替比夫定与恩替卡韦治疗HBeAg阳性慢性乙型肝炎短期疗效比较的荟萃分析

目的评价替比夫定与恩替卡韦对HBeAg阳性慢性乙型肝炎的疗效。方法检索CochraneLibrary、PubMed、EM—BASE、中国生物医学文献数据库、万方数字化期刊群、中国期刊全文数据库等公开发表与研究目的相关随机对照试验，2人独立进行筛选及资料提取，根据Cochrane Handbook5．0．2质量评价标准进行评价，用RevMan5．1．1软件进行荟萃分析。结果9个随机对照试验（875例患者）纳入分析。荟萃分析结果显示：替比夫定在第12、24周HBeAg转阴率OR=0．16，95％CI（0．08，0．30）]、EOR=0．64，95％CI（0．44，0．92）]，第12、24周HBeAg血清学转换率OR=0．25，95％CI（0．13，0．49）]、OR=0．54，95％CI（0．37，0．81）]，肌酸激酶（CK）升高-OR：0．12，95％CI（0．05，0．27）]方面高于恩替卡韦；在第12、24周HBVDNA转阴率EOR=1．08，95％CI（0．81，1．43）]、VOR=0．80，95％CI（0．60，1．07）]，第12、24周丙氨酸转氨酶（ALT）复常率OR=1．08，95％CI（0．75，1．56）]、OR=0．90，95％CI（0．62，1．32）]，胃肠道反应-OR=2．42，95％CI（0．61，9．53）]、疲劳OR=1．46，95％CI（0．42，5．04）]方面与恩替卡韦相比差异无统计学意义。结论现有的证据显示，在治疗的第12周及第24周，替比夫定在HBeAg转阴率及血清学转换率中疗效优于恩替卡韦，在HBVDNA转阴率、ALT复常率、胃肠道反应、疲劳与恩替卡韦相似，替比夫定有升高CK的风险。由于纳入研究的随访时间较短，样本量较小，两者的远期疗效有待进一步比较。

Short-term efficacy of telbivudine versus entecavir for HBeAg-positive chronic hepa- titis B. a meta-analysis

Objective To evaluate the efficacy of telbivudine versus entecavir in the short-term treatment of HBeAg-positive chronic hepatitis B. Methods Cochrane Library, PubMed, EMBASE, Chinese Biomedical Database, WanFang Database Online, China Journal Full-text Database were searched to retrieve the published randomized controlled trials （RCTs） involving telbivudine versus entecavir for HBeAg-positive chronic hepatitis 13. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies with Cochrane Handbook 5.0. 2. Meta-analysis was performed by using RevManS. 1.1 software. Results Nine eligible RCTs with 875 patients were included in this analysis. Meta-analysis showed that telbivudine was more effective than entecavir in terms of loss of serum HBeAg at 12 weeks OR= 0. 16, 95% CI （0.08, 0. 30）] and 24 weeks OR = 0. 64, 95%//00 CI （0. 44, 0. 92）], in terms of HBeAg seroconversion at 12 weeks OR= 0. 25, 95% CI （0. 13, 0.49）] and 24 weeks OR= 0.54, 95% CI （0. 37, 0. 81）]. But telbivudine was more likely associated with increased level of creatinine phosphokinase （CK） than entecavir OR = 0. 12, 95% CI （0. 05, 0. 27）]. Telbivudine was comparable to entecavir in terms of loss of serum HBV DNA at 12 weeks OR= 1.08, 95%//00 CI （0.81, 1.43）] and 24 weeks -OR= 0. 80, 95% CI （0. 60, 1.07）]; serum alanine aminotransferase （ALT） normalization at 12 weeks OR = 1.08, 95o//oo CI （0. 75, 1.56）] and 24 weeks OR = 0. 90, 95 % CI （0. 62, 1.32）]; gastrointestinal reactions -OR = 2.42, 95 % CI （0. 61, 9.53）], or fatigue OR= 1.46, 95% CI （0. 42, 5.04）]. Conclusions In HBeAg-positive chronic hepatitis B patients, telbivudine is more effective than entecavir in loss of serum HBeAg, HBeA_g seroconversion, but telbivudine is more likely associated with increased CK level than entecavir. No significant difference was found between telbivudine and entecavir in terms of loss of serum HBV DNA, serum ALT normalization, gastrointestinal reactions or fatigue.