乙型肝炎病毒疫苗治疗慢性HBV感染的疗效：系统评价和荟萃

StephenW

Rev Med Virol. 2019 Dec 6:e2089. doi: 10.1002/rmv.2089. [Epub ahead of print]
Therapeutic efficacy of hepatitis B virus vaccine in treatment of chronic HBV infections: A systematic review and meta-analysis.
Ghozy S1,2, Nam NH2,3, Radwan I2,4, Karimzadeh S2,5, Tieu TM2,6, Hashan MR2,7, Abbas AS2,8, Eid PS2,4, Vuong NL2,9, Khang NV2,10, Elagabalawy E2,4, Kamal A11, Hoa PTL12, Huy NT13,14,15.
Author information

1
    Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt.
2
    Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.
3
    Department of General Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
4
    Faculty of Medicine, Ain Shams University, Cairo, Egypt.
5
    School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
6
    Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
7
    Respiratory and Enteric Infections Department, Infectious Disease Division, International Centre for Diarrheal Disease and Research, Dhaka, Bangladesh.
8
    Department of Anesthesia, Al-Ahrar Teaching Hospital, Zagazig, Egypt.
9
    Department of Medical Statistics and Informatics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
10
    Department of Neurology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
11
    Faculty of Medicine, Minia University, Minia, Egypt.
12
    Department of Infectious Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
13
    Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
14
    Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
15
    Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.

Abstract

There is a need for improved treatment of patients with chronic hepatitis B (CHB). We reviewed the literature to explore the efficacy of HB vaccines alone or in combination therapy (CT) with antiviral drugs in CHB patients and to meta-analyze data from randomized controlled trials. We conducted a systematic search in ten databases. All studies investigating the efficacy of HBV vaccine in HBV infected patients were included with no restrictions. Among 1359 studies initially identified, 23 studies (n = 1956 patients) were included for the final analysis. CT showed a significant reduction of HBV DNA compared with analogue monotherapy (AM) at the 12-month follow-up period (odds ratio (OR) = 2.835, 95% confidence interval (CI) [1.275, 6.306], p = .011). Additionally, CT also remarkably induce HbsAg loss in comparison with AM (OR = 11.736, 95% CI [1.841, 74.794], p = .009). Our pooled data revealed no difference between treatment and control regarding alanine aminotransferase normalization, HBeAg seroconversion, and HBeAg disappearance. In addition, CT using vaccine and NAs resulted in a statistically significant higher incidence of adverse effects than AM. The therapeutic effects of combination therapy for patients with CHB were encouraging, but future studies need to investigate all possible treatment combinations and assess their cost-effectiveness.

© 2019 John Wiley & Sons, Ltd.
KEYWORDS:

HBeAg loss; HBeAg seroconversion; analogue monotherapy; chronic hepatitis B; combination therapy; nucleotide analogues; vaccine monotherapy

PMID:
    31811678
DOI:
    10.1002/rmv.2089

StephenW

Rev Med Virol。 2019年12月6日：e2089。 doi：10.1002 / rmv.2089。 [Epub提前发布]
乙型肝炎病毒疫苗治疗慢性HBV感染的疗效：系统评价和荟萃分析。
Ghozy S1,2，Nam NH2,3，Radwan I2,4，Karimzadeh S2,5，Tieu TM2,6，Hashan MR2,7，Abbas AS2,8，Eid PS2,4，Vuong NL2,9，Khang NV2,10， Elagabalawy E2,4，Kamal A11，Hoa PTL12，Huy NT13、14、15。
作者信息

1个
    埃及吉萨，El Sheikh Zayed专科医院神经外科。
2
    日本长崎的Online Research Club（http://www.onlineresearchclub.org）。
3
    越南胡志明市胡志明市医药大学普通外科。
4
    埃及开罗艾因沙姆斯大学医学院。
5
    萨布扎瓦尔医科大学医学院，伊朗萨布泽瓦尔。
6
    麦克马斯特大学健康科学学院，加拿大安大略省汉密尔顿。
7
    孟加拉国达卡国际腹泻病和研究中心传染病科呼吸和肠感染科。
8
    埃及扎嘎兹格，Al-Alhrar教学医院麻醉科。
9
    越南胡志明市胡志明市医药大学医学统计与信息学系。
10
    越南胡志明市胡志明市医药大学神经病学系。
11
    埃及米尼亚的米尼亚大学医学院。
12
    越南胡志明市胡志明市医学院和药房大学传染病学系。
13
    越南胡志明市同德堂大学循证医学研究组。
14
    同德堂大学应用科学学院，越南胡志明市。
15
    长崎大学热带医学与全球健康学院热带医学研究所（NEKKEN）临床产品开发系，日本长崎。

抽象

需要改善对慢性乙型肝炎（CHB）患者的治疗。我们回顾了文献，以探讨单独或结合抗病毒药物联合治疗（CT）的HB疫苗在CHB患者中的疗效，并对来自随机对照试验的数据进行荟萃分析。我们在十个数据库中进行了系统的搜索。所有研究HBV疫苗对HBV感染患者疗效的研究均不受限制。在最初确定的1359项研究中，有23项研究（n = 1956例患者）被纳入最终分析。在12个月的随访期间，CT显示与模拟单一疗法（AM）相比，HBV DNA显着降低（优势比（OR）= 2.835，95％置信区间（CI）[1.275，6.306]，p = .011） ）。另外，与AM相比，CT还明显引起HbsAg丢失（OR = 11.736，95％CI [1.841，74.794]，p = .009）。我们的汇总数据显示，治疗和对照之间在丙氨酸氨基转移酶正常化，HBeAg血清转化和HBeAg消失方面没有差异。另外，使用疫苗和NA的CT导致的不良反应发生率在统计学上高于AM。联合治疗对CHB患者的治疗效果令人鼓舞，但未来的研究需要研究所有可能的治疗组合并评估其成本效益。

©2019 John Wiley＆Sons，Ltd.
关键字：

HBeAg丢失； HBeAg血清转化；模拟单一疗法慢性乙型肝炎联合疗法核苷酸类似物；疫苗单一疗法

PMID：
    31811678
DOI：
    10.1002 / rmv.2089

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