阿德福韦酯、恩替卡韦单用及拉米夫定联合阿德福韦酯三种方法治疗耐拉米夫定慢性乙型肝炎患者的评价

摘要

目的 比较阿德福韦酯、恩替卡韦单用及拉米夫定联合阿德福韦酯三种方法治疗拉米夫定耐药慢性乙型肝炎的效果.方法 计算机检索2010年7月以前在PubMed、Embase、CNKI等全文数据库公开发表的有关阿德福韦酯单用(剂量10 mg/d)、恩替卡韦单用(剂量1 mg/d)及拉米夫定(剂量100 mg/d)联合阿德福韦酯(剂量10 mg/d)治疗拉米夫定耐药慢性乙型肝炎(疗程≥ 48周)的随机对照临床研究,按照纳入与排除标准由2名研究者独立检索并提取资料,采用RevMan 4.2软件进行Meta分析.χ2检验分析研究间的异质性,以相对危险度为疗效分析统计量进行合并分析并绘制森林图.疗效判定指标为血清HBV DNA检测不到率(阴转率).结果 阿德福韦酯单用与恩替卡韦单用对拉米夫定耐药株的48周疗效差异有统计学意义(Z= 2.26,P= 0.02),相对危险度的95%置信区间为0.51～0.9;拉米夫定联合阿德福韦酯与恩替卡韦单用对拉米夫定耐药株的48周疗效差异无统计学意义(P= 0.25).结论 恩替卡韦单用治疗拉米夫定耐药患者的疗效优于阿德福韦酯单用,但拉米夫定联合阿德福韦酯与恩替卡韦单用对拉米夫定耐药慢性乙型肝炎患者的疗效相似.%Objective To evaluate the efficacy of adefovir dipivoxil monotherapy,entecavir monotherapy and lamivudine plus adefovir dipivoxil in lamivudine-refractory patients with chronic hepatitis B. Methods Chinese and English articles published in PUBMED ,EMBASE, CNKI before July 2010 about comparison of efficacy adefovir dipivoxil monotherapy, entecavir monotherapy and lamivudine plus adefovir dipivoxil in lamivudine-refractory patients with chronic hepatitis B were searched. The dosage of lamivudine,adefovir dipivoxil and entecavir were 100 mg/d, 10mg/d and 1 mg/d respectively, with continuing time all last over 48 weeks. Heterogeneity was examined by Chi-square test,the relative risk was calculated and forest-plot was drawn The evaluated index was the rate of undetected serum HBV DNA. Results The rate of undetected serum HBV DNA in 48 weeks in the group of adefovir dipivoxil monotherapy was lower than that in the group of entecavir monotherapy ( Z = 2. 26 ,P = 0. 02 ), and the confidence interval of relative risk was 0. 51 ～ 0. 95 ,however,there was no significant differece in the rates of undetected serum HBV DNA ( P =0. 25 ) in 48 weeks between the group of lamivudine plus adefovir dipivoxil and the group of entecavir mono-therapy. Conclusion Entecavir monotherapy is superior to adofovir dipivoxil monotherapy in decreasing serum HBV DNA in lamivudine-refractory patients with chronic hepatitis B,but the efficacy between lamivudine plus adefovir dipivoxil and entecavir monotherapy for lamivudine-refractory patients with chronic hepatitis B is similar.