干扰素联合恩替卡韦治疗HBeAg阳性慢性乙型肝炎的疗效及安全性分析

发布时间：2019-07-10 22:02

【摘要】：目的比较干扰素(IFN)联合恩替卡韦(ETV)与IFN、ETV单用对HBeAg阳性慢性乙型肝炎患者的疗效和安全性。方法计算机检索PubMed、EMbase、Cochrane Library、知网、万方、维普等数据库,收集以IFN联合ETV、IFN或ETV单独使用为主要干预措施,对HBeAg阳性的慢性乙型肝炎患者进行治疗的随机对照试验,数据资料用Review Manager5.0进行分析。结果 (1)共纳入12篇随机对照试验研究,1 313例HBeAg阳性慢性乙型肝炎患者。(2)与单用ETV相比,IFN联合ETV治疗患者HBV DNA低于下限率在治疗后48周(RR=1.21,95%CI:1.03~1.41)增加,HBeAg转阴率在治疗后12周(RR=1.72,95%CI:1.06~2.81)、24周(RR=1.84,95%CI:1.34~2.68)和48周(RR=1.76,95%CI:1.42~2.17)增加,HBeAg转换率在治疗后24周(RR=1.62,95%CI:1.16~2.28)和48周(RR=1.82,95%CI:1.46~2.27)增加。(3)与单用IFN相比,IFN联合ETV治疗患者ALT复常率在治疗后12周(RR=1.47,95%CI:1.14~1.89)、24周(RR=1.74,95%CI:1.47~2.06)和48周(RR=1.37,95%CI:1.22~1.54)增加,HBV DNA低于下限率在治疗后12周(RR=2.02,95%CI:1.52~2.68)、24周(RR=1.90,95%CI:1.57~2.30)和48周(RR=1.42,95%CI:1.26~1.61)增加,HBeAg转阴率在治疗后24周(RR=1.80,95%CI:1.34~2.43)和48周(RR=1.38,95%CI:1.16~1.65)增加,HBeAg转换率在治疗后24周(RR=1.75,95%CI:1.17~2.60)和48周(RR=1.38,95%CI:1.09~1.73)增加。(4)IFN联合ETV治疗与单用ETV或IFN相比不良反应无统计学差异。结论 HBeAg阳性的慢性乙型肝炎患者联合使用IFN与ETV的疗效优于单用ETV或IFN,并且安全。
[Abstract]:Objective to compare the efficacy and safety of interferon (IFN) combined with entecavir (ETV) and IFN,ETV in patients with HBeAg positive chronic hepatitis B. Methods the databases of PubMed,EMbase,Cochrane Library, Wanfang and Vipu were searched by computer. IFN combined with ETV,IFN or ETV alone was used as the main intervention measure to carry out a randomized controlled trial of HBeAg positive patients with chronic hepatitis B. the data were analyzed by Review Manager5.0. Results (1) A total of 13 HBeAg positive patients with chronic hepatitis B were enrolled in 12 randomized controlled trials. (2) compared with ETV alone, the lower HBV DNA rate of IFN combined with ETV increased at 48 weeks after treatment (RR=1.21,95%CI:1.03~1.41), and the negative rate of HBeAg turned negative at 12 weeks after treatment (RR=1.72,95%CI:1.06~2.81). 24 weeks (RR=1.84,95%CI:1.34~2.68) and 48 weeks (RR=1.76,95%CI:1.42~2.17) increased, and the conversion rate of HBeAg increased at 24 weeks (RR=1.62,95%CI:1.16~2.28) and 48 weeks (RR=1.82,95%CI:1.46~2.27) after treatment. (3) compared with IFN alone, the recovery rate of ALT in patients treated with IFN combined with ETV increased at 12 weeks after treatment (RR=1.47,95%CI:1.14~1.89). The increase of, HBV DNA at 24 weeks (RR=1.74,95%CI:1.47~2.06) and 48 weeks (RR=1.37,95%CI:1.22~1.54) was lower than the lower limit rate at 12 weeks (RR=2.02,95%CI:1.52~2.68), 24 weeks (RR=1.90,95%CI:1.57~2.30) and 48 weeks (RR=1.42,95%CI:1.26~1.61) after treatment. The negative conversion rate of HBeAg increased at 24 weeks (RR=1.80,95%CI:1.34~2.43) and 48 weeks (RR=1.38,95%CI:1.16~1.65) after treatment, while the conversion rate of HBeAg increased at 24 weeks (RR=1.75,95%CI:1.17~2.60) and 48 weeks (RR=1.38,95%CI:1.09~1.73) after treatment. (4) there was no significant difference in adverse reactions between IFN combined with ETV and ETV or IFN alone. Conclusion the efficacy of IFN combined with ETV in HBeAg positive patients with chronic hepatitis B is better than that in ETV or IFN, alone and is safe.
【作者单位】：南昌大学第四临床医学院;南昌大学公共卫生学院;
【分类号】：R512.62

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