不同劑量干擾素α治療慢性丙型肝炎療效與安全性的系統評價_《中國循證醫學雜志》

作者：

蘇娜 , 吳逢波 ,  徐珽

四川大學華西醫院藥劑科（成都 610041）;

關鍵詞：

干擾素α 慢性丙型肝炎劑量系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130036

視頻：

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目的　系統評價不同劑量干擾素α治療慢性丙型肝炎的療效與安全性。
方法　計算機檢索MEDLINE、EMbase、CENTRAL、CBM、CNKI、VIP和WanFang Data，查找有關不同劑量干擾素α治療慢性丙型肝炎的隨機對照試驗，檢索時限截至2012年8月。由2位研究者根據納入與排除標準獨立篩選文獻、提取資料并評價質量后，采用RevMan 5.0軟件進行Meta分析。
結果　最終納入13個RCT，共1 442例患者。Meta分析結果顯示：① 干擾素α 3 MU組與1 MU組治療慢性丙型肝炎的完全應答率差異無統計學意義［RR=0.83，95%CI（0.52，1.32），P=0.43］，而兩組持續應答率差異有統計學意義［RR=1.89，95%CI（1.00，3.59），P=0.05］；② 干擾素α 3 MU組與6 MU組以及10 MU組治療慢性丙型肝炎的完全應答率和持續應答率差異均無統計學意義。
結論　干擾素α（治療劑量3 MU，1周3次）治療慢性丙型肝炎有效，但目前尚無證據確定是否存在劑量依賴效應。在使用干擾素α治療慢性丙型肝炎時，應根據患者的耐受性和經濟情況等實施個體化給藥以有效控制慢性丙型肝炎。

引用本文： 蘇娜,吳逢波,徐珽. 不同劑量干擾素α治療慢性丙型肝炎療效與安全性的系統評價. 中國循證醫學雜志, 2013, 13(2): 210-217. doi: 10.7507/1672-2531.20130036 復制

1.	Koretz RL, Stone O, Gitnick GL. The long-term course of non A,non B post-transfusion hepatitis. Gastroenterology, 1980, 79(5 Pt 1): 893-898.
2.	Hartwell D, Shepherd J. Pegylated and non-pegylated interferon-alfa and ribavirin for the treatment of mild chronic hepatitis C: a systematic review and meta-analysis. Int J Technol Assess Health Care, 2009, 25(1): 56-62.
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6.	Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
7.	Hakozaki Y, Shirahama T, Katou M. A controlled study to determine the optimal dose regimen of interferon-alpha 2b in chronic hepatitis C. The American journal of gastroenterology, 1995, 90(8): 1246-1249.
8.	Bjoro K, Krarup H, Bell H. Two dose regimens of recombinant interferon-alpha-2b in chronic hepatitis C virus infection. Biochemistry, hepatitis C virus RNA, and liver histology as response indices. Scandinavian journal of gastroenterology, 1995, 30(11): 1119-1124.
9.	Tassopoulos NC, Karvountzis G, Touloumi G. Comparative efficacy of a high or low dose of interferon alpha 2b in chronic hepatitis C: a randomized controlled trial. The American Journal of Gastroenterology, 1996, 91(9): 1734-1738.
10.	Imai Y, Kawata S, Tamura S. Recombinant interferon-alpha-2a for treatment of chronic hepatitis C: results of a multicenter randomized controlled dose study. Liver, 1997, 17(2): 88-92.
11.	Ohmiya M, Hayashi J, Furusyo N. Large dose natural interferon alpha therapy for patients with chronic hepatitis C. Fukuoka Igaku Zasshi, 1997, 88(12): 380-388.
12.	Piccinino F, Felaco FM, Sagnelli E. Long-term lymphoblastoid interferon-alpha therapy for non-cirrhotic chronic hepatitis C: an Italian multicentre study on dose and duration of IFN alpha treatment. Research in Virology, 1998, 149(5): 283-291.
13.	姚光弼, 計焱焱. 兩種劑量重組干擾素α2a治療慢性丙型肝炎隨機對照研究. 中華內科雜志, 1998, 37(2): 59-62.
14.	Matsumoto A, Tanaka E, Suzuki T. Viral and host factors that contribute to efficacy of interferon-a2a therapy in patients with chronic hepatitis C. Dig Dis Sci, 1994, 39(6): 1273-1280.
15.	Lin R, Roach E, Zimmerman M, et al. Interferon alfa-2b for chronic hepatitis C: effects of dose increment and duration of treatment on response rates. J Hepatol, 1995, 23(5): 487-496.
16.	Hagiwara H, Hayashi N, Mita E. Quantitative analysis of hepatitis C virus RNA in serum during interferon alfa therapy. Gastroenterology, 1993, 104(3): 877-883.
17.	Chemello L, Bonetti P, Cavalletto L. Randomized trial comparing three different regimens of alpha-2a-interferon in chronic hepatitis C. Hepatology, 1995, 22(3): 700-706.
18.	Marcellin P, Pouteau M, Martinot-Peignoux M. Lack of benefit of escalating dosage of interferon alfa in patients with chronic hepatitis C. Gastroenterology, 1995, 109(1): 156-165.
19.	Saracco G, Rosina F, Abate ML. Long term follow-up of patients with chronic hepatitis C Treated with different doses of interferon-a2b. Hepatology, 1993, 18(6): 1300-1305.
20.	謝堯, 徐道振. HCV基因型對慢性丙型肝炎干擾素療效的影響. 中華肝臟病雜志, 2004,12(2): 72-75.
21.	金生, 周衛平. 丙型肝炎抗病毒治療的影響因素及療效預測. 中華肝臟病雜志, 2004, 12(2): 124-125.
22.	Fried MW, Hoofnagle JH. Therapy of hepatitis C. Semin Liver Dis, 1995, 15(1): 82-91.

