CAJ | 학술논문

目的：系统评价恩替卡韦治疗慢加急性乙型肝炎肝衰竭的疗效和安全性。方法应用计算机检索PubMed、Cochrane Library、CBMdisc、CNKI、维普、万方等数据库公开发表的文献，检索年限均从2006年1月至2014年9月。纳入恩替卡韦与拉米夫定相比较治疗慢加急性乙型肝炎肝衰竭的随机对照试验。由两名评判员对纳入试验独立进行质量评价和资料提取，采用RevMan5.1软件进行Meta分析。结果经筛选共纳入7个随机对照试验，合计823例患者。Meta分析结果显示，恩替卡韦治疗6月以上的患者其病死率显著低于拉米夫定治疗患者[RR=0.75，95%CI（0.60，0.95），P＜0.05]；在治疗2～3 m和6 m以上评价，恩替卡韦治疗患者HBV DNA转阴率也显著高于拉米夫定治疗患者[RR=1.47，95%CI（1.29，1.68），P＜0.05；RR=1.48，95%CI（1.30，1.67），P＜0.05]，病毒学突破率也显著低于拉米夫定治疗组[RR=0.07，95%CI（0.01，0.54），P＜0.05]，且未出现严重不良反应。结论恩替卡韦治疗慢加急性乙型肝炎肝衰竭患者的远期病死率和病毒学突破率均显著低于拉米夫定，适合于长期抗病毒治疗。
목적：계통평개은체잡위치료만가급성을형간염간쇠갈적료효화안전성。방법응용계산궤검색PubMed、Cochrane Library、CBMdisc、CNKI、유보、만방등수거고공개발표적문헌，검색년한균종2006년1월지2014년9월。납입은체잡위여랍미부정상비교치료만가급성을형간염간쇠갈적수궤대조시험。유량명평판원대납입시험독립진행질량평개화자료제취，채용RevMan5.1연건진행Meta분석。결과경사선공납입7개수궤대조시험，합계823례환자。Meta분석결과현시，은체잡위치료6월이상적환자기병사솔현저저우랍미부정치료환자[RR=0.75，95%CI（0.60，0.95），P＜0.05]；재치료2～3 m화6 m이상평개，은체잡위치료환자HBV DNA전음솔야현저고우랍미부정치료환자[RR=1.47，95%CI（1.29，1.68），P＜0.05；RR=1.48，95%CI（1.30，1.67），P＜0.05]，병독학돌파솔야현저저우랍미부정치료조[RR=0.07，95%CI（0.01，0.54），P＜0.05]，차미출현엄중불량반응。결론은체잡위치료만가급성을형간염간쇠갈환자적원기병사솔화병독학돌파솔균현저저우랍미부정，괄합우장기항병독치료。
Objective To evaluate the efficacy and safety of entecavir in treatment of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure. Methods All randomized controlled trials comparing the efficacy of entecavir versus lamivudine in patients with HBV-related acute-on-chronic liver failure published in January 2006 to September 2014 were collected by searching PubMed,Cochrane Library,CBMdisc,Chinese Na-tional Knowledge Infrastructure (CNKI),Chinese VIP database and WanFang database. The quality assessment of literatures and the extraction of information were accomplished by two independent reviewers. Statistical analyses were performed with RevMan 5.1 software. Results Seven eligible trials including 823 patients were included. According to the results of meta-analysis,the mortality rates of patients in entecavir groups were significantly low-er than that of patients in lamivudine groups when the treatment lasted for more than 6 months [RR=0.75,95%CI (0.60,0.95),P<0.05];the negative conversion rates of serum HBV DNA in patients of entecavir groups were sig-nificantly higher than that of patients in lamivudine groups when the treatment lasted for 2 to 3 months and more than 6 months [RR=1.47,95%CI (1.29,1.68),P<0.05;RR=1.48,95%CI (1.30,1.67),P<0.05],and the virological breakthrough rate of patients in entecavir groups was significantly lower as compared to that of patients in lamivudine groups [RR=0.07,95%CI (0.01,0.54),P<0.05]. No serious adverse events were observed in the ente-cavir groups. Conclusion Entecavir leads to lower long-term mortality rate and virological breakthrough rate than lamivudine in patients with HBV-related acute-on-chronic liver failure,providing a better option for the long-term antiviral therapy.