拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化疗效的系统评价

摘要

OBJECTIVE:To evaluate the efficacy and safety of lamivudine combined with adefovir dipivoxil in the treatment of hepatitis B virus (HBV)-related decompensated cirrhosis.METHODS:Retrieved from Pubmed,Cochrane Library,CBMdisc,CNKI,Chinese VIP database and WanFang database,the randomized controlled trials (RCTs) about lamivudine alone or combined with adefovir dipivoxil in the treatment of HBV-related decompensated cirrhosis were included.Meta-analysis was carried out with Rev Man 5.1 software.RESULTS:19 RCTs were included,involving 1 236 patients.Results of meta-analysis showed that,but the mortality rate [RR=0.39,95％CI(0.16,0.97),P＜0.05] and virological breakthrough or genotypic resistance rates of 12 and 24 months in trial group were lower than in control group [RR=0.08,95％CI(0.03,0.23),P＜0.01 ;RR=0.04,95％CI(0.01,0.15),P＜ 0.01].The HBV-DNA negative rates of trial group were higher than that of control group both at the of 12 and 24 months treatment [RR=1.51,95％ CI (1.37,1.68),P＜0.01 ; RR=1.47,95％ CI (1.30,1.67),P＜0.01]; the difference of Child-Pugh scores of liver function had no statistical significance between 2 groups (P＞0.05),and no serious ADR was reported.CONCLUSIONS:Lamivudine combined with adefovir dipivoxil can inhibit virus replication significantly in the treatment of HBV-related decompensated cirrhosis.The virological breakthrough or genotypic resistance rates of it are significantly lower than lamivudine,and it can reduce mortality rate with sound safety.%目的:系统评价拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化的疗效.方法:计算机检索Pubmed、Cochrane Library、中国生物医学文献数据库、中国知识资源总库、维普数据库、万方数据库公开发表的文献,纳入拉米夫定联合阿德福韦酯与单用拉米夫定比较治疗失代偿期乙型肝炎肝硬化的随机对照试验,对纳入研究采用Rev Man5.1统计软件进行Meta分析.结果:共纳入19项随机对照试验,合计1 236例患者.Meta分析结果显示,试验组的病死率[RR=0.39,95％CI(0.16,0.97),P＜0.05]、12个月和24个月时的病毒学突破率或基因型耐药率均显著低于对照组[RR=0.08,95％CI(0.03,0.23),P＜0.01；RR=0.04,95％CI(0.01,0.15),P＜0.01],12个月和24个月时的HBV-DNA转阴率均显著高于对照组[RR=1.51,95％ CI(1.37,1.68),P＜0.01；RR=1.47,95％CI(1.30,1.67),P＜0.01]；两组在改善肝功能Child-Pugh评分方面比较差异无统计学意义(P＞0.05),并且均未发生严重不良反应.结论:拉米夫定联合阿德福韦酯治疗失代偿期乙型肝炎肝硬化能显著抑制病毒复制,病毒学突破或基因型耐药率也显著低于单用拉米夫定治疗,可降低病死率,且安全性较好.