1. Koretz RL, Stone O, Gitnick GL. The long-term course of non A,non B post-transfusion hepatitis. Gastroenterology, 1980, 79(5 Pt 1): 893-898.
2. Hartwell D, Shepherd J. Pegylated and non-pegylated interferon-alfa and ribavirin for the treatment of mild chronic hepatitis C: a systematic review and meta-analysis. Int J Technol Assess Health Care, 2009, 25(1): 56-62.
3. Kjaergard LL, Krogsgaard K, Gluud C. Interferon alfa with or without ribavirin for chronic hepatitis C: systematic review of randomised trials. BMJ, 2001, 323(7322): 1151-1155.
4. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from: www.cochrane-handbook.org.
5. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008.
6. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med, 2002, 21(11): 1539-1558.
7. Hakozaki Y, Shirahama T, Katou M. A controlled study to determine the optimal dose regimen of interferon-alpha 2b in chronic hepatitis C. The American journal of gastroenterology, 1995, 90(8): 1246-1249.
8. Bjoro K, Krarup H, Bell H. Two dose regimens of recombinant interferon-alpha-2b in chronic hepatitis C virus infection. Biochemistry, hepatitis C virus RNA, and liver histology as response indices. Scandinavian journal of gastroenterology, 1995, 30(11): 1119-1124.
9. Tassopoulos NC, Karvountzis G, Touloumi G. Comparative efficacy of a high or low dose of interferon alpha 2b in chronic hepatitis C: a randomized controlled trial. The American Journal of Gastroenterology, 1996, 91(9): 1734-1738.
10. Imai Y, Kawata S, Tamura S. Recombinant interferon-alpha-2a for treatment of chronic hepatitis C: results of a multicenter randomized controlled dose study. Liver, 1997, 17(2): 88-92.
11. Ohmiya M, Hayashi J, Furusyo N. Large dose natural interferon alpha therapy for patients with chronic hepatitis C. Fukuoka Igaku Zasshi, 1997, 88(12): 380-388.
12. Piccinino F, Felaco FM, Sagnelli E. Long-term lymphoblastoid interferon-alpha therapy for non-cirrhotic chronic hepatitis C: an Italian multicentre study on dose and duration of IFN alpha treatment. Research in Virology, 1998, 149(5): 283-291.
13. 姚光弼, 計焱焱. 兩種劑量重組干擾素α2a治療慢性丙型肝炎隨機對照研究. 中華內科雜志, 1998, 37(2): 59-62.
14. Matsumoto A, Tanaka E, Suzuki T. Viral and host factors that contribute to efficacy of interferon-a2a therapy in patients with chronic hepatitis C. Dig Dis Sci, 1994, 39(6): 1273-1280.
15. Lin R, Roach E, Zimmerman M, et al. Interferon alfa-2b for chronic hepatitis C: effects of dose increment and duration of treatment on response rates. J Hepatol, 1995, 23(5): 487-496.
16. Hagiwara H, Hayashi N, Mita E. Quantitative analysis of hepatitis C virus RNA in serum during interferon alfa therapy. Gastroenterology, 1993, 104(3): 877-883.
17. Chemello L, Bonetti P, Cavalletto L. Randomized trial comparing three different regimens of alpha-2a-interferon in chronic hepatitis C. Hepatology, 1995, 22(3): 700-706.
18. Marcellin P, Pouteau M, Martinot-Peignoux M. Lack of benefit of escalating dosage of interferon alfa in patients with chronic hepatitis C. Gastroenterology, 1995, 109(1): 156-165.
19. Saracco G, Rosina F, Abate ML. Long term follow-up of patients with chronic hepatitis C Treated with different doses of interferon-a2b. Hepatology, 1993, 18(6): 1300-1305.
20. 謝堯, 徐道振. HCV基因型對慢性丙型肝炎干擾素療效的影響. 中華肝臟病雜志, 2004,12(2): 72-75.
21. 金生, 周衛平. 丙型肝炎抗病毒治療的影響因素及療效預測. 中華肝臟病雜志, 2004, 12(2): 124-125.
22. Fried MW, Hoofnagle JH. Therapy of hepatitis C. Semin Liver Dis, 1995, 15(1): 82-91.

《中國循證醫學雜志》

不同劑量干擾素α治療慢性丙型肝炎療效與安全性的系統評價

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《中國循證醫學雜志》

不同劑量干擾素α治療慢性丙型肝炎療效與安全性的系統評價

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