苦参素联合拉米夫定对比单纯苦参素治疗慢性乙型肝炎临床疗效及YMDD变异的系统评价及Meta分析

发布时间：2018-07-15 09:37

【摘要】：目的:运用循证医学的方法,将苦参素联合拉米夫定对比单纯苦参素治疗慢性乙型肝炎患者HBe Ag阴转、HBe Ag血清转换率、HBV-DNA阴转及YMDD变异率进行分析。方法:收集CNKI、CBM、维普、万方、Pubmed数据库(2015年11月以前)苦参素联合拉米夫定对比单纯苦参素干预慢性乙型肝炎的临床RCT试验资料,用Cochrane系统评价的方法对文章的偏倚进行评价。利用Rev Man 5.3软件对结果的总体效应进行分析。结果:一共纳入9篇文献,Meta分析结果示:苦参素联合拉米夫定与苦参素相比,HBe Ag阴转率:RR=2.00,95%Cl为[1.37,2.93](P=0.000 4),苦参素联合拉米夫定疗效是苦参素组的2倍。HBe Ag血清转换率:RR=2.24,95%Cl为[1.56,3.21](P0.000 1),苦参素联合拉米夫定疗效是苦参素组的2.24倍。HBV DNA阴转率:RR=1.76,95%Cl为[1.24,2.50](P=0.002),苦参素联合拉米夫定比苦参素干预增加了76%的HBV DNA阴转率。YMDD:RR=4,95%Cl为[0.46,34.54],无统计学意义(P=0.21),苦参素联合拉米夫定组和苦参素组无明显差别。结论:苦参素联合拉米夫定在改善HBe Ag阴转率、HBe Ag血清转换率、HBV-DNA阴转率较好,且未使YMDD基序变异率增加,但纳入文献质量不高,需高质量大样本的随机对照三盲试验支持。
[Abstract]:Objective: to analyze the seroconversion rate of HBe Ag negative to HBe Ag and YMDD mutation rate in patients with chronic hepatitis B treated with oxymatrine combined with lamivudine by evidence-based medicine. Methods: the clinical RCT data of CNKI CBM, Wiper, Wanfang Pubmed database (before November 2015) were collected, and the bias of the article was evaluated by Cochrane systematic evaluation. The overall effect of the result was analyzed by using Revman 5.3 software. Results: the results of Meta-analysis showed that the negative conversion rate of HBe Ag was [1.37 卤2.93] (P < 0.0004), and the seroconversion rate of HBe Ag was 2 times than that of the matrine group. The seroconversion rate of HBe Ag was 2 times than that of the matrine group, and the seroconversion rate of HBe Ag was 2 times than that of the matrine group, and the seroconversion rate of HBe Ag was 2 times that of the matrine group. The seroconversion rate of HBe Ag was 2 times than that of the matrine group. [1.56 卤3.21] (P0.000 1), the therapeutic effect of oxymatrine combined with lamivudine was 2.24 times as high as that of the matrine group. The negative conversion rate of HBV DNA was 2.24 times higher than that of the matrine group. The negative conversion rate of HBV DNA was increased by 76% in combination with lamivudine (P0. 002), and there was no statistical significance (P0. 21). There was no significant difference between mivudine group and matrine group. Conclusion: Matrine combined with lamivudine can improve HBe Ag seroconversion rate and HBV-DNA seroconversion rate, and does not increase the YMDD motif mutation rate, but the quality of the literature is not high, so it needs to be supported by three blind randomized controlled trials of high quality and large sample.
【作者单位】：广州中医药大学附属深圳市宝安中医院(集团);广州中医药大学;
【基金】：国家自然科学基金项目(81102714) 国家级大学生创新创业训练项目(201410572026) 广东省大学生创新创业训练项目(201610572103) 深圳市科技计划项目(JCYJ20150401161033969)
【分类号】：R512.62

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