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基于索非布韦的方案联合利巴韦林治疗肝移植后HCV基因1型肝炎受者的Meta分析

江啸 姜晓娟 苏锐良 任志俭 杨金伟 李玉民

江啸, 姜晓娟, 苏锐良, 等. 基于索非布韦的方案联合利巴韦林治疗肝移植后HCV基因1型肝炎受者的Meta分析[J]. 器官移植, 2019, 10(5): 570-577. doi: 10.3969/j.issn.1674-7445.2019.05.017
引用本文: 江啸, 姜晓娟, 苏锐良, 等. 基于索非布韦的方案联合利巴韦林治疗肝移植后HCV基因1型肝炎受者的Meta分析[J]. 器官移植, 2019, 10(5): 570-577. doi: 10.3969/j.issn.1674-7445.2019.05.017
Jiang Xiao, Jiang Xiaojuan, Su Ruiliang, et al. Sofosbuvir-based regimens combined with ribavirin for recipients with genotype 1 hepatitis C after liver transplantation: a Meta-analysis[J]. ORGAN TRANSPLANTATION, 2019, 10(5): 570-577. doi: 10.3969/j.issn.1674-7445.2019.05.017
Citation: Jiang Xiao, Jiang Xiaojuan, Su Ruiliang, et al. Sofosbuvir-based regimens combined with ribavirin for recipients with genotype 1 hepatitis C after liver transplantation: a Meta-analysis[J]. ORGAN TRANSPLANTATION, 2019, 10(5): 570-577. doi: 10.3969/j.issn.1674-7445.2019.05.017

基于索非布韦的方案联合利巴韦林治疗肝移植后HCV基因1型肝炎受者的Meta分析

doi: 10.3969/j.issn.1674-7445.2019.05.017
基金项目: 

国家自然科学基金面上项目 31770537

中央高校基本科研业务费 lzujbky-2018-kb13

详细信息
    作者简介:

    江啸,男,1989年生,硕士,研究方向为消化器官移植,Email:jiangx16@lzu.edu.cn

    通讯作者:

    李玉民,男,1962年生,博士,教授,研究方向为消化器官移植,Email:liym@lzu.edu.cn

  • 中图分类号: R617, R195.1

Sofosbuvir-based regimens combined with ribavirin for recipients with genotype 1 hepatitis C after liver transplantation: a Meta-analysis

More Information
  • 摘要:   目的  通过系统评价和Meta分析评估以索非布韦(SOF)为基础的直接抗病毒药物(DAAs)联合利巴韦林(RBV)(联合RBV)治疗肝移植术后丙型肝炎病毒(HCV)基因1型(GT1)肝炎受者能否获益。  方法  系统检索国内外多个数据库,根据标准筛选文献,并进行文献质量评价,提取数据。将文献按肝移植术后HCV-GT1肝炎受者接受联合RBV或只用SOF的DAAs不联合RBV(不联合RBV)治疗分为两组。采用Rev Man 5.3和R3.4.3软件对数据进行Meta分析。对治疗结束后12周持续病毒学应答(SVR12)的发生率进行评估。  结果  检索文献2 195篇,按纳入标准筛选共纳入6篇英文文献。Meta分析结果表明联合RBV组和不联合RBV组两组间SVR12的发生率差异无统计学意义(P=0.28),但是联合RBV组贫血的发生率明显增高(P < 0.01)。联合RBV或不联合RBV治疗方案对肝移植术后HCV-GT1a和HCV-GT1b两个亚型同样有效,两基因亚型间疗效差异无统计学意义(P=0.33)。将肝移植术后HCV-GT1肝炎受者的疗程从12周延长至24周的SVR率差异无统计学意义(P=0.95)。  结论  采用基于SOF的DAAs方案治疗肝移植术后HCV-GT1肝炎受者时,联合RBV不仅不能提高病毒的清除率,反而增加了受者发生贫血的风险,不能从中获益。

     

  • 图  1  文献的筛选流程

    Figure  1.  Process of literature screening

    图  2  文献[12]的风险偏倚评估

    Figure  2.  Risk bias assessment of reference [12]

    图  3  联合RBV组及不联合RBV组总的SVR12发生率

    Figure  3.  The overall rate of SVR12 in combined with RBV or not combined with RBV groups

    图  4  联合RBV组与不联合RBV组SVR12发生率的比较

    Figure  4.  Comparison of SVR12 rate of patients between combined with RBV or not combined with RBV groups

    图  5  Begg’s漏斗图

    SE为标准误,RR为相对危险度

    Figure  5.  Funnel diagram of Begg's

    图  6  联合RBV组与不联合RBV组间贫血发生率的比较

    Figure  6.  Comparison of the incidence of anemia of patients between combined with RBV and not combined with RBV groups

    图  7  联合RBV与不联合RBV方案对肝移植术后HCVGT1a与GT1b治疗效果的比较

    Figure  7.  Comparison of treatment effect in combined with RBV or not combined with RBV therapy between HCV-GT1a group and HCV-GT1b group

    图  8  联合RBV与不联合RBV方案对肝移植术后HCV-GT1肝炎患者治疗12周和24周治疗效果的比较

    Figure  8.  Comparison of treatment effect in combined with RBV or not combined with RBV therapy between 12 weeks group and 24 weeks group

    表  1  纳入文献的基本特征

    Table  1.   Basic characteristics of the included articles

    研究作者 年份 研究机构 国家 样本量(n 男性[n(%)] 年龄(岁) MINORS评分 HCV肝炎治疗史[n(%)] 治疗方案 疗程(周)
    O'Leary JG, et al[12] 2016 多中心 美国 46 34(74) 60(49~68)a 0(0) SOF+SMV±RBV 12或24
    Brown RS JR, et al[13] 2016 多中心 美国 151 112(74) 61(46~78)b 19 85(56) SOF+SMV±RBV 12或24
    Crittenden NE, et al[14] 2016 多中心 美国 56 42(75) 61(7)c 20 41(73) SOF+SMV±RBV 12
    Nair S, et al[15] 2017 单中心 美国 50 34(68) 56±7 18 30(60) SOF+SMV±RBV 12
    Saab S, et al[16] 2017 单中心 美国 85 57 (67) 63±9 19 39(46) SOF+LDV±RBV 12或24
    Pillai AA, et al[17] 2016 单中心 美国 57 43 (75) 58±6 19 24(42) SOF+SMV±RBV 12
    a中位数(极差),b均数(极差),c中位数(四分位数间距),SMV为西咪匹韦,LDV为雷迪帕韦,—表示无
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出版历程
  • 收稿日期:  2019-06-08
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-09-15

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