替比夫定治疗慢性乙型肝炎疗效的系统评价

发布时间：2018-11-26 16:12

【摘要】：目的:系统评价替比夫定(LDT)治疗慢性乙型肝炎(CHB)的治疗效果.方法:应用Cochrane系统评价方法计算机检索Cochrane Library(2009年第3期)、PubMed(1966-2009.9)、EMBASE(1974-2009.9)、中国生物医学数据库(CBM,1978-2009.9)、相关期刊论文(CNKI,1979-2009.9)和维普数据库(VIP,1989-2009.9),同时在临床试验注册网站及Google搜索引擎进行检索,并追查纳入研究参考文献,收集以LDT治疗CHB的所有随机对照试验(RCT)和交叉试验.根据Cochrane协作网推荐的"风险评估工具"进行风险偏倚评估,用RevMan5.0软件进行统计学分析.结果:最终纳入10个RCTs,共4037例患者.7篇LDT对比拉米夫定(LAM)的研究结果显示,对于HBeAg阳性患者,LDT组较LAM组更有效提高血清HBVDNA检测不到率(RR=1.50,95%CI:1.38-1.64)、ALT复常率(RR=1.10,95%CI:1.05-1.16)、HBeAg转阴率(RR=1.23,95%CI:1.08-1.40)和HBeAg血清转换率(RR=1.17,95%CI:1.01-1.35);对于HBeAg阴性患者,LDT组较LAM组更有效提高血清HBVDNA检测不到率(RR=1.29,95%CI:1.12-1.40),两组ALT复常率差异无统计学意义(RR=1.08,95%CI:0.96-1.21).2篇LDT对比阿德福韦酯以及1篇LDT对比治疗方案不详的常规内科治疗的研究结果均显示LDT组效果优于对照组.结论:LDT相比其他药物治疗CHB对病毒学应答、血清学应答、生化学应答等方面指标有效,但对于不同疗程的总体效果还需要更为大量的高质量文献提供科学的证据.
[Abstract]:Objective: to evaluate the efficacy of tibivudine (LDT) in the treatment of chronic hepatitis B (CHB). Methods: the third issue of), PubMed (1966-2009.9), EMBASE (1974-2009.9, China Biomedical Database (CBM,1978-2009.9) and the full text Database of Chinese Journals (CNKI,) were searched by Cochrane system evaluation method. And WIP Database (VIP,1989-2009.9), which are also searched on clinical trial registration sites and Google search engines, and tracked down for inclusion in research references, All randomized controlled trials (RCT) and crossover trials) with LDT for CHB were collected. According to the "risk assessment tool" recommended by Cochrane Cooperative Network, the risk bias is evaluated and the statistical analysis is carried out with RevMan5.0 software. Results: a total of 4037 patients with 10 RCTs, were included. The results of 7 LDT studies compared with lamivudine (LAM) showed that, for HBeAg positive patients, Compared with LAM group, LDT group was more effective than LAM group in increasing serum HBVDNA undetectable rate (RR=1.10,95%CI:1.05-1.16). HBeAg negative rate (RR=1.23,95%CI:1.08-1.40) and HBeAg seroconversion rate (RR=1.17,95%CI:1.01-1.35); For HBeAg negative patients, LDT group was more effective than LAM group in increasing the RR=1.29,95%CI:1.12-1.40 rate of serum. There was no significant difference in ALT recovery rate between the two groups (RR=1.08,95%CI:0.96-1.21). The results of two studies of LDT versus adefovir and one LDT comparison of routine medical treatment with unknown protocol showed that the LDT group had both. The effect was better than that of the control group. Conclusion: compared with other drugs, LDT is effective in virological response, serological response, biochemical response and so on, but more scientific evidence is needed for the overall effect of different courses of treatment.
【作者单位】：兰州大学循证医学中心兰州大学基础医学院;兰州大学第一临床医学院;平凉市人民医院;
【分类号】：R512.62

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