[1]王雪娟,龙富立,覃艳新,等.中医基于补肾疗法拟方治疗慢性 HBV 携带者疗效的 meta 分析[J].大众科技,2019,21(10):71-76.
　The Efficacy of Traditional Chinese Medicine forTreating Chronic Hepatitis B Virus Carriers based on Kidney-Tonifying Therapy: A Meta-Analysis[J].Popular Science & Technology,2019,21(10):71-76.
点击复制

中医基于补肾疗法拟方治疗慢性 HBV 携带者疗效的 meta 分析()
分享到：

《大众科技》[ISSN:1008-1151/CN:45-1235/N]

卷:
21
期数:
2019年10
页码:
71-76
栏目:
医药与卫生
出版日期:
2019-10-20

文章信息/Info

Title:
The Efficacy of Traditional Chinese Medicine forTreating Chronic Hepatitis B Virus Carriers based on Kidney-Tonifying Therapy: A Meta-Analysis
作者:
王雪娟 1;  龙富立 1;  覃艳新 2;  张建玲 2;  马玉珍 1
（1.广西中医药大学第一附属医院，广西 南宁 530023；2.广西中医药大学研究生学院，广西 南宁 530001）
关键词:
慢性乙肝病毒携带者; 补肾疗法; 中医药;  随机对照试验; Meta 分析
Keywords:
chronic hepatitis b virus carriers;  kidney-tonifying therapy;  traditional Chinese medicine;  randomized controlled trials;  meta analysis
文献标志码:
A
摘要:
目的：系统评价中医基于补肾疗法拟方对治疗慢性 HBV 携带者的抗病毒疗效。方法：计算机检索中英文相应数据库。收集有关中医以补肾疗法为主拟方治疗慢性 HBV 携带者的 RCTs，检索时限均为各库建库至 2019 年 4 月 2 日。由评价员 收集数据，并对纳入的文献进行质量评价，最后采用 RevMan5.3 软件对所收集的数据进行 Meta 分析。结果：共纳入 12 个 RCTs， 共计 1921 例患者。Meta 分析结果显示，中医基于补肾疗法拟方治疗慢性乙肝病毒携带者在提高 HBV-DNA 较基线下降＞2 log率［RR＝4.72，95%CI(3.58，6.23)，P＜0.00001］、血清 HBV-DNA 转阴率[RR＝3.24，95% CI(1.73，6.07)，P＝0.0002]、HBeAg阴转率[RR＝2.14,95% CI(1.25，3.66)，P＝0.006]、HBeAg 血清学转换率[RR＝2.22，95% CI(1.29，3.82)，P＝0.004］均优于对照组，且各指标的亚组分析显示中医基于补肾疗法拟方在治疗 48 周时与对照组比较差异具有统计学意义。但在提高 HBsAg 阴转率[RR＝1.53, 95% CI (0.24，9.63)，P＝0.64]的效果则与对照组安慰剂相当。结论：中医基于补肾疗法拟方对于治疗慢性乙肝 病毒携带者，具有较强抑制病毒复制和实现 HBeAg 血清学转换的作用，能够在一定程度上延缓疾病的进展。本次研究受纳入研 究质量和数量的限制，确切结论尚需开展更多大样本高质量的试验验证。
Abstract:
Objective: To systematically evaluate the effect of Traditional Chinese Medicine (TCM)kidney-tonifying therapy on chronic HBV carriers. Methods: Chinese and English databases were retrieved by computer. To collect a randomized controlled study of traditional Chinese medicine that takes Kidney-tonifying therapy as a main prescription for the treatment of chronic HBV carriers. The retrieval time limits were all from each establishment of the database to April 2, 2019. Two reviewers evaluate the quality of the included literature by the Cochrane bias risk assessment tool and the data was performed by the RevMan 5.3 software. Results: A total of 12 RCTs with 1921 patients were included, Meta analysis results showed that the TCM prescription for the treatment of chronic hepatitis B virus carriers based on kidney-nourishing therapy improved the rate of HBV-DNA＞2log［RR＝4.72, 95% CI (3.58, 6.23), P＜0.00001］, the negative conversion rate of serum HBV-DNA [RR＝3.24, 95% CI(1.73, 6.07), P＝0.0002], and the negative conversion rate of HBeAg [RR＝2.14, 95% CI(1.25, 3.66), P＝0.006] and HBeAg serological conversion rate [RR＝2.22, 95% CI(1.29, 3.82), P＝0.004］were better than the control group, moreover, the subgroup analysis of each indicator showed that there was a statistically significant difference between TCM prescription based on kidney tonic therapy and the control group at 48 weeks of treatment. However, in terms of the efficacy of achieving negative conversion rate of HBsAg [RR＝1.53, 95% CI(0.24，9.63)，P＝0.64], it was comparable to placebo. Conclusion: The prescription of traditional Chinese medicine for treating chronic hepatitis B virus carriers based on kidney-nourishing therapy have a strong function of inhibiting virus replication and achieving HBeAg serological transformation, and can delay the progress of disease to a certain extent. This study is limited by the quality and quantity of included studies, and the exact conclusion still needs to be verified by more experiments with large samples and high quality.

