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目的:评估与比较抗乙型肝炎病毒(HBV)药物替比夫定(LDT)和阿德福韦酯(ADV)治疗HBeAg阳性慢性乙型肝炎(CHB)的疗效及安全性。方法:检索2007年1月—2014年7月Medline、PubMed、中国生物医学文献数据库、中国期刊全文数据库等公开发表与研究目的相关的随机对照试验(RCT)等文献,采用RevMan 5.0软件进行Meta分析。结果:共检索到文献285篇,经初选纳入19篇,根据纳入标准与排除标准,共入选8篇,纳入患者856例,其中LDT治疗400例,ADV治疗456例。评估显示,LDT比ADV更能非常显著提高HBeAg阳性CHB患者的HBV DNA转阴率、HBeAg血清转换率、HBeAg血清转阴率、ALT复常率和完全应答率(P<0.01);两药不良事件发生率差异不显著(P>0.05)。结论:LDT治疗HBeAg阳性CHB的疗效在HBV DNA转阴率、HBeAg血清转换率、HBeAg血清转阴率、ALT复常率和完全应答率方面优于ADV,且较安全。
Objective: To evaluate and compare the efficacy and safety of anti-hepatitis B virus (HBV) drug telbivudine (LDT) and adefovir dipivoxil (ADV) in the treatment of HBeAg-positive chronic hepatitis B (CHB). Methods: The published literature about randomized controlled trials (RCTs) related to the purpose of research such as Medline, PubMed, Chinese Biomedical Literature Database and Chinese Periodical Full-text Database from January 2007 to July 2014 were searched by Meta-analysis using RevMan 5.0 software . Results: A total of 285 articles were retrieved and 19 were selected by primary selection. According to inclusion criteria and exclusion criteria, a total of 8 articles were enrolled in this study. A total of 856 patients were enrolled, of which 400 were LDT and 456 were ADV. Assessments showed that LDT significantly improved the rate of HBV DNA negative conversion, HBeAg seroconversion, HBeAg seroconversion, ALT normalization and complete response (P <0.01) in HBeAg-positive CHB patients compared with ADV; There was no significant difference in the incidence of events (P> 0.05). Conclusion: The efficacy of LDT in the treatment of HBeAg-positive CHB is superior to ADV in HBV DNA negative rate, HBeAg seroconversion rate, HBeAg seroconversion rate, ALT normalization rate and complete response rate.