Effect of peginterferon alfa-2a on liver histology in chronic hepatitis C:: A meta-analysis of individual patient data
Effect of peginterferon alfa-2a on liver histology in chronic hepatitis C:: A meta-analysis of individual patient data
复制标题
DOI：
10.1002/hep.20073
复制
发表时间：
2004-02-01
期刊：
影响因子：
13.5
通讯作者：
Craxì, A
中科院分区：
文献类型：
--
作者：
Cammà, C;Di Bona, D;Craxì, A
多中心随机试验表明，每周一次的聚乙二醇化干扰素(聚乙二醇化干扰素)α-2a治疗慢性丙型肝炎患者比常规干扰素α-2a(干扰素)更有效。我们对1,013名以前未接受治疗的患者(来自3个随机试验)进行了荟萃分析，以评估聚乙二醇化干扰素α-2a和干扰素对肝脏组织学影响的差异。报告值是接受聚乙二醇α-2a干扰素治疗的患者和接受干扰素治疗的患者之间的标准化平均差异(SMD)(两组患者的治疗后值减去基线值)。我们使用随机效应模型来量化聚乙二醇化干扰素α-2a对肝脏组织学的平均影响。与干扰素相比，聚乙二醇化干扰素α-2a显著减少了纤维化(SMD，-0.14；95%CI：-0.27，-0.01；P=0.04)。持续病毒学应答者(SMD，-0.59；95%CI：-0.89，-0-30；P<；.0001)和复发性疾病患者(SMD，-0.34；95%CI：-0.54，-0.14；P=.0007)的纤维化程度降低，而无应答者(SMD，-0.13；95%CI：-0.32，0.05；P=.15)没有明显减少。Logistic回归分析显示，与无持续病毒学应答的患者相比，有持续病毒学应答的患者减少纤维化的优势比(OR)为1.61(95%CI：1.14，2.29)，而肥胖患者(BMI和GT；30 kg/m(2))与正常体重(BMI和lt；25 kg/m(2))和超重患者(BMI，25-30 kg/m-2)相比，OR为0.56(95%CI：0.35，0.90)。总而言之，在有或没有肝硬变的慢性丙型肝炎患者中，聚乙二醇化干扰素α-2a(相对于干扰素)显著减少了纤维化。聚乙二醇干扰素对肝脏组织学的有益作用与病毒学应答密切相关。
Multicenter randomized trials have shown that once-weekly pegylated interferon (peginterferon) alfa-2a is more efficacious than conventional interferon alfa-2a (IFN) in patients with chronic hepatitis C. We performed a meta-analysis of 1,013 previously untreated patients (from 3 randomized trials) with pretreatment and post-treatment liver biopsies to assess the differences between peginterferon alfa-2a and IFN in terms of their effects on liver histology. Reported values were standardized mean differences (SMD) between patients receiving peginterferon alfa-2a and those receiving IFN (post-treatment value minus baseline value for each group). We used a random-effects model to quantify the average effect of peginterferon alfa-2a on liver histology. Peginterferon alfa-2a significantly reduced fibrosis compared with IFN (SMD, -0.14; 95% CI: -0.27, -0.01; P = .04). A reduction in fibrosis was observed among sustained virologic responders (SMD, -0.59; 95% CI: -0.89, -0-30; P < .0001) and patients with recurrent disease (SMD, -0.34; 95% CI: -0.54, -0.14; P = .0007), whereas no significant reduction was observed among nonresponders (SMD, -0.13; 95% CI: -0.32, 0.05; P = .15). Logistic regression analysis indicated that patients with sustained virologic responses (SVRs) had an odds ratio (OR) of 1.61 (95% CI: 1.14, 2.29) for reduction in fibrosis compared with patients without SVRs, whereas obese patients (body mass index [BMI] > 30 kg/m(2)) had an OR of 0.56 (95% CI: 0.35, 0.90) compared with normal-weight (BMI < 25 kg/m(2)) and overweight patients (BMI, 25-30 kg/M-2). In conclusion, in patients with chronic hepatitis C with or without cirrhosis, peginterferon alfa-2a (relative to IFN) significantly reduced fibrosis. The beneficial effects of peginterferon on liver histology are closely related to virologic response.