益生菌联合恩替卡韦治疗乙型肝炎肝硬化临床疗效的meta分析

Clinical effect of probiotics combined with entecavir in the treatment of hepatitis B cirrhosis:a meta analysis

目的系统性评价益生菌联合抗病毒药物恩替卡韦治疗乙型肝炎(简称乙肝)肝硬化的临床疗效以及对肝功能和肝纤维化程度的影响。方法检索中国知网、万方、中国生物医学文献服务系统、PubMed、Embase等数据库建库至2022年1月前公开发表的有关益生菌联合恩替卡韦治疗乙肝肝硬化的随机对照研究的高质量文献。按照纳入及排除标准对文献进行筛选。对最终纳入的14篇文献进行质量分析,并使用统计软件RevMan 5.4对收集的数据进行meta分析。结果本研究共纳入14项随机对照研究(共1222例患者),进行统计处理。益生菌联合恩替卡韦治疗乙肝肝硬化可提高患者总有效率(OR=5.62,95%CI 2.75~11.48,Z=4.74,P<0.01);HBV-DNA的转阴率更高(OR=2.43,95%CI 1.39~4.25,Z=3.12,P<0.01)。肝功能ALT(OR=-8.74,95%CI-12.56~-4.91,Z=4.48,P<0.01);AST(OR=-24.27,95%CI-33.5~-15.03,Z=5.75,P<0.01);ALB(OR=4.17,95%CI 3.32~5.02,Z=9.62,P<0.01)。肝纤维化指标HA(OR=-33.09,95%CI-40.08~-25.35,Z=11.48,P<0.01);LN(OR=-20.47,95%CI-23.03~-17.90,Z=15.66,P<0.01)。结论益生菌联合恩替卡韦治疗乙肝肝硬化,能够提高乙肝肝硬化患者的临床疗效以及乙肝HBV-DNA的转阴率,改善患者的肝功能及肝纤维化程度。

Objective To systematically evaluate the clinical efficacy of probiotics combined with antiviral drug entecavir in the treatment of hepatitis B cirrhosis and its effect on liver function and the degree of liver fibrosis.Methods The high-quality literature on the randomized controlled study of probiotics combined with entecavir in the treatment of hepatitis B cirrhosis published in Chinese and foreign databases such as CNKI,Wanfang,China biomedical literature service system,PubMed and EMBase from the establishment of the database to January 2022 were searched.The literatures were screened according to the inclusion and exclusion criteria.The quality of the 14 articles finally included was analyzed,and the collected data were meta analyzed using the statistical software revman 5.4.Results A total of 14 randomized controlled studies(1222 patients)were included in this study for statistical processing.Probiotics combined with entecavir in the treatment of hepatitis B cirrhosis could improve the total effective rate of patients(OR=5.62,95%CI:2.75-11.48,Z=4.74,P<0.000001);Probiotics combined with entecavir had a higher negative conversion rate of HBV-DNA(OR=2.43,95%CI:1.39-4.25,Z=3.12,P<0.01).Liver function index:ALT(OR=-8.74,95%CI:-12.56~-4.91,Z=4.48,P<0.01);AST(OR=-24.27,95%CI:-33.5~-15.03,Z=5.75,P<0.01);ALB(OR=4.17,95%CI:3.32-5.02,Z=9.62,P<0.01).Liver fibrosis index:HA(OR=-33.09,95%CI:-40.08~-25.35,Z=11.48,P<0.01);LN(OR=-20.47,95%CI:-23.03~-17.90,Z=15.66,P<0.01).Conclusion Probiotics combined with entecavir in the treatment of hepatitis B cirrhosis can improve the clinical efficacy of patients with hepatitis B cirrhosis and the negative conversion rate of hepatitis B HBV-DNA,and improve the liver function and the degree of liver fibrosis.