Shandong University, Shandong, 250100, China.
Department of Gastroenterology and Hepatology, Shandong Province Hospital Affiliated to Shandong University, Shandong, 250021, China.
Sci Rep. 2016 Sep 7;6:32722. doi: 10.1038/srep32722.
Evidence about the clinical effects of entecavir (ETV) for patients with hepatitis B decompensated cirrhosis remain controversial. Therefore, we perform this meta-analysis to assess the treatment outcomes of ETV in participants with hepatitis B decompensated cirrhosis. Relevant studies were identified by searching databases until the March 2016. A random-effects model was used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). GRADEprofiler3.6 was used to evaluate the quality of the evidence. A total of 26 studies (involving 2040 patients) were included. The quality of the evidence was classified from very low to high by the GRADED approach for all included RCTs. Meta-analysis showed that patients were more likely to experience HBV-DNA loss (RR:1.85, 95%CIs: 1.41 to 2.43, P < 0.0001 at 48 weeks), have normalized alanine aminotransferase levels (ALT) (P = 0.003 at 24 weeks, P = 0.02 at 48 weeks), and have a low mortality rate at 24 weeks (P = 0.003) when treated with ETV. There was no significant different between ETV and the control groups at the total mortality (P = 0.06) and HBeAg seroconversion (P = 0.14). In conclusion, ETV could be the first line therapy for patients with HBV related decompensated cirrhosis, because ETV could reduce the early mortality and move HBV DNA load down.
关于恩替卡韦（ETV）治疗乙型肝炎失代偿性肝硬化患者的临床疗效仍存在争议。因此，我们进行了这项荟萃分析，以评估 ETV 治疗乙型肝炎失代偿性肝硬化患者的治疗效果。通过检索数据库，直到 2016 年 3 月，我们确定了相关研究。使用随机效应模型来估计汇总相对风险（RR）和 95％置信区间（CI）。使用 GRADEprofiler3.6 评估证据质量。共纳入 26 项研究（涉及 2040 例患者）。根据 GRADED 方法，所有纳入的 RCT 均将证据质量分为极低到高。荟萃分析表明，患者更有可能经历 HBV-DNA 丢失（RR：1.85，95％CI：1.41 至 2.43，P<0.0001，48 周），丙氨酸氨基转移酶（ALT）水平正常化（P=0.003，24 周，P=0.02，48 周），并且在 24 周时死亡率较低（P=0.003），当使用 ETV 治疗时。在总死亡率（P=0.06）和 HBeAg 血清转换率（P=0.14）方面，ETV 与对照组之间没有显著差异。总之，ETV 可以作为乙型肝炎相关失代偿性肝硬化患者的一线治疗药物，因为 ETV 可以降低早期死亡率并降低 HBV DNA 载量。
