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基于索非布韦的方案联合利巴韦林治疗肝移植后HCV基因1型肝炎受者的Meta分析

江啸 姜晓娟 苏锐良 任志俭 杨金伟 李玉民

江啸, 姜晓娟, 苏锐良, 等. 基于索非布韦的方案联合利巴韦林治疗肝移植后HCV基因1型肝炎受者的Meta分析[J]. 器官移植, 2019, 10(5): 570-577. doi: 10.3969/j.issn.1674-7445.2019.05.017
引用本文: 江啸, 姜晓娟, 苏锐良, 等. 基于索非布韦的方案联合利巴韦林治疗肝移植后HCV基因1型肝炎受者的Meta分析[J]. 器官移植, 2019, 10(5): 570-577. doi: 10.3969/j.issn.1674-7445.2019.05.017
Jiang Xiao, Jiang Xiaojuan, Su Ruiliang, et al. Sofosbuvir-based regimens combined with ribavirin for recipients with genotype 1 hepatitis C after liver transplantation: a Meta-analysis[J]. ORGAN TRANSPLANTATION, 2019, 10(5): 570-577. doi: 10.3969/j.issn.1674-7445.2019.05.017
Citation: Jiang Xiao, Jiang Xiaojuan, Su Ruiliang, et al. Sofosbuvir-based regimens combined with ribavirin for recipients with genotype 1 hepatitis C after liver transplantation: a Meta-analysis[J]. ORGAN TRANSPLANTATION, 2019, 10(5): 570-577. doi: 10.3969/j.issn.1674-7445.2019.05.017

基于索非布韦的方案联合利巴韦林治疗肝移植后HCV基因1型肝炎受者的Meta分析

doi: 10.3969/j.issn.1674-7445.2019.05.017
基金项目: 

国家自然科学基金面上项目 31770537

中央高校基本科研业务费 lzujbky-2018-kb13

详细信息
    作者简介:

    江啸,男,1989年生,硕士,研究方向为消化器官移植,Email:jiangx16@lzu.edu.cn

    通讯作者:

    李玉民,男,1962年生,博士,教授,研究方向为消化器官移植,Email:liym@lzu.edu.cn

  • 中图分类号: R617, R195.1

Sofosbuvir-based regimens combined with ribavirin for recipients with genotype 1 hepatitis C after liver transplantation: a Meta-analysis

More Information
  • 摘要:   目的  通过系统评价和Meta分析评估以索非布韦(SOF)为基础的直接抗病毒药物(DAAs)联合利巴韦林(RBV)(联合RBV)治疗肝移植术后丙型肝炎病毒(HCV)基因1型(GT1)肝炎受者能否获益。  方法  系统检索国内外多个数据库,根据标准筛选文献,并进行文献质量评价,提取数据。将文献按肝移植术后HCV-GT1肝炎受者接受联合RBV或只用SOF的DAAs不联合RBV(不联合RBV)治疗分为两组。采用Rev Man 5.3和R3.4.3软件对数据进行Meta分析。对治疗结束后12周持续病毒学应答(SVR12)的发生率进行评估。  结果  检索文献2 195篇,按纳入标准筛选共纳入6篇英文文献。Meta分析结果表明联合RBV组和不联合RBV组两组间SVR12的发生率差异无统计学意义(P=0.28),但是联合RBV组贫血的发生率明显增高(P < 0.01)。联合RBV或不联合RBV治疗方案对肝移植术后HCV-GT1a和HCV-GT1b两个亚型同样有效,两基因亚型间疗效差异无统计学意义(P=0.33)。将肝移植术后HCV-GT1肝炎受者的疗程从12周延长至24周的SVR率差异无统计学意义(P=0.95)。  结论  采用基于SOF的DAAs方案治疗肝移植术后HCV-GT1肝炎受者时,联合RBV不仅不能提高病毒的清除率,反而增加了受者发生贫血的风险,不能从中获益。

     

  • 图  1  文献的筛选流程

    Figure  1.  Process of literature screening

    图  2  文献[12]的风险偏倚评估

    Figure  2.  Risk bias assessment of reference [12]

    图  3  联合RBV组及不联合RBV组总的SVR12发生率

    Figure  3.  The overall rate of SVR12 in combined with RBV or not combined with RBV groups

    图  4  联合RBV组与不联合RBV组SVR12发生率的比较

    Figure  4.  Comparison of SVR12 rate of patients between combined with RBV or not combined with RBV groups

    图  5  Begg’s漏斗图

    SE为标准误,RR为相对危险度

    Figure  5.  Funnel diagram of Begg's

    图  6  联合RBV组与不联合RBV组间贫血发生率的比较

    Figure  6.  Comparison of the incidence of anemia of patients between combined with RBV and not combined with RBV groups

