本文選題：核苷(酸)類似物　切入點：干擾素　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:比較核苷(酸)類似物(NAs)與干擾素(IFN)序貫治療與NAs單藥治療對慢性乙型肝炎(CHB)患者的療效,并進一步探索該三階段治療方法(經(jīng)NAs初治,過渡期短暫聯(lián)合IFN,IFN單藥治療)的最佳治療方案。方法:采用RevMan5.3軟件對納入的24篇國內(nèi)外隨機對照試驗及隊列研究進行meta分析,分析治療結(jié)束時及隨訪時ALT復(fù)常率、HBV DNA轉(zhuǎn)陰率、HBe Ag轉(zhuǎn)陰率、HBe Ag轉(zhuǎn)換率、HBsAg轉(zhuǎn)陰率、HBsAg轉(zhuǎn)換率,并進行不同治療方案下各項指標的亞組分析。結(jié)果:1、治療結(jié)束時序貫治療組的ALT復(fù)常率、HBV DNA轉(zhuǎn)陰率、HBeAg轉(zhuǎn)陰率、HBe Ag轉(zhuǎn)換率、HBsAg轉(zhuǎn)陰率、HBsAg轉(zhuǎn)換率分別為83.9%、78.4%、47.2%、41.6%、9.1%和5.6%,均高于單藥治療組68.6%、67.3%、26.8%、17.3%、0%和0%(P0.05)。2、根據(jù)NAs用藥不同(ETV或LAM)行亞組分析發(fā)現(xiàn),兩亞組間ALT復(fù)常率和HBV DNA轉(zhuǎn)陰率上差異有統(tǒng)計學(xué)意義,ETV組ALT復(fù)常率(92.1%)高于LAM組(85.7%),HBV DNA轉(zhuǎn)陰率(78.9%)則略低于LAM組(79.0%),且差異均有統(tǒng)計學(xué)意義(P0.05)。3、根據(jù)IFN用藥不同(COM IFN或PEG IFN)行亞組分析發(fā)現(xiàn),ALT復(fù)常率在兩亞組間差異有統(tǒng)計學(xué)意義(P0.05),PEG IFN組(64.7%)低于COM IFN組(86.5%)。進一步根據(jù)IFN治療時間不同(≥48周和48周)行亞組分析后提示,兩亞組間差異無統(tǒng)計學(xué)意義。4、余各項指標在不同的亞組內(nèi)均提示,HBeAg轉(zhuǎn)陰率、HBeAg轉(zhuǎn)換率在序貫治療組較單藥組有優(yōu)勢。5、治療結(jié)束時ALT復(fù)常率、HBV DNA轉(zhuǎn)陰率、HBeAg轉(zhuǎn)陰率分別為84.4%、81.9%和85.0%,均高于隨訪時74.1%、63.1%和50%(P0.05),HBeAg轉(zhuǎn)換率在前者(48.8%)高于后者(47.4%),但差異無統(tǒng)計學(xué)意義(P0.05)。治療結(jié)束時HBsAg轉(zhuǎn)陰率和HBsAg轉(zhuǎn)換率(10.6%、8.3%)均低于隨訪時[(12.3%、10.3%),P0.05]。6、根據(jù)IFN用藥時間不同(≥48周和48周)行亞組分析后提示,在IFN用藥時間48周組,ALT復(fù)常率和HBV DNA轉(zhuǎn)陰率在治療結(jié)束時明顯高于隨訪時(84.4%vs 73.1%,81.0%vs 63.4%),差異有統(tǒng)計學(xué)意義(P0.05),余指標在兩亞組內(nèi)差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1、治療結(jié)束時,序貫用藥組在ALT復(fù)常率、HBV DNA轉(zhuǎn)陰率、HBe Ag轉(zhuǎn)陰率、HBe Ag轉(zhuǎn)換率、HBsAg轉(zhuǎn)陰率、HBsAg轉(zhuǎn)換率方面均優(yōu)于NAs單藥治療組。2、IFN治療時間48周時,在停藥后隨訪時其ALT復(fù)常率和HBV DNA轉(zhuǎn)陰率均低于治療結(jié)束時,因此考慮長期停藥有導(dǎo)致HBV復(fù)發(fā)的可能。3、IFN治療時間≥48周時,既往應(yīng)用ETV或LAM經(jīng)治的患者序貫IFN治療后停藥24周是安全可行的,但仍需長期隨訪觀察。
[Abstract]:Objective: to compare the efficacy of sequential treatment of nucleoside (acid) analogue with interferon (IFN) in patients with chronic hepatitis B (CHB), and to explore the three stages of treatment (initial treatment via NAs).Short transition period combined with IFNN IFN monotherapy) is the best treatment.Methods: RevMan5.3 software was used to analyze 24 randomized controlled trials and cohort studies at home and abroad. At the end of the treatment and follow-up, the ALT conversion rate and the HBe Ag conversion rate were analyzed. The HBe Ag conversion rate and the HBe Ag conversion rate were analyzed.The subgroup analysis of the indexes under different treatment schemes was carried out.The results of subgroup analysis showed that the recovery rate of alt in the two subgroups was significantly lower than that in the COM IFN group (P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05%, P 0.05).Further subgroup analysis showed that according to the time of IFN treatment (鈮，

本文編號：1722208