系统评价和荟萃分析：抗病毒治疗对晚期慢性肝病 HBV 患者门

StephenW

系统评价和荟萃分析：抗病毒治疗对晚期慢性肝病 HBV 患者门脉高压并发症的影响

    孔媛媛、吕婷婷、李敏、赵良辉、孟彤彤、吴珊珊、魏薇、张倩、陈沙、游红、Sabela Lens、Hitoshi Yoshiji、Sven Francque、Emmanouil Tsochatzis、Shiv K. Sarin、Mattias Mandorfer、 Jidong Jia 代表 BAVENO 合作：EASL 财团

Hepatology International 第 16 卷，第 1052–1063 页（2022 年）引用这篇文章

    147 次访问

    5 高度计

    指标详情

抽象的
背景

核苷（酸）类似物（NAs）在非肝硬化慢性乙型肝炎（CHB）患者中的疗效是公认的。然而，它们对晚期慢性肝病 (ACLD) 门静脉高压并发症的影响尚不清楚。
方法

检索了 1995 年 1 月 1 日至 2021 年 11 月 30 日期间的 MEDLINE/PubMed、EMBASE、Web of Science、Cochrane Central Register of Controlled Trials 和主要国际肝病学会议的摘要。随机对照试验和观察性研究报告了 NAs 的疗效ACLD 患者符合条件。酌情使用随机效应或固定效应模型计算感兴趣结果的汇总风险比 (RR)。
结果

纳入了 39 项研究，包括 14,212 名 ACLD 患者。 NA 治疗与总体肝功能失代偿事件风险降低相关（RR，0.51；95% 置信区间 [CI]：0.37-0.71），例如静脉曲张出血（RR，0.44；95% CI：0.26-0.74）和腹水（ RR，0.10；95% CI：0.01–1.59），在趋势水平上。此外，NA 治疗也降低了肝细胞癌 (HCC) (RR, 0.48; 95% CI: 0.30–0.75) 和肝移植/死亡 (RR, 0.36; 95% CI: 0.25–0.53) 的风险。在改善这些结果方面，一线 NA 优于非一线 NA（RR，0.85；95% CI：0.75-0.97 和 RR，0.85；95% CI：0.73-0.99）。
结论

NA 治疗可降低门静脉高压相关并发症的风险，包括静脉曲张出血、HCC 和肝移植/死亡。

StephenW

Systematic review and meta-analysis: impact of anti-viral therapy on portal hypertensive complications in HBV patients with advanced chronic liver disease

    Yuanyuan Kong, Tingting Lv, Min Li, Lianghui Zhao, Tongtong Meng, Shanshan Wu, Wei Wei, Qian Zhang, Sha Chen, Hong You, Sabela Lens, Hitoshi Yoshiji, Sven Francque, Emmanouil Tsochatzis, Shiv K. Sarin, Mattias Mandorfer, Jidong Jia on behalf of the BAVENO Cooperation: an EASL consortium

Hepatology International volume 16, pages 1052–1063 (2022)Cite this article

    147 Accesses

    5 Altmetric

    Metrics details

Abstract
Background

The efficacy of nucleos(t)ide analogs (NAs) in non-cirrhotic chronic hepatitis B (CHB) patients is well-established. However, their impact on complications of portal hypertension in advanced chronic liver disease (ACLD) is less well characterized.
Methods

MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and abstracts of major international hepatology meetings were searched for publications from Jan 1, 1995 to Nov 30, 2021. Randomized control trials and observational studies reporting the efficacy of NAs in ACLD patients were eligible. Pooled risk ratios (RRs) for outcomes of interest were calculated with a random-effect or fixed-effect model, as appropriate.
Results

Thirty-nine studies including 14,212 ACLD patients were included. NA treatment was associated with reduced risks of overall hepatic decompensation events (RR, 0.51; 95% confidence interval [CI]: 0.37–0.71), such as variceal bleeding (RR, 0.44; 95% CI: 0.26–0.74) and ascites (RR, 0.10; 95% CI: 0.01–1.59), on a trend-wise level. Moreover, the risks of hepatocellular carcinoma (HCC) (RR, 0.48; 95% CI: 0.30–0.75) and liver transplantation/death (RR, 0.36; 95% CI: 0.25–0.53) were also reduced by NA treatment and the first-line NAs were superior to non-first-line NAs in improving these outcomes (RR, 0.85; 95% CI: 0.75–0.97 and RR, 0.85; 95% CI: 0.73–0.99, respectively).
Conclusion

NA therapy lowers the risk of portal hypertension-related complications, including variceal bleeding, HCC, and liver transplantation/death.