    图  7  联合RBV与不联合RBV方案对肝移植术后HCVGT1a与GT1b治疗效果的比较

    Figure  7.  Comparison of treatment effect in combined with RBV or not combined with RBV therapy between HCV-GT1a group and HCV-GT1b group

    图  8  联合RBV与不联合RBV方案对肝移植术后HCV-GT1肝炎患者治疗12周和24周治疗效果的比较

    Figure  8.  Comparison of treatment effect in combined with RBV or not combined with RBV therapy between 12 weeks group and 24 weeks group

    表  1  纳入文献的基本特征

    Table  1.   Basic characteristics of the included articles

    研究作者 年份 研究机构 国家 样本量(n 男性[n(%)] 年龄(岁) MINORS评分 HCV肝炎治疗史[n(%)] 治疗方案 疗程(周)
    O'Leary JG, et al[12] 2016 多中心 美国 46 34(74) 60(49~68)a 0(0) SOF+SMV±RBV 12或24
    Brown RS JR, et al[13] 2016 多中心 美国 151 112(74) 61(46~78)b 19 85(56) SOF+SMV±RBV 12或24
    Crittenden NE, et al[14] 2016 多中心 美国 56 42(75) 61(7)c 20 41(73) SOF+SMV±RBV 12
    Nair S, et al[15] 2017 单中心 美国 50 34(68) 56±7 18 30(60) SOF+SMV±RBV 12
    Saab S, et al[16] 2017 单中心 美国 85 57 (67) 63±9 19 39(46) SOF+LDV±RBV 12或24
    Pillai AA, et al[17] 2016 单中心 美国 57 43 (75) 58±6 19 24(42) SOF+SMV±RBV 12
    a中位数(极差),b均数(极差),c中位数(四分位数间距),SMV为西咪匹韦,LDV为雷迪帕韦,—表示无
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  • [1] WRIGHT TL, DONEGAN E, HSU HH, et al. Recurrent and acquired hepatitis C viral infection in liver transplant recipients[J]. Gastroenterology, 1992, 103(1):317-322. doi: 10.1016/0016-5085(92)91129-R
    [2] KALAMBOKIS G, MANOUSOU P, SAMONAKIS D, et al. Clinical outcome of HCV-related graft cirrhosis and prognostic value of hepatic venous pressure gradient[J]. Transpl Int, 2009, 22(2):172-181. DOI: 10.1111/j.1432-2277.2008.00744.x.
    [3] BERENGUER M, PRIETO M, RAYÓN JM, et al. Natural history of clinically compensated hepatitis C virus-related graft cirrhosis after liver transplantation[J]. Hepatology, 2000, 32(4 Pt 1):852-858.
    [4] COILLY A, ROCHE B, DUCLOS-VALLÉE JC, et al. Management of HCV transplant patients with triple therapy[J]. Liver Int, 2014, 34(Suppl 1):46-52. DOI: 10.1111/liv.12406.
    [5] ANGELICO M, PETROLATI A, LIONETTI R, et al. A randomized study on peg-interferon alfa-2a with or without ribavirin in liver transplant recipients with recurrent hepatitis C[J]. J Hepatol, 2007, 46(6):1009-1017. doi: 10.1016/j.jhep.2006.12.017
    [6] DUMORTIER J, SCOAZEC JY, CHEVALLIER P, et al. Treatment of recurrent hepatitis C after liver transplantation: a pilot study of peginterferon alfa-2b and ribavirin combination[J]. J Hepatol, 2004, 40(4):669-674. doi: 10.1016/j.jhep.2003.12.015
    [7] European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C 2018[J]. J Hepatol, 2018, 69(2):461-511. DOI: 10.1016/j.jhep.2018.03.026.
    [8] ELFEKI MA, ABOU MRAD R, MODARESI ESFEH J, et al. Sofosbuvir/ledipasvir without ribavirin achieved high sustained virologic response for hepatitis C recurrence after liver transplantation: two-center experience[J]. Transplantation, 2017, 101(5):996-1000. DOI: 10.1097/TP.0000000000001467.
    [9] ZHANG X. Direct anti-HCV agents[J]. Acta Pharm Sin B, 2016, 6(1):26-31. DOI: 10.1016/j.apsb.2015.09.008.
    [10] AASLD-IDSA HCV Guidance Panel. Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection[J]. Clin Infect Dis, 2018, 67(10):1477-1492. DOI: 10.1093/cid/ciy585.
    [11] PETRUZZIELLO A, MARIGLIANO S, LOQUERCIO G, et al. Global epidemiology of hepatitis C virus infection: an up-date of the distribution and circulation of hepatitis C virus genotypes[J]. World J Gastroenterol, 2016, 22(34):7824-7840. DOI: 10.3748/wjg.v22.i34.7824.
