CAJ | 학술논문

目的：系统评价恩替卡韦（ETV）、拉米夫定（LAM）对慢性乙型肝炎（CHB）患者肝细胞癌（HCC）发生率的影响。方法使用关键词“entecavir”和“lamivudine”，在PubMed中对种属为人、发表时间为2000年1月1日至2015年5月30日的英文文献进行系统性检索。入选文献满足如下标准：①确诊的CHB成年患者（年龄≥16岁）；②治疗方案为口服ETV或LAM；③回顾性或前瞻性病例对照研究；④随访中发现的HCC有明确诊断标准且提供数据。比较ETV或LAM治疗后CHB患者的HCC发生率。结果按检索条件共检索到751篇英文文献，其中3篇最终进入本次研究，纳入研究对象共计5014例，其中采用ETV治疗2327例（ ETV组）、采用LAM治疗2687例（LAM组）。 Begg检验及漏斗图显示无发表偏倚（P＝0．602）。固定效应模型及随机效应模型分析结果均显示ETV组HCC发生率低于LAM组（固定效应模型：RR＝0．547，95％ CI：0．450～0．666，P＝0．000；随机效应模型：RR＝0．444，95％CI：0．210～0．937，P＝0．033）。结论 ETV及LAM均能降低CHB患者发生HCC的风险，ETV作用更强。
목적：계통평개은체잡위（ETV）、랍미부정（LAM）대만성을형간염（CHB）환자간세포암（HCC）발생솔적영향。방법사용관건사“entecavir”화“lamivudine”，재PubMed중대충속위인、발표시간위2000년1월1일지2015년5월30일적영문문헌진행계통성검색。입선문헌만족여하표준：①학진적CHB성년환자（년령≥16세）；②치료방안위구복ETV혹LAM；③회고성혹전첨성병례대조연구；④수방중발현적HCC유명학진단표준차제공수거。비교ETV혹LAM치료후CHB환자적HCC발생솔。결과안검색조건공검색도751편영문문헌，기중3편최종진입본차연구，납입연구대상공계5014례，기중채용ETV치료2327례（ ETV조）、채용LAM치료2687례（LAM조）。 Begg검험급루두도현시무발표편의（P＝0．602）。고정효응모형급수궤효응모형분석결과균현시ETV조HCC발생솔저우LAM조（고정효응모형：RR＝0．547，95％ CI：0．450～0．666，P＝0．000；수궤효응모형：RR＝0．444，95％CI：0．210～0．937，P＝0．033）。결론 ETV급LAM균능강저CHB환자발생HCC적풍험，ETV작용경강。
Objective To systematically evaluate the effect of entecavir ( ETV) or lamivudine ( LAM) on the hepato-cellular carcinoma ( HCC) incidence of patients with chronic hepatitis B ( CHB) .Methods Using key words of entecavir and lamivudine, we systematically searched in PubMed from January 1st, 2000 to May 30th, 2015 with species limited in human.The included articles must satisfied the following criterions:①definite diagnosed adult patients (age≥16 years),②treatment protocols:take ETV or LAM orally ,③experimental design: retrospective or prospective case-control study ,④ clearly diagnostic criteria and relative dates must be provided in HCC patients during follow -up.HCC incidence after be-ing treated with ETV or LAM was compared .Results A total of 751 English literatures conformed to the search condition , and 3 studies including 5 014 patients were selected in this analysis , and 2327 cases of them treated with ETV ( ETV group) , 2687 cases with LAM ( LAM group) .No significant publication bias was found both in Begg test and funnel plot (P=0.602).Compared with the LAM group, both fixed effect model and random effect model showed the incidence of HCC in ETV group was lower (fixed effect model:RR=0.547, 95%CI:0.450-0.666, P=0.000;random effect model:RR=0.444, 95%CI:0.210-0.937, P=0.033).Conclusion Both ETV and LAM treatment can reduce the risk of HCC in CHB patients , but the effect of ETV is better .