Clinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing, China.
Liver Research Center, Beijing Friendship Hospital, National Clinical Research Center of Digestive Diseases, Capital Medical University, Beijing, China.
Hepatol Int. 2022 Oct;16(5):1052-1063. doi: 10.1007/s12072-022-10369-w. Epub 2022 Sep 9.
The efficacy of nucleos(t)ide analogs (NAs) in non-cirrhotic chronic hepatitis B (CHB) patients is well-established. However, their impact on complications of portal hypertension in advanced chronic liver disease (ACLD) is less well characterized.
MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and abstracts of major international hepatology meetings were searched for publications from Jan 1, 1995 to Nov 30, 2021. Randomized control trials and observational studies reporting the efficacy of NAs in ACLD patients were eligible. Pooled risk ratios (RRs) for outcomes of interest were calculated with a random-effect or fixed-effect model, as appropriate.
Thirty-nine studies including 14,212 ACLD patients were included. NA treatment was associated with reduced risks of overall hepatic decompensation events (RR, 0.51; 95% confidence interval [CI]: 0.37-0.71), such as variceal bleeding (RR, 0.44; 95% CI: 0.26-0.74) and ascites (RR, 0.10; 95% CI: 0.01-1.59), on a trend-wise level. Moreover, the risks of hepatocellular carcinoma (HCC) (RR, 0.48; 95% CI: 0.30-0.75) and liver transplantation/death (RR, 0.36; 95% CI: 0.25-0.53) were also reduced by NA treatment and the first-line NAs were superior to non-first-line NAs in improving these outcomes (RR, 0.85; 95% CI: 0.75-0.97 and RR, 0.85; 95% CI: 0.73-0.99, respectively).
NA therapy lowers the risk of portal hypertension-related complications, including variceal bleeding, HCC, and liver transplantation/death.
核苷（酸）类似物（NAs）在非肝硬化慢性乙型肝炎（CHB）患者中的疗效已得到充分证实。然而，它们对晚期慢性肝病（ACLD）中门脉高压并发症的影响尚未得到充分描述。
检索 1995 年 1 月 1 日至 2021 年 11 月 30 日期间 MEDLINE/PubMed、EMBASE、Web of Science、Cochrane 对照试验中心注册库和主要国际肝脏病学会议摘要中的文献，纳入报道 NAs 在 ACLD 患者中的疗效的随机对照试验和观察性研究。采用随机效应或固定效应模型，计算感兴趣结局的汇总风险比（RR）。
共纳入 39 项研究，包括 14212 例 ACLD 患者。NA 治疗与总体肝脏失代偿事件（RR，0.51；95%置信区间 [CI]：0.37-0.71）风险降低相关，如静脉曲张出血（RR，0.44；95%CI：0.26-0.74）和腹水（RR，0.10；95%CI：0.01-1.59），呈趋势性降低。此外，NA 治疗还降低了肝细胞癌（HCC）（RR，0.48；95%CI：0.30-0.75）和肝移植/死亡（RR，0.36；95%CI：0.25-0.53）的风险，一线 NAs 在改善这些结局方面优于非一线 NAs（RR，0.85；95%CI：0.75-0.97 和 RR，0.85；95%CI：0.73-0.99）。
NA 治疗可降低门脉高压相关并发症的风险，包括静脉曲张出血、HCC 和肝移植/死亡。
