目的 比较替比夫定与拉米夫定对慢性乙型肝炎患者的疗效.方法 检索PUBMED、EMBASE、Web of Science、The Cochrane Central Register of Controlled Trials、中国期刊全文数据库、中国科技期刊数据库(维普)、万方数字化期刊全文数据库等有关替比夫定与拉米夫定治疗慢性乙型肝炎的临床随机对照试验,采用RevMan 4.2.10软件对入选试验进行Meta分析.结果 共7项随机对照试验包含2672例慢性乙肝患者符合入选标准.Meta分析结果显示:替比夫定组的HBV DNA阴转率、HBeAg消失率、HBeAg血清学转换率、治疗应答率均明显高于拉米夫定组,RR值分别为1.46(95%CI:1.35～1.57,P<0.00001)、1.28(95%CI:1.13～1.45,P=0.0001)、1.31(95%CI:1.14～1.52,P=0.0002)、1.31(95%CI:1.23～1.40,P<0.00001),而病毒耐药率和病毒学突破率则显著低于拉米夫定组,RR值分别为0.58(95%CI:0.48～O.69,P<0.00001)和0.52(95%CI:0.44～0.60,P<0.00001).替比夫定组的ALT复常率和一般药物不良反应率与拉米夫定组比较无统计学差异(RR=1.13,95%CI:0.99～1.27,P=0.06;RR=1.05,95%CI:1.00～1.11,P=0.07).替比夫定组肌酸激酶(CK)升高率高于拉米夫定组,RR值为3.26(95%CI:2.28～4.67,P<0.00001).结论 替比夫定可强效抑制乙肝病毒复制,对慢性乙型肝炎的疗效优于拉米夫定,且相对较为安全,但其引起CK值升高应予以注意.%Objective To evaluate the effect of telbivudine and lamivudine in the treatment of patients with chronic hepatitis B (CHB). Methods Correspondent data were retrieved form PUBMED, EMBASE. Web of Science. The Cochrane Central Register of Controlled Trials, Chinese Journals Full-text Database, Chinese Biomedical Database and Wan Fang Digital Journal Full-text database to collect clinical randomized controlled trials regarding the treatment of CHB by telbivudine and lamivudine. Statistical analysis was performed by Meta-analysis using Reiew Manager 4.2.10. Results Seven randomized controlled trials including 2672 CHB cases met the inclusion criteria. Meta-analysis showed that: a) Patients in telbivudine group had the higher rates of lowering of HBV DNA to undetectable levels,loss of HBeAg, HBeAg seroconversion, and therapeutic response as compared with those in lamivudine group, and the RR values were 1.46 (95％CI: 1.35-1.57, P＜0. 00001), 1.28 (95％CI: 1.13-1.45, P=0.0001), 1.31 (95％CI: 1.14-1.52, P=0.0002), and 1.31 (95％Cl:1.23-1.40, P＜0.00001) . respectively. But the rates of viral resistance and viral breakthrough were lower in telbivudine group than in lamivudine group, and the RR values were 0.58 (95％ CI: 0.48- 0.69, P＜0.00001) and 0.52 (95％CI: 0.44 - 0.60, P＜0.00001) , respectively. b) There were no significant differences between the two groups in the ALT normalization and nonspecific adverse events (RR=1.13, 95％ CI : 0.99-1.27, P=0.06; RR=1.05, 95％CI: 1.00-1.11, P=0.07). c) Elevated creatine kinase (CK) levels were more common in patients who received telbivudine as compared with those received lamivudine (RR=3.26, 95％CI: 2.28-4.67,P＜0.00001) . Conclusion Telbivudine shows a better effect and safety than lamivudine in the treatment of CHB. Telbivudine can inhibit the replication of HBV, but particular attention should be paid to the elevation of the CK value.
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