Liming;ZHANG Jianjun(Clinical College of Chinese Medicine,Hubei University of Chinese Medicine,Wuhan 430065,China;Department of Hepatology with Integrative Medicine,Hubei No.3 People s Hospital of Jianghan University,Wuhan 430033,China)
出处 《现代医学》 2023年第12期1661-1667,共7页 Modern Medical Journal
基金 第二届湖北省医学领军人才项目(2019)。
关键词 慢性乙型肝炎 低病毒血症 META分析 chronic hepatitis B low-level viremia Meta analysis
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