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目的评价α-干扰素(alpa interferon,IFN-α)联合糖皮质激素序贯治疗与α-干扰素单独治疗HBeAg阳性慢性乙型肝炎儿童的疗效差异。方法检索PubMed和CHKD期刊全文数据库,并追查所有纳入研究的参考文献。检索年限均从建库检索到2006年10月。纳入用英文或中文发表的比较IFN-α联合糖皮质激素序贯治疗与IFN-α单独治疗HBeAg阳性慢性乙型肝炎儿童疗效的随机对照试验。由2名评价员独立筛查文献,评价质量和提取资料。结果共纳入4个随机对照试验,包括181个HBeAg阳性的慢性乙型肝炎患儿。Meta分析结果显示,随访9个月至2年后,IFN-α联用糖皮质激素序贯组治疗HBeAg转阴率稍低于IFN-α单独治疗组,HBV-DNA转阴率稍高于IFN-α单独治疗组,HBsAg转阴率稍低于IFN-α单独治疗组,丙氨酸转氨酶(ALT)复常率稍低于IFN-α单独治疗组,HBeAg血清转换率稍低于IFN-α单独治疗组,HBsAg血清转换率稍高于IFN-α单独治疗组,两组差异均无统计学意义。结论对HBeAg阳性的慢性乙型肝炎患儿,IFN-α联用糖皮质激素序贯治疗与IFN-α单独治疗对比,在HBeAg转阴、HBV-DNA转阴、HBsAg转阴、ALT复常、HBeAg及HBsAg血清转换等方面均无明显的效能。
Objective To evaluate the efficacy of interferon alfa-interferon (IFN-α) in combination with glucocorticoid sequential therapy and α-interferon alone in children with HBeAg-positive chronic hepatitis B. METHODS: PubMed and CHKD journal full-text databases were searched and all references included in the study were traced. The retrieval years are retrieved from the database to October 2006. A randomized controlled trial comparing the efficacy of sequential IFN-α plus glucocorticoid therapy with IFN-α alone in children with HBeAg-positive chronic hepatitis B, published in English or Chinese, was included. Two reviewers independently screened the literature, rated the quality and extracted the information. Results A total of 4 randomized controlled trials were included, including 181 HBeAg-positive children with chronic hepatitis B. Meta-analysis showed that after 9 months to 2 years of follow-up, HBeAg negative rate was slightly lower than that of IFN-α alone treatment group, the HBV-DNA negative rate slightly higher than that of IFN-α combined with glucocorticoid sequential group -α alone treatment group, HBsAg negative rate slightly lower than IFN-α alone treatment group, alanine aminotransferase (ALT) normalization rate slightly lower than the IFN-α treatment group, HBeAg seroconversion rate slightly lower than IFN-α HBsAg seroconversion rate was slightly higher in IFN-α-treated group than in IFN-α alone group, with no significant difference between the two groups. Conclusion HBeAg-positive children with chronic hepatitis B, IFN-α combined with glucocorticoid sequential therapy and IFN-α treatment alone, in HBeAg negative, HBV-DNA negative, HBsAg negative, ALT normal, HBeAg and HBsAg seroconversion no significant effect.