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目的评价核苷(酸)类似物长期治疗失代偿期乙型肝炎(乙肝)肝硬化的效果。方法根据制定的检索策略收集核苷(酸)类似物长期治疗失代偿期乙肝肝硬化的临床对照研究,以Jadad和NOS评分量表进行文献质量评价,在Meta分析中应用异质性检验、敏感性分析、亚组分析、漏斗图分析等方法处理相关数据。检索时间选取1997年1月至2015年12月。结果共纳入9篇文献,患者总数为802例。Meta分析显示,与对照组相比,治疗组病死率[RR=0.32,95%CI(0.23,0.42),P=0.000]、肝癌发生率[RR=0.33,95%CI(0.19,0.58),P=0.000]、ChildPugh评分[MD=-3.10,95%CI(-4.53,-1.68),P=0.000]显著降低,丙氨酸氨基转移酶(ALT)[MD=-65.26U/L,95%CI(-104.33,-26.49)U/L,P=0.001]、血清总胆红素(TBIL)[MD=-36.87μmol/L,95%CI(-51.94,-21.80)μmol/L,P=0.000]明显降低,而血清白蛋白(ALB)[MD=8.16 g/L,95%CI(5.99,10.33)g/L,P=0.000]明显升高,两组间差异有统计学意义;治疗组HBV-DNA转阴率[RR=5.57,95%CI(2.71,11.47),P=0.000]、HBe Ag转阴率[RR=3.54,95%CI(1.27,9.89),P=0.020]、HBe Ag血清转换率[RR=6.74,95%CI(1.31,34.73),P=0.020]显著升高,两组间差异有统计学意义。结论核苷(酸)类似物长期治疗失代偿期乙肝肝硬化能使患者的病死率、肝癌发生率和Child-Pugh评分明显降低,同时能使ALT、TBIL、ALB等肝功能指标和HBV-DNA转阴率、HBe Ag转阴率、HBe Ag血清学转换率等病毒学指标明显改善。
Objective To evaluate the long-term effect of nucleoside (acid) analogues on decompensated hepatitis B (HBV) cirrhosis. Methods A controlled clinical study was conducted to collect long-term treatment of decompensated hepatitis B in patients with nucleoside (acid) analogues according to the search strategy. The quality of literature was evaluated by Jadad and NOS scale. Meta-analysis was used to test the heterogeneity of hepatitis B Sensitivity analysis, sub-group analysis, funnel analysis and other methods to deal with the relevant data. Retrieval time selected from January 1997 to December 2015. Results A total of 9 articles were included, with a total of 802 patients. Meta-analysis showed that the mortality of the treatment group [RR = 0.32, 95% CI (0.23, 0.42), P = 0.000], the incidence of liver cancer [RR = 0.33, 95% CI P = 0.000], ChildPugh score [MD = -3.10, 95% CI (-4.53, -1.68), P = 0.000] % CI (-104.33, -26.49) U / L, P = 0.001], serum TBIL [MD = -36.87μmol / L, 95% CI (-51.94, -21.80) μmol / L, P = 0.000], but the serum albumin (ALB) was significantly higher in the two groups (MD = 8.16 g / L, 95% CI 5.99,10.33 g / L, P = 0.000] The negative rates of HBV DNA in the treatment group (RR = 5.57,95% CI 2.71,11.47, P = 0.000], HBeAg negative rates [RR = 3.54,95% CI 1.27,9.89, P = 0.020] , HBeAg seroconversion rate [RR = 6.74,95% CI (1.31,34.73), P = 0.020] was significantly higher, the difference between the two groups was statistically significant. Conclusion Long-term treatment of decompensated hepatitis B with nucleos (s) analogues can significantly reduce the incidence of liver cancer and Child-Pugh scores, as well as liver function indicators such as ALT, TBIL and ALB and HBV- DNA negative rate, HBeAg negative rate, HBeAg serological conversion rate and other virological indicators significantly improved.