Meta Analysis On The Clinical Efficacy Of Two Strategies For The Treatment Of Liver Fibrosis Caused By HBV

Objective:Conventional antiviral schemes for chronic hepatitis B include nucleoside/nucleotide analogues and interferon alpha.Whether they have an effect on fibrosis in the course of antiviral therapy that was controversial in different reports.Therefore,we used meta-analysis method to explore the clinical efficacy of two strategies(interferon alpha and Fuzheng Huayu capsule combined with nucleotide)in the treatment of liver fibrosis caused by HBV.Methods:We got RCTS of two strategies(interferon alpha and Fuzheng Huayu capsule combined with nucleotide)in the treatment of liver fibrosis caused by HBV after searching China national knowledge internet(CNKI),China biomedical database(CBM),Wan Fang,Chongqing VIP(CQVIP),Pub Med,Embase database.The data published from the establishment to November 30,2016.Jadad score was used to evaluate the quality of data.Rev Man5.0 software was used to perform meta analysis.The odds ratio(OR)and the mean difference(MD)or standard mean difference(SMD)were used to calculate the 95% confidence interval(CI).The fixed effect model was used by meta analysis when the results of literature heterogeneity test were P>0.05 and I2<50%,otherwise the random effect model was adopted.Funnel plot was used to evaluate publication bias.Results:(1).Ten RCTs(812 patients)were included in the strategy of IFN-α.The methodological quality was generally low.Results of Meta-analysisshowed that the IFN-α treatment group could significantly reduce the HA(standard mean difference-1.61[-2.03,-1.18])and LN(standard mean difference-0.88[-1.15,-0.62])and PC-III(standard mean difference-1.09[-1.56,-0.62])and IV-C(standard mean difference-1.08 [-1.45,-0.70]).The IFN-α treatment group had definite effect on decreasing ALT(mean difference-5.59[-12.32,1.15])and raising ratio of HBe Ag seroconversion(odds ratio 6.76[4.12,11.12])as well as decreasing HBV-DNA to undetectable level(odds ratio 8.64[4.48,16.68]).(2).Ten RCTs(896 patients)were included in the strategy of Fuzheng Huayu capsule combined with nucleotide.A total of 896 patients were treated by Fuzheng Huayu capsule combined with nucleotide.The methodological quality was generally low.Results of Meta-analysis showed that the combined therapy could significantly reduce the HA(standard mean difference-0.78[-1.07,-0.49])and LN(standard mean difference-0.76[-1.12,-0.39])and PC-III(standard mean difference-0.65[-0.80,-0.50)])and IV-C(standard mean difference-0.84,[-1.00,-0.69]).The combined therapy had definite effect on decreasing ALT(mean difference-6.98[-12.78,-1.19])and decreasing HBV-DNA to undetectable level(odds ratio 1.63[1.11,2.39]),but it can not raise the ratio of HBe Ag seroconversion(odds ratio 1.58[0.99,2.53)]).The combined therapy could also significantly reduce the portal vein diameter(standard mean difference-1.56[-0.97,-0.15])and the thickness of spleen(standard mean difference-1.08[-1.62,-0.54)].the liver stiffness valuesmeasured by Fibroscan was not different significant(mean difference-6.51[-17.59,4.58]).Conclusion:The meta analysis showed the clinical effect of IFN-α and Fuzheng Huayu capsule combined with nucleotides in the treatment of liver fibrosis caused by HBV.Both of these strategies were worthy to further promotion.But the clinical RCTs are relatively small,the RCTS of multi center,large sample,high quality need to further study.