核苷(酸)类似物单药或与干扰素序贯治疗慢性乙型肝炎的Meta分析

目的 比较核苷(酸)类似物(NAs)经治患者过渡期短暂联合IFN序贯治疗及NAs单药治疗对慢性乙型肝炎(CHB)患者的疗效,并探索最佳治疗方案.方法 采用RevMan5.3软件对纳入的24篇国内外研究进行Meta分析,比较治疗结束时及随访时ALT复常率、HBV DNA转阴率、HBeAg转阴率、HBeAg转换率、HBsAg转阴率、HBsAg转换率,并进行不同治疗方案下各项指标的亚组分析.结果 治疗结束时序贯治疗组的ALT复常率、HBV DNA转阴率、HBeAg转阴率、HBeAg转换率、HBsAg转阴率、HBsAg转换率分别为83.9％、78.4％、47.2％、41.6％、9.1％和5.6％,均高于单药治疗组的68.6％、67.3％、26.8％、17.3％、0和0(RR=1.18、1.13、1.73、2.33、9.86和6.58,P均＜0.01).治疗结束时ALT复常率、HBV DNA转阴率、HBeAg转阴率分别为84.4％、81.9％和85.0％,均高于随访时的74.1％、63.1％和50.0％(RR=1.14、1.26和1.61,P均＜0.01).根据IFN用药时间不同(≥48周和＜48周)行亚组分析提示,在IFN用药＜48周组,ALT复常率和HBV DNA转阴率在治疗结束时明显高于随访时(84.4％ vs 73.1％,81.0％ vs 63.4％,RR=1.16和1.24).结论 治疗结束时,序贯用药组各项指标均优于NAs单药治疗组.IFN治疗＜48周患者考虑长期停药有导致HBV复发可能.

Meta-analysis on nucleos(t)ide analogue monotherapy or nucleos(t)ide analogue/interferon sequential therapy for chronic hepatitis B

Objective To evaluate the efficacy of nucleos (t) ide analogues (NAs) and interferon (IFN) sequential therapy versus NAs monotherapy for CHB,and to further explore the optimal therapeutic treatment.Methods The meta-analysis of the included 24 articles was performed by Review Manager Software 5.3.ALT normalization rate,HBV DNA undetectable rate,HBeAg and HBsAg loss rate,HBeAg and HBsAg seroconversion rate were measured.Results At the end of the treatment,patients who had received sequential therapy had higher rates of ALT normalization,HBV DNA negative conversion,HBeAg negative conversion,HBeAg conversion,HBsAg negative conversion and HBsAg conversion,which were 83.9％,78.4％,47.2％,41.6％,9.1％,and 5.6％ respectively,than those in NAs monotherapy group which were 68.6％,67.3％,26.8％,17.3％,0 and 0 (RR=1.18,1.13,1.73,2.33,9.86 and 6.58,P all＜0.01).At the end of treatment,rates of ALT normalization,HBV DNA negtive conversion and HBeAg negtive conversion were 84.4％,81.9％ and 85.0％,which were higher than 74.1％,63.1％ and 50.0％ respectively during follow-up visit (RR=1.14,1.26 and 1.61,Pall＜0.01).According to the different duration of IFN therapy (≥48 weeks and＜48 weeks),the results showed that those at the rates of ALT normalization and HBV DNA negative conversion were higher at the end of treatment than those at the end of follow-up (84.4％ vs 73.1％,81.0％ vs 63.4％,RR =1.16 and 1.24) in IFN therapy ＜48 weeks group.Conclusions At the end of treatment,all indexes in the sequential therapy group are better than those in NAs monotherapy group.Patients with IFN therapeutic duration ＜48 weeks have a high risk of HBV may reactivation after long-term drug withdrawal.