0088 拉米夫定耐药慢性乙型肝炎患者换用和加用阿德福韦疗效比较.docVIP

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： HYPERLINK mailto:nedvedfsk@163.com 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 cli