拉米夫定耐药的慢性乙型肝炎患者换用与加用阿德福韦疗效比较.doc

拉米夫定耐药的慢性乙型肝炎患者换用与加用阿德福韦疗效比较的Meta分析 程 凯，徐 珽，胡海波，唐 尧* 四川大学华西医院药剂科，成都 610041 摘要 目的：采用Meta分析方法比较拉米夫定耐药的CHB患者换用与加用阿德福韦的疗效。方法：采用Cochrane系统评价方法，检索Cochrane图书馆，Pubmed，CNKI及CBMdice等数据库。纳入拉米夫定耐药的CHB患者换用与加用阿德福韦的随机对照试验（RCT），并逐篇进行质量评价和资料提取。统计学分析采用RevMan 5.0软件处理。结果：共纳入16个RCT，患者1083例，分析结果显示：⑴加用ADV与直接换用ADV比较，在HBeAg转换率、HBeAg转阴率、HBV-DNA转阴率、ALT复常率四个方面，加用ADV均显示出优于换用ADV的疗效；⑵加用ADV与联用LAM和ADV1～3个月过渡后换用ADV的比较，在HBeAg转换率方面尚未达到统计学的差异，但在HBeAg转阴率、HBV-DNA转阴率、ALT复常率方面，试验组显示出明显优于对照组的疗效。结论：目前证据表明，LAM耐药患者加用ADV可以比换用ADV更好的控制乙肝病毒，减轻病毒对肝脏的损害。期待更多高质量、大样本的RCT，以提供更可靠的证据。 关键词 阿德福韦；拉米夫定；慢性乙型肝炎；Meta分析 【作者简介】程凯，男，临床药学硕士，电话e-mail：nedvedfsk@163.com 【通讯作者】唐尧，男，主任药师，电话：028Adefovir alone or in combination with lamivudine in patients with lamivudine resistant chronic hepatitis B: A Meta analysis Cheng Kai,Xu Ting,Hu Haibo,Tang Yao* Department of Pharmacy, Huaxi Hospital, Sichuan University, Chengdu 610041, China 【Abstract】Objective:To compare the effectiveness of adefovir alone or in combination with lamivudine in patients with lamivudine resistant chronic hepatitis B. Methods:We searched The Cochrane Library, PubMed, CBMdisc,and CNKI.Two authors collected data included randomized controlled trials that met the inclusion and exclusion criteria,evaluated the quality of those trials and performed the meta-analysis by RevMan 5.0. Results:16 studies involving 1083 participants were included,the results showed that:⑴Adding adefovir to lamivudine was more effective than swiching to adefovir directly in HBeAg seroconversion、HBeAg loss、HBV-DNA、ALT;⑵Adding adefovir to lamivudine was more effective than swiching to adefovir after 1～3 months adefovir in combination with lamivudine in HBeAg loss、HBV-DNA and ALT,but there was not significant diffenerce in HBeAg seroconversion.Conclusions:The current evidence shows adefovir in combination with lamivudine is more effective than adefovir alone in patients with lamivudine resistant chronic hepatitis B.More high quality clinical trials are expected for further