聚乙二醇干扰素a和其他抗乙肝病毒药物对中国HBeAg阳性慢性乙型肝炎患者的疗效对比

目的：通过Meta分析来评价聚乙二醇干扰素（peg interferon，PEG—IFN）a与IFNa、阿德福韦酯（adefovir dipivoxil，ADV）和恩替卡韦（entecavir，ETV）对中国HBeAg阳性慢性乙型肝炎患者的疗效。方法：计算机检索MEDLINE和3个主要的中文数据库（万方、维普和CNKI），检索年限为1966年到2012年。由两名评价员对纳入的有关PEG—IFNa治疗中国HBeAg阳性慢性乙型肝炎患者的随机对照试验独立进行评价。结果：14个随机对照试验符合最终的纳入条件。Meta分析结果显示：在中国HBeAg阳性慢性乙型肝炎患者中，PEG-IFNa组的ALT复常率、HBVDNA阴转率、HBeAg血清转换率、HBeAg血浆清除率和肝纤维化的改善率均高TIFNa组，差异有统计学意义（P〈0．05）。PEG-IFNa对HBeAg血清转换率和HBeAg血浆清除率明显优于ETV组，差异有统计学意义（P〈0．05），但总体的HBeAg血清转换率和HBeAg血浆清除率较低。PEG-IFNa与ADV的联合用药组ALT复常率、HBVDNA阴转率和HBeAg血清转换率高TADV单药治疗组，差异有统计学意义（p〈0．05）。PEG—IFNa对血浆HBsAg清除率和其他几种抗乙肝病毒药物相比无明显优势。结论：PEG-IFNa对中国HBeAg阳性慢性乙型肝炎患者疗效显著，可作为治疗中国HBeAg阳性慢性乙型肝炎的一线药物。而对PEG—IFNa的联合用药对中国HBeAg阳性慢性乙型肝炎患者的益处和危害尚缺乏足够的证据。

Peginterferon alpha versus other antiviral regimes for Chinese HBeAg-positive chronic hepatitis B patients

Objective： To conduct a meta-analysis to determine the efficacy of peginterferon alpha （PEG- IFN a） therapy versus IFN a, adefovir dipivoxil （ADV） and entecavir （ETV） for chronic hepatitis B patients in China. HBeAg-positive Methods： MEDLINE database and 3 main Chinese biomedical databases between 1966 and 2012 was retrieved. Two reviewers independently screened all reports to identify randomized controlled trials that evaluated PEG-IFN a therapy for the treatment of chronic hepatitis B in China. Results： Fourteen trials met the eligibility criteria for this Meta analysis. PEG-IFN a therapy was more effective than IFN a therapy in achieving ALT normalization, serum HBV DNA clearance, HBeAg seroconversion, serum HBeAg clearance and fibrosis improvement in Chinese hepatitis B patients （P〈0.05）. PEG-IFN a was obviously superior to ETV in HBeAg seroconversion and serum HBeAg clearance （P〈0.05）, but the seroconversion rate was low. The combination therapy of PEG- IFN a and ADV was more effective than ADV monotherapy in ALT normalization, serum HBV DNA clearance and HBeAg seroconversion （P〈0.05）. PEG-IFN a showed no priority to other treatment regimes in HBsAg clearance. Conclusion： Treatment with PEG-IFN a is safe and effective, and can be prescribed as first- line treatment options for chronic hepatitis B patients in China. Data are too limited to exclude a substantial benefit or harm ofPEG-IFN a combination therapy for CHB patients in China.