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
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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
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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

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

    摘要
  • 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。

     

    Abstract:
      Objective  To evaluate whether sofosbuvir (SOF)-based direct-acting antiviral agents (DAAs) combined with ribavirin (RBV) (combined RBV) can yield benefits to the recipients infected with hepatitis C virus (HCV) genotype 1 (GT1) after liver transplantation through systematic evaluation and Meta-analysis.
      Methods  Multiple databases at home and abroad were systematically searched, the literature screening was conducted according to relevant standards, the quality of literatures was evaluated and data extraction was performed. The literature was divided into two groups according to the recipients with HCV-GT1 hepatitis after liver transplantation who received the treatment combined RBV or SOF-based DAAs alone without RBV (not combined RBV). Meta-analysis of the data was carried out using Rev Man 5.3 and R3.4.3 software. The incidence of sustained virological response 12 weeks (SVR12) after therapy was evaluated.
      Results  A total of 2 195 articles were retrieved, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis results demonstrated that the incidence of SVR12 did not significantly differ between the combined RBV and not combined RBV groups (P=0.28). However, the incidence of anemia in the combined RBV group was significantly higher than that in the other group (P < 0.01). Both combined RBV and not combined RBV therapies were efficacious in treating HCV-GT1a and HCV-GT1b subtypes after liver transplantation with similar clinical efficacy (P=0.33). The incidence of SVR in HCV-GT1 recipients did not significantly differ after receiving 12- and 24-weeks therapy after liver transplantation (P=0.95).
      Conclusions  When SOF-based DAAs regimen is adopted to treat HCV-GT1 in recipients after liver transplantation, combination with RBV not only fails to improve the virus clearance rate and bring clinical benefits, but also increases the risk of anemia in the recipients.

     

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