中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2013年
3期
166-171
,共6页
肝炎病毒,乙型%肝功能衰竭%恩替卡韦%荟萃分析
肝炎病毒,乙型%肝功能衰竭%恩替卡韋%薈萃分析
간염병독,을형%간공능쇠갈%은체잡위%회췌분석
Hepatitis B virus%Liver failure%Entecavir%Meta-analysis
目的 系统评价恩替卡韦治疗HBV相关性肝衰竭的短期疗效.方法 检索2005年3月至2012年9月在Embase、PubMed、BIOSIS Previews、HMIC、中国知网全文数据库(CNKI)、万方数据库、维普数据库和中国生物医学文献数据库等公开发表的涉及恩替卡韦治疗肝衰竭的临床研究文献,研究类型为随机对照试验.应用RevMan 5.0软件对文献进行荟萃分析,根据异质性差异采用固定效应模型或随机效应模型,以风险比(RR)或加权平均数(WMD)对效应量进行综合分析,应用漏斗图、失安全系数对判定指标进行敏感性和发表偏倚分析.结果 共选出10篇中、英文文献,共计790例病例纳入研究.荟萃分析结果显示:恩替卡韦治疗组患者的病死率、总胆红素(TBil)和丙氨酸转氨酶(ALT)水平显著低于对照组(病死率:RR=0.68,95％可信区间(CI)为0.56～0.81,Z=4.21,P＜0.01;TBil和ALT:WMD=-133.97和-99.81,95％ CI为-185.15 ～-82.78和-187.37 ～-12.24,Z =5.13和2.23,P＜0.01).恩替卡韦治疗组HBV DNA转阴率、血浆凝血酶原活动度(PTA)和白蛋白(Alb)水平明显高于对照组(HBV DNA转阴率:RR=5.21,95％ CI为3.66～7.42,Z =9.15,P＜0.01;PTA和Alb:WMD=21.49和3.81,95％ CI为19.32 ～ 23.67和1.24 ～ 6.37,Z=19.37和2.91,P＜0.01).结论 与常规内科治疗相比,加用恩替卡韦可以降低肝衰竭患者的病死率、ALT和TBil水平,提高PTA、Alb水平和HBV DNA转阴率.
目的 繫統評價恩替卡韋治療HBV相關性肝衰竭的短期療效.方法 檢索2005年3月至2012年9月在Embase、PubMed、BIOSIS Previews、HMIC、中國知網全文數據庫(CNKI)、萬方數據庫、維普數據庫和中國生物醫學文獻數據庫等公開髮錶的涉及恩替卡韋治療肝衰竭的臨床研究文獻,研究類型為隨機對照試驗.應用RevMan 5.0軟件對文獻進行薈萃分析,根據異質性差異採用固定效應模型或隨機效應模型,以風險比(RR)或加權平均數(WMD)對效應量進行綜閤分析,應用漏鬥圖、失安全繫數對判定指標進行敏感性和髮錶偏倚分析.結果 共選齣10篇中、英文文獻,共計790例病例納入研究.薈萃分析結果顯示:恩替卡韋治療組患者的病死率、總膽紅素(TBil)和丙氨痠轉氨酶(ALT)水平顯著低于對照組(病死率:RR=0.68,95％可信區間(CI)為0.56～0.81,Z=4.21,P＜0.01;TBil和ALT:WMD=-133.97和-99.81,95％ CI為-185.15 ～-82.78和-187.37 ～-12.24,Z =5.13和2.23,P＜0.01).恩替卡韋治療組HBV DNA轉陰率、血漿凝血酶原活動度(PTA)和白蛋白(Alb)水平明顯高于對照組(HBV DNA轉陰率:RR=5.21,95％ CI為3.66～7.42,Z =9.15,P＜0.01;PTA和Alb:WMD=21.49和3.81,95％ CI為19.32 ～ 23.67和1.24 ～ 6.37,Z=19.37和2.91,P＜0.01).結論 與常規內科治療相比,加用恩替卡韋可以降低肝衰竭患者的病死率、ALT和TBil水平,提高PTA、Alb水平和HBV DNA轉陰率.
