核苷（酸）类似物和干扰素序贯治疗和核苷（酸）类似物单药治疗慢性乙型肝炎疗效的系统评价及meta分析

发布时间：2018-04-08 15:28

  本文选题：核苷(酸)类似物　切入点：干扰素　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:比较核苷(酸)类似物(NAs)与干扰素(IFN)序贯治疗与NAs单药治疗对慢性乙型肝炎(CHB)患者的疗效,并进一步探索该三阶段治疗方法(经NAs初治,过渡期短暂联合IFN,IFN单药治疗)的最佳治疗方案。方法:采用RevMan5.3软件对纳入的24篇国内外随机对照试验及队列研究进行meta分析,分析治疗结束时及随访时ALT复常率、HBV DNA转阴率、HBe Ag转阴率、HBe Ag转换率、HBsAg转阴率、HBsAg转换率,并进行不同治疗方案下各项指标的亚组分析。结果:1、治疗结束时序贯治疗组的ALT复常率、HBV DNA转阴率、HBeAg转阴率、HBe Ag转换率、HBsAg转阴率、HBsAg转换率分别为83.9%、78.4%、47.2%、41.6%、9.1%和5.6%,均高于单药治疗组68.6%、67.3%、26.8%、17.3%、0%和0%(P0.05)。2、根据NAs用药不同(ETV或LAM)行亚组分析发现,两亚组间ALT复常率和HBV DNA转阴率上差异有统计学意义,ETV组ALT复常率(92.1%)高于LAM组(85.7%),HBV DNA转阴率(78.9%)则略低于LAM组(79.0%),且差异均有统计学意义(P0.05)。3、根据IFN用药不同(COM IFN或PEG IFN)行亚组分析发现,ALT复常率在两亚组间差异有统计学意义(P0.05),PEG IFN组(64.7%)低于COM IFN组(86.5%)。进一步根据IFN治疗时间不同(≥48周和48周)行亚组分析后提示,两亚组间差异无统计学意义。4、余各项指标在不同的亚组内均提示,HBeAg转阴率、HBeAg转换率在序贯治疗组较单药组有优势。5、治疗结束时ALT复常率、HBV DNA转阴率、HBeAg转阴率分别为84.4%、81.9%和85.0%,均高于随访时74.1%、63.1%和50%(P0.05),HBeAg转换率在前者(48.8%)高于后者(47.4%),但差异无统计学意义(P0.05)。治疗结束时HBsAg转阴率和HBsAg转换率(10.6%、8.3%)均低于随访时[(12.3%、10.3%),P0.05]。6、根据IFN用药时间不同(≥48周和48周)行亚组分析后提示,在IFN用药时间48周组,ALT复常率和HBV DNA转阴率在治疗结束时明显高于随访时(84.4%vs 73.1%,81.0%vs 63.4%),差异有统计学意义(P0.05),余指标在两亚组内差异均无统计学意义(P0.05)。结论:1、治疗结束时,序贯用药组在ALT复常率、HBV DNA转阴率、HBe Ag转阴率、HBe Ag转换率、HBsAg转阴率、HBsAg转换率方面均优于NAs单药治疗组。2、IFN治疗时间48周时,在停药后随访时其ALT复常率和HBV DNA转阴率均低于治疗结束时,因此考虑长期停药有导致HBV复发的可能。3、IFN治疗时间≥48周时,既往应用ETV或LAM经治的患者序贯IFN治疗后停药24周是安全可行的,但仍需长期随访观察。
[Abstract]:Objective: to compare the efficacy of sequential treatment of nucleoside (acid) analogue with interferon (IFN) in patients with chronic hepatitis B (CHB), and to explore the three stages of treatment (initial treatment via NAs).Short transition period combined with IFNN IFN monotherapy) is the best treatment.Methods: RevMan5.3 software was used to analyze 24 randomized controlled trials and cohort studies at home and abroad. At the end of the treatment and follow-up, the ALT conversion rate and the HBe Ag conversion rate were analyzed. The HBe Ag conversion rate and the HBe Ag conversion rate were analyzed.The subgroup analysis of the indexes under different treatment schemes was carried out.The results of subgroup analysis showed that the recovery rate of alt in the two subgroups was significantly lower than that in the COM IFN group (P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05).Further subgroup analysis showed that according to the time of IFN treatment (鈮，

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