    [12] O'LEARY JG, FONTANA RJ, BROWN K, et al. Efficacy and safety of simeprevir and sofosbuvir with and without ribavirin in subjects with recurrent genotype 1 hepatitis C postorthotopic liver transplant: the randomized GALAXY study[J]. Transpl Int, 2017, 30(2):196-208. DOI: 10.1111/tri.12896.
    [13] BROWN RS JR, O'LEARY JG, REDDY KR, et al. Interferon-free therapy for genotype 1 hepatitis C in liver transplant recipients: real-world experience from the hepatitis C therapeutic registry and research network[J]. Liver Transpl, 2016, 22(1):24-33. DOI: 10.1002/lt.24366.
    [14] CRITTENDEN NE, BUCHANAN LA, PINKSTON CM, et al. Simeprevir and sofosbuvir with or without ribavirin to treat recurrent genotype 1 hepatitis C virus infection after orthotopic liver transplantation[J]. Liver Transpl, 2016, 22(5):635-643. DOI: 10.1002/lt.24422.
    [15] NAIR S, SATAPATHY SK, GONZALEZ HC. Sofosbuvir and simeprevir for treatment of recurrent hepatitis C infection after liver transplant[J]. Exp Clin Transplant, 2017, 15(3):314-319. DOI: 10.6002/ect.2015.0289.
    [16] SAAB S, RHEEM J, JIMENEZ MA, et al. Effectiveness of ledipasvir/sofosbuvir with/without ribavarin in liver transplant recipients with hepatitis C[J]. J Clin Transl Hepatol, 2017, 5(2):101-108. DOI: 10.14218/JCTH.2016.00070.
    [17] PILLAI AA, WEDD J, NORVELL JP, et al. Simeprevir and sofosbuvir (SMV-SOF) for 12 weeks for the treatment of chronic hepatitis C genotype 1 infection: a real world (transplant) hepatology practice experience[J]. Am J Gastroenterol, 2016, 111(2):250-260. DOI: 10.1038/ajg.2015.422.
    [18] TERRAULT NA, SHIFFMAN ML, LOK AS, et al. Outcomes in hepatitis C virus-infected recipients of living donor vs. deceased donor liver transplantation[J]. Liver Transpl, 2007, 13(1):122-129. doi: 10.1002/lt.20995
    [19] LIAO HT, TAN P, HUANG JW, et al. Ledipasvir + sofosbuvir for liver transplant recipients with recurrent hepatitis C: a systematic review and Meta-analysis[J]. Transplant Proc, 2017, 49(8):1855-1863. DOI: 10.1016/j.transproceed.2017.04.014.
    [20] LIAO H, TAN P, ZHU Z, et al. Sofosbuvir in combination with daclatasvir in liver transplant recipients with HCV infection: a systematic review and Meta-analysis[J]. Clin Res Hepatol Gastroenterol, 2017, 41(3):262-271. DOI: 10.1016/j.clinre.2016.12.001.
    [21] LIONETTI R, CALVARUSO V, PICCOLO P, et al. Sofosbuvir plus daclatasvir with or without ribavirin is safe and effective for post-transplant hepatitis C recurrence and severe fibrosis and cirrhosis: a prospective study[J]. Clin Transplant, 2018, 32(2). DOI: 10.1111/ctr.13165.
    [22] PUNGPAPONG S, AQEL B, LEISE M, et al. Multicenter experience using simeprevir and sofosbuvir with or without ribavirin to treat hepatitis C genotype 1 after liver transplant[J]. Hepatology, 2015, 61(6):1880-1886. DOI: 10.1002/hep.27770.
    [23] FONTANA RJ, BROWN RS JR, MORENO-ZAMORA A, et al. Daclatasvir combined with sofosbuvir or simeprevir in liver transplant recipients with severe recurrent hepatitis C infection[J]. Liver Transpl, 2016, 22(4):446-458. DOI: 10.1002/lt.24416.
    [24] CARDONA-GONZALEZ MG, GOLDMAN JD, NARAYAN L, et al. Sofosbuvir, velpatasvir, and voxilaprevir for treatment of recurrent hepatitis C virus infection after liver transplantation[J]. Hepatol Commun, 2018, 2(12):1446-1450. DOI: 10.1002/hep4.1280.
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出版历程
  • 收稿日期:  2019-06-08
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2019-09-15

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