比较替比夫定与拉米夫定治疗慢性乙型肝炎疗效的Meta分析

宋立文; 赵桂鸣; 曹武奎; 卢诚震

比较替比夫定与拉米夫定治疗慢性乙型肝炎疗效的Meta分析

天津市传染病医院天津市肝病医学研究所

详细信息

中图分类号: R512.62
计量
- 文章访问数: 2509
- HTML全文浏览量: 14
- PDF下载量: 745
- 被引次数: 0
出版历程
- 出版日期: 2011-09-20

Meta analysis of the comparison of the efficacy of lamivudine and telbivudine in the treatment of chronic hepatitis B

摘要

摘要: 目的评价替比夫定与拉米夫定对比治疗慢性乙型肝炎(CHB)的疗效。方法检索2007年4月至2010年8月万方数据、维普资讯、中国生物医学文献数据库,根据纳入标准、排除标准,对入选的6篇随机对照试验(RCT)的研究结果,采用RevMan5.0.2软件进行分析。结果与对照组相比,替比夫定能更显著地提高HBV DNA转阴率、HBeAg转阴率、HBeAg血清转换率和ALT复常率:相对危险度(RR)分别为1.39[95%CI(1.26～1.54),Z=6.45,P<0.00001]、1.46[95%CI(1.16～1.84),Z=3.24,P=0.001]、1.47[95%CI(1.12～1.92),Z=2.77,P=0.006]和1.15[95%CI(1.09～1.22),Z=4.88,P<0.00001];且降低耐药率:优势比(OR)为0.31[95%CI(0.20～0.48),Z=5.15,P<0.00001];而两组不良事件发生率的差异无统计学意义[OR=1.36,95%CI(0.84～2.20),Z=1.27,P=0.20]。结论采用替比夫定与拉米夫定对比治疗CHB患者...
- 肝炎,乙型,慢性 /
- 替比夫定 /
- 拉米夫定 /
- Meta分析
Abstract: Objective To evaluate the treatment of telbivudine compared with lamivudine on chronic hepatitis B patients in china.Methods The papers were searched from April 2007 to August 2010 in the database of wanfangdata, CQVIP and CBM according to inclusion criteria and exclusion criteria.The selected six randomized controlled trials (RCT) findings were analysed by RevMan5.0.2 Software.Results Compared with the control group, telbivudine improved HBV DNA negative rate, HBeAg negative rate, HBeAg seroconversion rate and ALT normalization rate more significant than those of lamivudine: RR were 1.39[95%CI (1.261.54) , Z=6.45, P<0.00001], 1.46[95%CI (1.161.84) , Z=3.24, P=0.001], 1.47[95%CI (1.121.92) , Z=2.77, P=0.006] and 1.15[95%CI (1.091.22) , Z=4.88, P<0.00001];Telbivudine can reduce the rate of drug resistance: OR is 0.31[95%CI (0.200.48) , Z=5.15, P<0.00001];There was no significant difference of the adverse events[OR=1.36, 95%CI (0.842.20) , Z=1.27, P=0.20].Conclusion Telbivudine is more effective in the HBV DNA reduction, increase of serum HBeAg negative rate, conversion rate and ALT normalization rate, with lower resistance rate and without increasing drug adverse reactions compared with lamivudine.
- hepatitis B /
- chronic /
- telbivudine /
- lamivudine

HTML全文

参考文献(28)

[1]Schiff ER.Prevention of mortality from hepatitis B and hepa-titis C[J].Lancet, 2006, 368 (9539) :896-897.

[2]Perz JF, Armstrong GL, Farrington LA, et al.The contribu-tions of hepatitis B virus and hepatitis C virus infections to cir-rhosis and primary liver cancer worldwide[J].J Hepatol, 2006, 45 (4) :529-538.

[3]斯崇文.重视对慢性乙型肝炎的防治[J].中国实用内科杂志, 2005, 25 (9) :769.

[4] 中华医学会.慢性乙型肝炎防治指南[J].中华肝脏病杂志, 2005, 13:881-891.

[5]Dieostag JL, Schiff ER, Wright TL, et al.Lamivudine as ini-tialtreatment for chronic hepatitis B in the United States[J].N Engl J Med, 1999, 341 (17) :1256-1263.

[6]Lai CL, Dienstag J, Schiff E, et al.Prevalence and clinicalcorrelates of YMDD variants during lamivudine therapy for pa-tients with chronic hepatitis B[J].Clin Infect Dis, 2003, 36 (6) :687-696.

[7]Locarnini S, Mason WS.Cellular and virological mechanismsof HBV drug resistance[J].J Hepatol, 2006, 44 (2) :422-431.

