论文部分内容阅读
目的:运用循证医学的方法,将苦参素联合拉米夫定对比单纯苦参素治疗慢性乙型肝炎患者HBe Ag阴转、HBe Ag血清转换率、HBV-DNA阴转及YMDD变异率进行分析。方法:收集CNKI、CBM、维普、万方、Pubmed数据库(2015年11月以前)苦参素联合拉米夫定对比单纯苦参素干预慢性乙型肝炎的临床RCT试验资料,用Cochrane系统评价的方法对文章的偏倚进行评价。利用Rev Man 5.3软件对结果的总体效应进行分析。结果:一共纳入9篇文献,Meta分析结果示:苦参素联合拉米夫定与苦参素相比,HBe Ag阴转率:RR=2.00,95%Cl为[1.37,2.93](P=0.000 4),苦参素联合拉米夫定疗效是苦参素组的2倍。HBe Ag血清转换率:RR=2.24,95%Cl为[1.56,3.21](P<0.000 1),苦参素联合拉米夫定疗效是苦参素组的2.24倍。HBV DNA阴转率:RR=1.76,95%Cl为[1.24,2.50](P=0.002),苦参素联合拉米夫定比苦参素干预增加了76%的HBV DNA阴转率。YMDD:RR=4,95%Cl为[0.46,34.54],无统计学意义(P=0.21),苦参素联合拉米夫定组和苦参素组无明显差别。结论:苦参素联合拉米夫定在改善HBe Ag阴转率、HBe Ag血清转换率、HBV-DNA阴转率较好,且未使YMDD基序变异率增加,但纳入文献质量不高,需高质量大样本的随机对照三盲试验支持。
OBJECTIVE: To evaluate the efficacy of oxymatrine combined with lamivudine in the treatment of chronic hepatitis B patients with HBe Ag overcast, HBeAg seroconversion, HBV-DNA overcast and YMDD mutation rate using evidence-based medicine analysis. Methods: The clinical RCT data of CNKI, CBM, VIP, Wanfang and Pubmed databases (before Nov. 2015) comparing with oxymatrine and lamivudine alone in the treatment of chronic hepatitis B were collected and evaluated by Cochrane systematic evaluation Method to evaluate the bias of the article. Rev Man 5.3 software was used to analyze the overall effect of the results. Results: A total of 9 articles were included in the meta-analysis. Meta analysis showed that the ratio of negative conversion of HBeAg to oxymatrine plus lamivudine was (RR = 2.00, 95% Cl [1.37,2.93], P = 0.000 4), matrine combined with lamivudine efficacy is 2 times the oxymatrine group. HBeAg seroconversion rate: RR = 2.24, 95% Cl [1.56,3.21] (P <0.0001), the effect of oxymatrine combined with lamivudine is 2.24 times that of the oxymatrine group. HBV DNA negative conversion rate: RR = 1.76, 95% Cl [1.24,2.50] (P = 0.002). Oxymatrine combined with lamivudine increased the negative rate of HBV DNA by 76% when treated with oxymatrine. YMDD: RR = 4, 95% Cl was [0.46,34.54], no statistical significance (P = 0.21). There was no significant difference between oxymatrine and lamivudine groups. Conclusion: Oxymatrine combined with lamivudine can improve the rate of HBeAg negative conversion, HBeAg seroconversion rate and HBV-DNA negative conversion rate without increasing the mutation rate of YMDD motif. However, Need for high-quality large-scale randomized controlled triple-blind trial support.