【作者】 白冰； 何清； 唐奇远； 敖飞健； 唐蔚； 赵连三；

【机构】 深圳市第三人民医院； 四川大学华西医院；

【摘要】 目的系统评价干扰素联合阿德福韦酯治疗HBeAg阳性慢性乙型肝炎的效果和安全性。方法采用Cochrane系统评价方法,检索Cochrane图书馆临床对照试验数据库、PubMed、EMbase、CBM、CNKI、中文科技期刊数据库VIP、万方数据库等电子资料库。由2名评价者共同评价纳入研究的质量,对同质研究进行Meta分析。结果共纳入9个研究,653例慢性乙型肝炎患者。纳入文献均未描述具体随机方法,未描述分配隐藏方法,未实施盲法。按测量指标和干预措施进行亚组分析:①与单用阿德福韦酯比较,治疗24周时联合用药在HBeAg血清学转换率方面与对照组差异无统计学意义,治疗48周时联合用药在ALT复常率、HBVDNA转阴率、HBeAg血清学转换率方面优于对照组,差异有统计学意义,但HBsAg转阴率与对照组差异无统计学意义;②与单用干扰素比较,治疗24、48周时联合用药在ALT复常率、HBVDNA转阴率、HBeAg血清学转换率方面优于对照组,但随访48周时与对照组差异无统计学意义,HBsAg转阴率与对照组差异无统计学意义;③与干扰素联合拉米夫定组比较,在HBVDNA转阴率、HBeAg血清学转换率、HBsAg转阴率方面与对照组差异无统计学意义。结论现有研究显示,干扰素联合阿德福韦酯治疗HBeAg阳性慢性乙型肝炎对ALT、病毒学指标、病毒学应答的改善较单药治疗可能有效,且不增加严重的不良反应发生率。但本系统评价所纳入的文献多为较低质量的小样本研究,且用药时间不同,因此无法进行总体的效应合并分析,尚需更大量的文献支持。更多还原

【Abstract】 Objective To evaluate the effectiveness and safety of Adefovir dipivoxil plus interferon for HBeAg-positive chronic hepatitis B.Methods We searched The Cochrane Database of Controlled Trials Register(CCTR),PubMed,EMBASE,the Chinese Biomedical Database(CBM),CNKI,Chinese Scientific and Technological Journal Database(VIP database)and Wanfang Database.Quality assessment and data extraction were conducted by two reviewers independently,and disagreement,if any,was resolved by discussion.Meta-analyses were performed for homogeneous studies.Results A total of 9 studies involving,and 653 patients met the inclusion criteria.None of the trials enforced allocation concealment and none of the trials performed blinding.We conducted subgroup analyses based on the outcome measures and interventions.Comparison with ADV monotherapy:There was no significant differences were noted in terms of the HBeAg,seroconversion rate when the treatment course was 24 weeks.Treatment group was significantly more effective in normalizing ALT,clearing HBV DNA,and HBeAg,seroconversion rate when the treatment course was longer than 48 weeks.But there was no significant differences were noted in improving HBsAg,seroconversion rate.Comparison with interferon monotherapy:Treatment group was significantly more effective in reducing normalizing ALT,clearing HBV DNA,and HBeAg,seroconversion rate when the treatment course was 24 or 48 weeks,but.no significant differences were noted when the following up was48 weeks.Comparison with LAM plus interferon combination therapy:There was no significant differences were noted in terms of the in normalizing ALT,clearing HBV DNA,HBeAg,seroconversion rate,and HBsAg,seroconversion rate.Conclusion ADV plus interferon combination therapy might be effective in normalizing ALT levels,clearing HBV DNA,and achieving virus seroconversion,without any more serious adverse effects.However,because the overall effects cannot be pooled for analysis,more evidence is needed to support this finding.更多还原