发生自然抗性突变天真慢性乙型肝炎患者的系统评价和荟萃

StephenW

Incidence of natural resistance mutations in naïve chronic hepatitis B patients: A systematic review and meta-analysis

    Qi Zhang†,
    Yun Liao†,
    Bei Cai,
    Yi Li,
    Lixin Li,
    Junlong Zhang,
    Yunfei An and
    Lanlan Wang*

Article first published online: 24 JAN 2015

DOI: 10.1111/jgh.12831

© 2014 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd

Issue
Journal of Gastroenterology and Hepatology
Journal of Gastroenterology and Hepatology

Volume 30, Issue 2, pages 252–261, February 2015
Article has an altmetric score of 1

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Author Information

    Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China

    †

    Qi Zhang and Yun Liao contributed equally to this work.

* Correspondence
Dr Lanlan Wang, Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China. Email: [email protected]

Issue
Journal of Gastroenterology and Hepatology

Volume 30, Issue 2, pages 252–261, February 2015
Article has an altmetric score of 1



Abstract
Background and Aim

Studies focused on the naturally occurring resistance mutation rate in treatment-naïve chronic hepatitis B (CHB) patients have set off a furious dispute. We conduct this meta-analysis to appraise the pooled incidence of spontaneous hepatitis B virus resistance mutations worldwide and its distribution.
Methods

We searched PubMed, EMBASE, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure until December 31, 2013. Cross-sectional or case-control studies reporting incidence of natural resistance mutations in untreated CHB patients were included. Pooled incidence was performed in fixed- or random-effects models, and heterogeneity among studies was assessed.
Results

A total of 106 studies were included involving 12 212 naive CHB patients. The summarized incidence of natural mutations worldwide was 5.73% (95% confidence interval [CI]: 4.85–6.61%), primary mutation rate 5.39% (95%CI: 4.54–6.24%), and secondary mutation rate 2.94% (95%CI: 1.59–4.29%). The pooled incidence reached up to 8.00% (95%CI: 6.63–9.38%) in China, higher than that in other countries (1.88% [95%CI: 1.06–2.69%]). Mutation rtM204V/I had the highest incidence of 4.89% (95%CI: 4.13–5.65%), and other primary mutations seldom spontaneously occurred. In subgroup analysis, genotype C hepatitis B virus infection, male, and hepatitis B antigen (HBeAg) negative patients had a slightly higher natural mutation rate.
Conclusion

The resistance mutations occurred frequently in untreated CHB patients, especially in China. The lamivudine resistance had the highest natural prevalence rate, while other nucleos(t)ide analogues showed rarely spontaneous resistance. Detecting the spontaneous resistance mutations will benefit the clinical management of CHB patients.

StephenW

发生自然抗性突变天真慢性乙型肝炎患者的系统评价和荟萃分析

    齐查嗯†，
    恽哩翱†，
    北蔡，
    易立
    李立新，
    俊龙张，
    云飞和一个
    兰兰王​​

文章首次在网上公布：2015年1月24日

DOI：10.1111 / jgh.12831

©2014年胃肠病学和肝病基金会和威利出版亚洲控股有限公司

问题
胃肠病学和肝病学
胃肠病学和肝病学

第30卷，第2期，页252-261，2015年2月
第二十有altmetric比分1

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作者信息

    检验医学，中国西部医院，四川大学，成都，中国的部

    †

    齐查嗯和恽哩聱同等贡献这项工作。

*通讯
兰兰王​​医生，检验医学，中国西部医院，四川大学，第37号国学巷，武侯区，成都610041，中国系。电子邮件：[email protected]

问题
胃肠病学和肝病学

第30卷，第2期，页252-261，2015年2月
第二十有altmetric比分1



抽象
背景和目的

研究治疗初治慢性乙型肝炎（CHB）患者主要集中在天然耐药突变率都掀起了激烈的争执。我们进行这项荟萃分析，以评估全球自发乙肝病毒耐药变异及其分布的集中发病。
方法：

我们检索PubMed，EMBASE，中国生物医学文献数据库，中国国家知识基础设施，直到12月31日，被列入报告自然抗性突变的未经处理的慢性乙型肝炎患者的发病率2013年横断面或病例对照研究。在固定或随机效应模型进行合并发生，研究的异质性进行了评估。
结果

共有106研究被列入，涉及12 212天真CHB患者。自然突变的发生总结了全球5.73％（95％置信区间[CI]：4.85-6.61％），主要的突变率5.39％（95％CI：4.54-6.24％），和二级突变率2.94％（95％ CI：1.59-4.29％）。汇集发病率达到了8.00％（95％CI：6.63-9.38％），在中国比其他国家高（1.88％[95％CI：1.06-2.69％]）。突变rtM204V / I有4.89％的发病率最高（95％CI：4.13-5.65％），以及其他主要的突变很少发生自发。在亚组分析中，C基因型乙肝病毒感染，男性，乙肝抗原（HBeAg）阴性患者有略高的自然突变率。
结论

电阻突变经常发生在未经治疗的慢性乙肝患者，特别是在中国。对拉米夫定耐药具有最高的自然发病率，而其他核苷（酸）类似物表现出很少的自发抵抗。检测自发耐药突变将有利于慢性乙型肝炎患者的临床管理。

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