参考文献/References:

[1] Ott J J, Stevens G A, Groege R J, et al. Global epidemiology of hepatitis B virus infection:new estimates of age-specific HbsAg seroprevalence and endemicity[J]. Vaccine, 2012, 30(12):2212-2219. [2] Lozano R, Naghavi M, Foeman K, etal. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010:a systematic analysis for the Global Burden of Disease Study 2010[J]．Lancet，2012，380(9859): 2095-2128. [3] Wang F S, Fan J G, Zhang Z, et al. The global burden of liver disease: the major impact of China[J]. Hepatology, 2014, 60(6):2099-2108. [4] Liang X, Bi S, Yang W, et al. Epidemiological serosurvey of hepatitis B in China-declining HBV prevalence due to hepatitis B vaccination[J].Vaccine, 2009, 27(47): 6550-6557. [5] Liang X, Bi S, Yang W, et al. Evaluation of the impact of hep-atitis B vaccination among children born during 1992-2005 in Chi-na[J]. J Infect Dis, 2009,200(1): 39-47． [6] Lu F M, Zhuang H. Management of hepatitis B in China[J]. Chin. Med. J. (Engl), 2009, 122(1): 3-4. [7] 中华医学会肝病学分会,中华医学会感染病学分会, Chinese Society of Hepatology,等.慢性乙型肝炎防治指南 (2015 更新版)[J].肝脏,2015,33(12):321-340. [8] 中华医学会肝病学分会,中华医学会感染病学分会.慢性 乙型肝炎防治指南[J].传染病信息,2005,18(增刊):1-12. [9] 中华医学会肝病学分会中华医学会感染病学分会.慢性 乙型肝炎防治指南 2010 年更新版[J].中华实验和临床 感染病杂志(电子版),2011,5(1):50. [10] 郑颖俊,贺劲松,陈亮,等.补肾健脾方对慢性乙肝病毒携带 者病毒复制及 Th1/Th2 型细胞因子的影响[J].南京中医药大学学报,2012, 28(3):211-215. [11] 程晶,唐海鸿,李群,等.补肾解毒健脾冲剂对慢性乙肝病毒 携带者 HBeAg、HBVDNA 和肝组织学的影响[J].中西医结合肝病杂志,2014(4):200-202. [12] 周大桥,邢宇锋,贺劲松,等.补肾健脾胶囊治疗慢性乙肝病 毒携带者的随机双盲临床研究[C].//中华中医药学会全国 第十四次肝胆病学术会议论文集.广州中医药大学深圳 附属医院,2010:39-44. [13] 余颜,俞旭君,王永磊,等.温肾方对乙肝携带者血清、精子HBV-DNA 的影响[J].亚太传统医药,2015,11(10):82-83. [14] 邢宇锋,童光东,贺劲松,等.补肾清透方对慢性 HBV 携带者 血清免疫因子的作用[J].传染病信息,2012,25(3):158-160. [15] 唐翠兰,袁菁菁,毛桂红,等.补肾健脾颗粒对肾虚型慢性HBV 携带者 HBeAg、HBV DNA 和肝组织学的影响[J].浙江中医药大学学报,2013,37(4):375-378. [16] 彭得倜,邢宇锋,魏春山,等.