Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China.
PLoS One. 2013;8(1):e54773. doi: 10.1371/journal.pone.0054773. Epub 2013 Jan 28.
The effectiveness of nucleoside analogue on patients with chronic hepatitis B-associated liver failure is still controversial. To address this issue, we did a review of the literatures and analyzed the data with emphasis on the survival and reduction in serum HBV DNA level.
We searched 11 randomized controlled trials that included 654 patients with chronic hepatitis B-associated liver failure. 340 patients adopted nucleoside analogue, such as lamivudine (LAM), entecavir (ETV), telbivudine (LdT), or tenofovir disoproxil fumarate (TDF), and the remaining 314 patients adopted no nucleoside analogue or placebo. A meta-analysis was carried out to examine the survival, HBV e antigen serologic conversion, and reduction in serum HBV DNA level. The pooled odds ratio (OR) was used to reflect the treatment effects.
The overall analysis revealed nucleoside analogue significantly improved 1-month (OR = 2.10; 95% CI, [1.29, 3.41]; p = 0.003), 3-month (OR = 2.15; 95% CI, [1.26, 3.65]; p = 0.005), 12-month survival (OR = 4.62; 95% CI, [1.96, 10.89]; p = 0.0005). Comparison of 3-month HBV DNA showed significant reduction for adoptive nucleoside analogue patients (OR = 54.47; 95% CI, [16.37, 201.74]; p<0.00001). Comparison of 3-month HBV e antigen serologic conversion showed a highly significant improvement of HBV e antigen lost for patients received adoptive antiviral therapy (OR = 6.57; 95% CI, [1.64, 26.31]; p = 0.008).
The benefits of nucleoside analogue on patients with chronic hepatitis B-associated liver failure is significant for improving patient survival, HBV e antigen serologic conversion, and rapid reduction of HBV DNA levels.
核苷（酸）类似物治疗慢性乙型肝炎相关肝衰竭的疗效仍存在争议。为解决这一问题，我们对文献进行了综述，并重点分析了生存率和血清 HBV DNA 水平降低情况的数据。
我们检索了 11 项包含 654 例慢性乙型肝炎相关肝衰竭患者的随机对照试验。340 例患者接受核苷（酸）类似物治疗，如拉米夫定（LAM）、恩替卡韦（ETV）、替比夫定（LdT）或替诺福韦酯富马酸（TDF），其余 314 例患者未接受核苷（酸）类似物或安慰剂治疗。采用荟萃分析方法评估生存率、HBV e 抗原血清学转换和血清 HBV DNA 水平降低情况。采用合并优势比（OR）反映治疗效果。
总体分析显示，核苷（酸）类似物治疗显著提高了 1 个月（OR=2.10；95%CI，[1.29，3.41]；p=0.003）、3 个月（OR=2.15；95%CI，[1.26，3.65]；p=0.005）和 12 个月的生存率（OR=4.62；95%CI，[1.96，10.89]；p=0.0005）。采用核苷（酸）类似物治疗患者的 3 个月 HBV DNA 比较显示，HBV DNA 显著降低（OR=54.47；95%CI，[16.37，201.74]；p<0.00001）。采用核苷（酸）类似物治疗患者的 3 个月 HBV e 抗原血清学转换比较显示，HBV e 抗原丢失的患者有显著改善（OR=6.57；95%CI，[1.64，26.31]；p=0.008）。
核苷（酸）类似物治疗慢性乙型肝炎相关肝衰竭可显著提高患者生存率、HBV e 抗原血清学转换率，以及迅速降低 HBV DNA 水平。
