摘要
目的 系统评价富马酸丙酚替诺福韦(TAF)在抗HBV或HIV治疗中对血脂及体重的影响。方法 以富马酸丙酚替诺福韦、替诺福韦、随机对照试验为中文检索词,Tenofovir alafenamide fumarate、 tenofovir、Randomised Controlled trials为英文检索词在相关数据库检索,截至2021年12月1日。根据纳入排除标准筛选文献,应用Cochrane偏倚风险工具对文献质量进行评估,采用RevMan 5.3进行Meta分析,评估TAF对TC、LDL-C、HDL-C和TG水平和血脂异常事件(LDL-C>190 mg/dL和TC>300 mg/dL)发生率以及体重增加事件的影响。结果 共纳入17篇符合条件的文献,总计15 515例患者。Meta分析表明,相比对照组,TAF组LDL-C>190 mg/dL和TC>300 mg/dL的发生率高于对照组(RR=3.61,95%CI:2.6~5.03,P<0.000 01)(RR=3.38,95%CI:1.6~7.11,P=0.000 1)。TAF剂量和用药疗程的亚组分析结果表明,TAF为10 mg、25 mg,以及TAF治疗48w、96w均可引起LDL异常率增加。TAF治疗后血脂谱水平与对照组比较明显升高,TC(17.29 mg/dL vs. 3.68 mg/dL,P=0.008),LDL-C(13.13 mg/dL vs.3.19 mg/dL,P=0.007),HDL-C (3.37 mg/dL vs. 0.83 mg/dL,P=0.04), TG(13.41 mg/dL vs. 2.00 mg/dL,P=0.04)。与对照组相比,TAF组治疗后体重增加无显著变化(P=0.39),但有体重增加的趋势。结论 TAF使用过程中,可引起TC和LDL-C异常率增加、血脂谱水平升高以及出现体重增加的趋势。
Objective To systematically evaluate the effects of Tenofovir alafenamide fumarate(TAF) on blood lipid and body weight during antiviral therapy for hepatitis B virus(HBV) or human immunodeficiency virus(HIV) infection.Methods Tenofovir alafenamide fumarate, Tenofovir, and Randomized Controlled Trials as Chinese and English search terms retrieved in related databases. Literature was screened according to inclusion and exclusion criteria. The Cochrane risk of bias tool was used to evaluate literature quality. And RevMan 5.3 was used for meta-analysis to evaluate the effect of TAF antiviral therapy on the incidence of total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), highdensity lipoprotein cholesterol(HDL-C) and triglyceride(TG), dyslipidemia events(LDL>190 mg/dL and TC>300 mg/dL) and body weight events. Results A total of 15515 patients were included in 17 eligible publications. The metaanalysis showed that the incidence of LDL>190 mg/dL and TC>300 mg/dL was higher in the TAF group than in the control group(RR=3.61, 95%CI: 2.6-5.03, P<0.00001)(RR=3.38, 95%CI: 1.6-7.11, P=0.0001). The subgroup analysis of TAF dose and TAF treatment course showed that TAF of 10 mg and 25 mg, as well as TAF treatment of 48 weeks and 96weeks, could lead to an increase in the incidence rate of LDL abnormalities. Serum lipid profile increased significantly after TAF treatment, TC(17.29 mg/dL in the treatment group vs. 3.68 mg/dL control group, P=0.008), LDL-C(13.13 mg/dL in the treatment group vs. 3.19 mg/dL in the control group, P=0.007), HDL-C(3.37 mg/dL in the treatment group vs. 0.83 mg/dL in the control group, P=0.04), and TG(13.41 mg/dL in the treatment group vs. 2.00 mg/dL in the control group, P=0.04). There was no significant weight gain after TAF treatment but with an increasing trend. Conclusions TAF can lead to a trend of an increase in the incidence rate of TC andLDL abnormalities, and an increase in blood lipid levels and body weight during the treatment course of antiviral therapy.
作者
赵文娟
刘昳
李佳韵
崔滋欣
魏佩瑶
李建州
陈云茹
叶峰
ZHAO Wenjuan;LIU Yi;LI Jiayun;CUI Zixin;WEI Peiyao;LI Jianzhou;CHEN Yunru;YE Feng(The First Affiliated Hospital of Xian Jiaotong University,Xi'an 710061,China)
出处
《中国艾滋病性病》
CAS
CSCD
北大核心
2023年第2期238-244,共7页
Chinese Journal of Aids & STD
基金
中医药传承创新暨“秦药”开发重点科学研究项目
陕西省自然科学基础研究计划面上项目(2020JM-399)
西安交通大学第一附属医院临床研究项目(XJTU1AF-CRF-2020-018)。
