Phlebotomy improves therapeutic response to interferon in patients with chronic hepatitis C: A meta-analysis of six prospective randomized controlled trials
Phlebotomy improves therapeutic response to interferon in patients with chronic hepatitis C: A meta-analysis of six prospective randomized controlled trials
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DOI：
10.1007/s10620-007-9945-7
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发表时间：
2008-03-01
影响因子：
3.1
通讯作者：
Bonkovsky, Herbert L.
中科院分区：
文献类型：
--
作者：
Desai, Tusar K.;Jamil, Laith H.;Bonkovsky, Herbert L.
对慢性丙型肝炎(CHC)患者进行的前瞻性随机对照试验(RCT)比较了静脉切割术和干扰素(干扰素)治疗与单独应用干扰素的疗效，结果表明静脉切除术组是有益的。然而，在这些试验中只有一项达到了统计学意义。我们进行了一项随机对照试验的荟萃分析，比较了放血和干扰素与单纯干扰素治疗慢性丙型肝炎的疗效。检索MEDLINE数据库和Cochrane对照试验注册表，检索词为“静脉切割术”和“丙型肝炎的治疗”。检索讨论铁和丙型肝炎之间相互作用的综述文章列表，以及比较放血加干扰素治疗和单纯干扰素治疗的预期随机对照试验，以确定更多比较放血加干扰素和单独干扰素的随机对照试验。为每个变量生成Peto赔率比及其95%可信区间和Forrest曲线图，以评估提供该信息的研究之间的关系。使用综合荟萃分析2.0版进行统计分析。确定了6个预期的随机对照试验：全部使用持续病毒应答(SVR)作为终点。三项最大的随机对照试验排除了肝硬变患者。两项随机对照试验仅包括铁蛋白过高或肝脏铁含量过高的患者。干扰素的治疗方案各不相同。疗程从6个月到12个月不等。单纯放血加干扰素组和单纯干扰素组在肝硬变患者和1型患者的比例上无差异。放血加干扰素组有50/182(27%)患者出现SVR，而干扰素组有22/185(12%)患者出现SVR。放血加干扰素组发生SVR的优势比为2.7；95%可信区间为1.6~4.5，P<；0.0001。所有5篇以手稿形式发表的随机对照试验显示，在获得SVR方面，采血加干扰素有受益的趋势，荟萃分析的结果不依赖于任何一项随机对照试验，因为排除任何一项随机对照试验都不会改变结果。静脉切开术改善慢性丙型肝炎患者对干扰素治疗的SVR。要证实这一点，需要进行随机对照试验，进行详细的前处理铁研究，并提供适当的动力，以证明统计上的显著好处。
Prospective randomized controlled trials (RCTs) comparing phlebotomy and interferon (IFN) treatment to IFN alone in patients with chronic hepatitis C (CHC) have suggested a benefit for the phlebotomy group. However, statistical significance was achieved in only one of these trials. We performed a meta-analysis of RCTs comparing phlebotomy and IFN to IFN alone for the treatment of CHC. The MEDLINE database and Cochrane registry of controlled trials were searched using the key words "phlebotomy" and "treatment of hepatitis C." Reference lists of review articles discussing the interaction between iron and CHC, and prospective RCTs comparing phlebotomy plus IFN therapy to IFN alone were searched to identify additional RCTs that compared phlebotomy plus IFN to IFN alone. Peto odds ratios with their 95% confidence intervals and Forrest plots were generated for each variable to assess the relationships among the studies that had provided that information. Statistical analysis was performed using Comprehensive META-Analysis version 2.0. Six prospective RCTs were identified: all used sustained viral response (SVR) as an endpoint. The three largest RCTs excluded patients with cirrhosis. Two RCTs specifically included only patients with either high ferritin or high hepatic iron content. IFN treatment regimes varied. Length of treatment varied between 6 and 12 months. The phlebotomy plus IFN group and the IFN group did not differ with respect to the percentage of patients with cirrhosis or genotype 1. SVR was attained in 50/182 (27%) patients in the phlebotomy plus IFN group, compared to 22/185 (12%) patients in the IFN group. Peto odds ratio for SVR in phlebotomy plus IFN group was 2.7; 95% CI 1.6-4.5, P < 0.0001. All five RCTs published in manuscript form showed a trend towards a benefit from the phlebotomy plus IFN in attaining SVR, and the results of the meta-analysis were not dependent on any single RCT, since excluding any single RCT did not change the results. Phlebotomy improves the SVR in response to IFN treatment in patients with CHC. Confirmation of this will require RCT with detailed pre-treatment iron studies and appropriately powered to demonstrate a statistically significant benefit.