목적 계통평개은체잡위치료HBV상관성간쇠갈적단기료효.방법 검색2005년3월지2012년9월재Embase、PubMed、BIOSIS Previews、HMIC、중국지망전문수거고(CNKI)、만방수거고、유보수거고화중국생물의학문헌수거고등공개발표적섭급은체잡위치료간쇠갈적림상연구문헌,연구류형위수궤대조시험.응용RevMan 5.0연건대문헌진행회췌분석,근거이질성차이채용고정효응모형혹수궤효응모형,이풍험비(RR)혹가권평균수(WMD)대효응량진행종합분석,응용루두도、실안전계수대판정지표진행민감성화발표편의분석.결과 공선출10편중、영문문헌,공계790례병례납입연구.회췌분석결과현시:은체잡위치료조환자적병사솔、총담홍소(TBil)화병안산전안매(ALT)수평현저저우대조조(병사솔:RR=0.68,95％가신구간(CI)위0.56～0.81,Z=4.21,P＜0.01;TBil화ALT:WMD=-133.97화-99.81,95％ CI위-185.15 ～-82.78화-187.37 ～-12.24,Z =5.13화2.23,P＜0.01).은체잡위치료조HBV DNA전음솔、혈장응혈매원활동도(PTA)화백단백(Alb)수평명현고우대조조(HBV DNA전음솔:RR=5.21,95％ CI위3.66～7.42,Z =9.15,P＜0.01;PTA화Alb:WMD=21.49화3.81,95％ CI위19.32 ～ 23.67화1.24 ～ 6.37,Z=19.37화2.91,P＜0.01).결론 여상규내과치료상비,가용은체잡위가이강저간쇠갈환자적병사솔、ALT화TBil수평,제고PTA、Alb수평화HBV DNA전음솔.
Objective To evaluate the short-term therapeutic effect of entecavir in treatment of HBV-related liver failure.Methods Randomized controlled trails on treatment of HBV-related liver failure with entecavir were searched in Embase,PubMed,BIOSIS Previews,HMIC,CNKI,Wanfang data,cqvip and SinoMed from March 2005 to September 2012.Meta-analysis was performed by using RevMan 5.0 software.Fixed effects model or random effect model was used according to heterogeneity differences.To evaluate the effect of entecavir,risk ratio (RR) was applied to assess the improvement of mortality rate and HBV DNA negative conversion rate,and weighted men differences (WMD) was applied to assess the changes of alanine aminotransferase (ALT),total bilirubin (TBil),albumin (Alb) and plasma thromboplastin antecedent (PTA) levels.Funnel plots and fail-safe number were used for sensitivitypublication bias analysis.Results Totally 10 eligible literatures with 790 patients were included in this analysis.Compared with the controls,the mortality rate (RR =0.68,95％ CI =0.56 to 0.81,Z =4.21,P＜0.01),TBil (WMD=-133.97,95％CI=-185.15 to-82.78,Z=5.13,P＜0.01) and ALT (WMD =-99.81,95％ CI =-187.37 to-12.24,Z =2.23,P ＜ 0.01) levels were lower in entecavir group,while HBV DNA negative conversion rate (RR =5.21,95％ CI =3.66 to 7.42,Z =9.15,P ＜0.01),PTA(WMD=21.49,95％CI=19.32 to 23.67,Z=19.37,P＜0.01) and Alb (WMD=3.81,95％CI=1.24 to 6.37,Z=2.91,P＜0.01) were higher in the entecavir group.Conclusion Entecavir can significantly reduce mortality rate,ALT and TBil levels,improve PTA,Alb levels and increase HBV DNA negative conversion rate for patients with HBV-related liver failure.