补肾解毒方对慢性 HBV 携带 者免疫耐受的临床研究[J].时珍国医国药,2016,27(12): 2949-2951. [17] 鲁艳平.岭南地区慢性 HBV 携带者证候特点及及补肾祛 湿法对其干预的研究[D].广州:广州中医药大学,2015. [18]] 李美燕.补肾疏肝解毒方对慢性 HBV 携带者临床疗效的研究[D].南宁:广西中医药大学,2017. [19] 李慧贞.补肾清透治疗慢性乙型肝炎病毒携带者随机对 照研究[D].广州:广州中医药大学,2012. [20] 贺劲松.慢性乙肝病毒携带者证候规律及补肾健脾法治 疗的研究[D].广州:广州中医药大学,2012. [21] 陈亮,贺劲松,赖姿娜,等.补肾健脾祛邪方治疗慢乙肝病毒 携带者的随机临床研究[J].中国保健营养,2012,22(14): 2446-2447. [22] Tseng T C, Kao J H. Treating immune-tolerant hepatitis B[J]. J Viral Hepat, 2015, 22(2): 77-84． [23] Lai M, Hyatt B J, Nasse R I, et al. The clinical significance of persistently normal ALT in chronic hepatitis B infection [J]. J Hep-atol, 2007, 47(6): 760-767． [24] Kumar M, Sarin S K, Hissar S, et al. Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT[J]. Gastroenterology, 2008,134(5):1376 -1384. [25] DegeＲTekin B, Lok A. Should liver biopsies be performed on all hepatitis B carriers[J]. Gastroenterology, 2008, 135 (5):1802． [26] Chen G, Lin W, Shen F, et al. Past HBV viral load as predic-tor of mortality and morbidity from HCC and chronic liver dis-ease in a prospective study[J].Am J of Gastroenterol, 2006, 101(8): 1797-1808. [27] Tseng T C, Liu C J, Yang H C, et al. Serum hepatitis B surface antigen levels help predict disease progression in patients with low hepatitis B virus loads[J]. Hepatology, 2013, 57(2): 441-450. [28] 申弘,凌琪华,杨涛,等.慢性 HBV 感染相关疾病患者的中医 体质分布规律研究[J].上海中医药杂志,2014,48(9):12-16. [29] 张炯善,杨宏志,戴敏,等.156 例慢性 HBV 携带者的体质分 布与 HBV-DNA 定量的相关性研究[J].中药材,2011,34 (2):320-322. [30] 倪伟,施维群,茹清静,等.194 例 HBeAg 阳性 HBV 携带者 中医证候及体质分布规律观察[J].中西医结合肝病杂志, 2014,24(6):328-331.

备注/Memo

备注/Memo:
【收稿日期】2019-08-05 【基金项目】广西科技计划项目（桂科 AD17129001，桂科攻 1598011-7，桂科 AA17202036）；广西高校中青年教师基础能力提升项目（P18011）。【作者简介】王雪娟（1980－），女，广西合浦人，广西中医药大学第一附属医院副主任护师。【通信作者】覃艳新（1992－），女，广西来宾人，广西中医药大学研究生学院在读硕士研究生，研究方向为中医药防 治肝病基础与临床研究。
更新日期/Last Update: 2020-02-14