摘要
目的系统评价慢性乙型肝炎(CHB)患者低病毒血症(LLV)的发生率及其影响因素,为临床有效干预和预防LLV的发生提供循证医学证据。方法本研究根据PRISMA指南完成,PROSPERO注册号:CRD42023455304。计算机检索中国知网、万方数据库、维普、中国生物医学文献服务系统、PubMed、Embase、Web of Science、Cochrane Library中有关CHB患者LLV发生及影响因素的观察性研究,检索时间为建库至2023年7月21日。应用Stata 16.0软件进行Meta分析。结果共纳入文献12篇,总样本量3408例,包括LLV患者1181例。Meta分析结果显示,经治CHB患者LLV发生率为32.8%(95%CI:27.6%~38.3%);HBsAg定量高(OR=2.107,95%CI:1.782~2.491,P<0.001)、HBeAg阳性(OR=3.258,95%CI:2.629~4.038,P<0.001)、高基线HBV DNA水平(OR=1.286,95%CI:1.157~1.430,P<0.001)及有恩替卡韦治疗史(OR=3.089,95%CI:1.880~5.074,P<0.001)是LLV发生的危险因素;抗病毒时间≥3年(OR=0.175,95%CI:0.093~0.331,P<0.001)和高基线ALT水平(OR=0.985,95%CI:0.978~0.992,P<0.001)是LLV的保护因素。敏感性分析显示效应值未发生明显变化,提示Meta分析结果相对稳定。纳入研究漏斗图基本对称,Egger’s检验和Begg’s检验结果提示纳入文献不存在明显发表偏倚。结论临床医生应根据LLV的影响因素,综合临床证据有效指导决策,降低远期临床风险,避免不良结局。
Objective To systematically evaluate the incidence rate of low-level viremia(LLV)in chronic hepatitis B(CHB)patients and related influencing factors,and to provide evidence-based medicine evidence for effective intervention and prevention of LLV in clinical practice.Methods This study was conducted according to the PRISMA guideline,with a PROSPERO registration number of CRD42023455304.CNKI,Wanfang Data,VIP,SinoMed,PubMed,Embase,Web of Science,and the Cochrane library were searched for observational studies on LLV and related influencing factors in CHB patients published up to July 21,2023.Stata 16.0 software was used to perform the meta-analysis.Results A total of 12 articles were included,with a total sample size of 3408 cases,among whom there were 1181 patients with LLV.The meta-analysis showed that the incidence rate of LLV was 32.8%(95%confidence interval[CI]:27.6%—38.3%)in treatment-experienced CHB patients.High HBsAg quantification(odds ratio[OR]=2.107,95%CI:1.782—2.491,P<0.001),positive HBeAg(OR=3.258,95%CI:2.629—4.038,P<0.001),high HBV DNA level at baseline(OR=1.286,95%CI:1.157—1.430,P<0.001),and history of entecavir treatment(OR=3.089,95%CI:1.880—5.074,P<0.001)were risk factors for LLV;duration of antiviral therapy≥3 years(OR=0.175,95%CI:0.093—0.331,P<0.001)and high alanine aminotransferase level at baseline(OR=0.985,95%CI:0.978—0.992,P<0.001)were protective factors against LLV.The sensitivity analysis showed no significant change in effective value,suggesting that the results of the meta-analysis were relatively stable.The funnel plot of the studies included was basically symmetrical,and the results of the Egger’s test and the Begg’s test suggested that there was no obvious publication bias in the articles included.Conclusion Clinicians should guide decision making based on the influencing factors for LLV and related clinical evidence,so as to reduce long-term clinical risks and avoid adverse outcomes.
作者
谢露
刘亚楠
刘光伟
李鹏宇
胡新宁
康秋佳
郭会军
XIE Lu;LIU Yanan;LIU Guangwei;LI Pengyu;HU Xinning;KANG Qiujia;GUO Huijun(AIDS Clinical Research Center,The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;Spleen,Stomach and Hepatobiliary Department,The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;The First Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450046,China;Henan Key Laboratory of Traditional Chinese Medicine Prevention and Treatment of Viral Diseases,Zhengzhou 450000,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2024年第7期1334-1342,共9页
Journal of Clinical Hepatology
基金
中原英才计划(育才系列)(ZYYCYU202012119)。
