CAJ | 학술논문

目的评价阿德福韦酯(Adefovir dipivoxil,AD)单独或联合拉米夫定(Lamivudine,LAM)对拉米夫定耐药的慢性乙型肝炎患者的疗效差异.方法根据纳入标准,摘录7篇随机对照试验(RCT)的研究结果,用RevMan 4.2软件进行分析.结果与单用AD(10mg/d)相比,AD(10 mg/d)+LAM(100 mg/d)能更显著地提高HBV-DNA、HBeAg转阴率,HBeAg血清学转换率和ALT复常率:RR(95% CI,P)分别为1.39(1.26～1.54,＜0.00001),2.28(1.58～3.30,＜0.0001),2.58(1.61～4.14,＜0.0001),1.29(1.17～1.42,＜0.00001);显著降低病毒学突破发生率和耐AD基因突变发生率:RR(95%CI,P)分别为0.10(0.03～0.34,0.0002)和0.12(0.02～0.95,0.04);而两组药物副作用发生率的差异无统计学意义(RR=0.94,95% CI 0.75～1.17,P=0.57).结论采用AD+LAM联合治疗LAM耐药的慢性乙肝患者,较之单用AD,能更显著地提高HBV-DNA、HBeAg转阴率、血清学转换率和ALT复常率,降低病毒学突破发生率和耐AD基因突变发生率,且不增加药物副作用,值得临床推广.
목적 평개아덕복위지(Adefovir dipivoxil,AD)단독혹연합랍미부정(Lamivudine,LAM)대랍미부정내약적만성을형간염환자적료효차이.방법 근거납입표준,적록7편수궤대조시험(RCT)적연구결과,용RevMan 4.2연건진행분석.결과 여단용AD(10mg/d)상비,AD(10 mg/d)+LAM(100 mg/d)능경현저지제고HBV-DNA、HBeAg전음솔,HBeAg혈청학전환솔화ALT복상솔:RR(95% CI,P)분별위1.39(1.26～1.54,＜0.00001),2.28(1.58～3.30,＜0.0001),2.58(1.61～4.14,＜0.0001),1.29(1.17～1.42,＜0.00001);현저강저병독학돌파발생솔화내AD기인돌변발생솔:RR(95%CI,P)분별위0.10(0.03～0.34,0.0002)화0.12(0.02～0.95,0.04);이량조약물부작용발생솔적차이무통계학의의(RR=0.94,95% CI 0.75～1.17,P=0.57).결론 채용AD+LAM연합치료LAM내약적만성을간환자,교지단용AD,능경현저지제고HBV-DNA、HBeAg전음솔、혈청학전환솔화ALT복상솔,강저병독학돌파발생솔화내AD기인돌변발생솔,차불증가약물부작용,치득림상추엄.