[8]Di Marco V, Maro A, Lampertico P, et al.Clinical outcomeof HBeAg-negative chronic hepatitis B in relation to virologi-cal response to lamivudine[J].Hepatology, 2004, 40 (4) :883-891.

[9]Keeffe EB, Dieterich DT, Han SH, et al.A treatment algo-rithm for the management of chronic hepatitis B virus infec-tion in the United States:an update[J].Clin GastroenterolHepatol, 2006, 4 (8) :936-962.

[10]Lok AS, McMahon BJ.Chronic hepatitis B[J].Hepatology, 2007, 45 (2) :507-539.

[11]Fung SK, Chae HB, Fontana RJ, et al.Virologic responseand resistance to adefovir in patients with chronic hepatitis B[J].Hepatol, 2006, 44 (2) :283-290.

[12]Lee YS.Suh OJ, Lim YS, et al.Increased risk of adefovirresistance in patients with lamivudine-resistant chronic hep-atitis B after 48 weeks of adefovir dipivoxil monotherapy[J].Hepatology, 2006, 43 (6) :1385-1391.

[13]王永刚, 黄燕萍, 王槐志, 等.拉米夫定耐药的HBV再感染者阿德福韦酯治疗前后HBV多聚酶基因区序列演变的研究[J].解放军医学杂志, 2007, 32 (1) :46-48.

[14]林丹, 尹德辉.替比夫定治疗慢性乙型肝炎45例[J].2009, 19 (2) :113-114.

[15]汤东澄, 谢冬梅, 徐娟娟, 等.替比夫定治疗慢性乙型肝炎的临床研究[J].浙江中医药大学学报, 2009, 33 (2) :214-215.

[16]任凤美, 粱振亚.慢性乙型肝炎的临床治疗体会[J].中国现代药物应用, 2010, 4 (5) :47-48.

[17]贾继东, 侯金林, 尹有宽, 等.替比夫定或拉米夫定抗乙型肝炎病毒的疗效预测探讨[J].中华肝脏病杂志, 2007, 15 (5) :342-345.

[18]钟旬华, 刘艳, 许诚, 等.替比夫定与拉米夫定治疗慢性乙型肝炎临床疗效比较研究[J].中西医结合肝病杂志, 2009, 19 (1) :19-21.

[19]李蔚莉, 马秀云, 吴璐, 等.替比夫定与拉米夫定长期治疗慢性乙型肝炎患者疗效与安全性的随机对照研[J].药物不良反应杂志, 2010, 12 (2) :77-82.

[20]Lok AS, McMahon BJ;Practice Guideline, American Associ-ation for the Study of Liver Diseases (AASLD) .Chronic hep-atitis B:update of recommendations[J].Hepatology, 2004, 39 (3) :857-861.

[21]Liaw YF, Leung N, Guan R, et al.Asian-Pacific consensusstatement on the management of chronic hepatitis B:an up-date[J].J Gastroenterol Hepatol, 2003, 18 (3) :239-245.

[22] 庄辉, 张文宏, 杨怀壹, 等.慢性乙型肝炎长期治疗的现实意义与抗病毒治疗的耐药管J型[N].中国医学论坛报, 2008-11-20 (D2) .

[23]卢银平, 董继华, 祝建芳, 等.新的抗病毒核苷类似物替比夫定体外对乙型肝炎病毒复制子的抑制作用[J].中国医院药学杂志, 2008, 28 (17) :1437-1439.

[24]Liaw YF, Gane E, Leung N, et al.2-Year GLOBE trial re-sults:telbivudine is superior to lamivudine in patients withchronic hepatitis B[J].Gastroenterology, 2009, 136 (2) :486-495.

[25] 贾继东, 侯金林, 尹有宽, 等.中国III期临床研究结果显示替比夫定治疗慢性乙肝疗效优于拉米夫定[N].中国医学论坛报, 2007-01-18 (A12) .

[26]Hoofnagle JH, Doo E, Liang TJ, et al.Management of hep-atitis B:summary of aclinical research workshop[J].Hepa-tology, 2007, 45 (4) :1056-1075.

[27]Hou J, Yin YK, Xu D, et al.Telbivudine versus lamivudine inChinese Patients with chronic hepatitis B:results at1 year ofarandomized, double-blind trial[J].Hepatology, 2008, 47 (2) :447-454.

[28]Tillmann HL, McHutchison JG.Telbivudine versus lamivudi-ne in patients with chronic hepatitis B[J].N Engl J Med, 2008, 358 (14) :1517-1518.

施引文献

资源附件(0)

访问统计