恩替卡韦治疗拉米夫定失效慢性乙型肝炎的Meta分析

目的 评价恩替卡韦对拉米夫定治疗失效的慢性乙型肝炎的疗效.方法 检索2001年1月至2008年12月Medline、Embase、中国生物医学文献数据库,根据纳入标准、排除标准,对入选的4篇随机对照试验(RCT)的研究结果,采用RevMan4.2软件进行分析.结果 与对照组相比,恩替卡韦能更显著地提高HBV-DNA转阴率、HBeAg血清转换率和ALT复常率:RR分别为13.90(95% CI 6.39～30.24,P＜0.00001)、2.49(95%CI 1.40～4.45,P=0.002)和3.53(95%CI 2.85～4.38,P＜0.00001);且有提高HBeAg转阴率的趋势(RR=2.27,95% CI 1.00～5.15,P=0.05);而2组药物副作用发生率的差异无统计学意义(OR=1.05,95%CI 0.97～1.13,P=0.21).结论 采用恩替卡韦治疗拉米夫定失效的慢性乙肝患者,较之继续使用拉米夫定或安慰剂,能更显著地降低HBV-DNA,提高HBeAg血清转换率和ALT复常率,且不增加药物副作用.

Meta-analysis of entecavir in lamivudine-refractory patients with chronic hepatitis B

Objective To evaluate the efficacy of entecavir in lamivudine-refractory patients with chronic hepatitis B.Methods Literature from Medline,Embase and CBM between January 2001 to December 2008 were reviewed.Acccording to the including and excwding criteria,four randomized controlled trials (RCT) were enrolled.The results of the trials were reviewed and analysed in software Revman 4.2.Results Patients in the entecavir group enjoyed significantly higher negative conversion ratios of HBV-DNA and ALT,and positive seroconversion of HBeAg:RR were 13.90(95% CI 6.39～30.24,P＜0.00001),2.49(95% CI 1.40～4.45,P=0.002),and 3.53 (95% CI 2.85～4.38,P＜0.000 01) respectively.There was a trend for the improvement of negative conversion ratio of HBeAg (RR=2.27,95% CI 1.00～5.15,P=0.05),but the incidence of side-effects of the drugs has no difference (RR=1.05,95% CI 0.97～1.14,P=0.21).Conclusions Compared with lamivudine or placebo,entecavir can significantly decrease HBV-DNA,improve liver function and positive seroconversion ratio of HBeAg without raising the incidence of drug side-effects.