| 【Background】Chronic hepatitis B(CHB)is a infectious disease caused by hepatitis B virus(HBV).According to the World Health Organization,about 2 billion people,among whom there were 350 million people that manifested chronic HBV infection and 1 million people that died from end-stage liver disease,including decompensated liver cirrhosis,liver failure and hepatocellular carcinoma,had been infected with HBV all over the world.Therefore,chronic HBV infection has been a serious global health problem for many years.China is called hepatitis B country,as in 2006 a study showed that hepatitis B surface antigen(HBsAg)positive rate was 7.18% in the general population aged 1 to 59 years in China.As shown by other data,new cases of HBV infection appeared to be reducing but we should not be blindly optimistic because of the large number of existing patients.Thus patients with chronic hepatitis B still need our special attention.The overall goals for treatment of chronic hepatitis B is to maintain inhibition of HBV by making best effort,relieve hepatocellular inflammation-necrosis and hepatic fibrosis,delay and reduce occurance of liver decompensation,cirrhosis,HCC and their complications,thereby improving patients’ quality of life and extend their survival time.Antiviral was recognized as the key to achieve the treatment goals above,in addition,the latest clinical guidelines put forward a new goal of "clinical cure" and proposed to prolong period of antiviral agents’ administration,therefore,the safety of agents became particularly important.We should note that,HBV can not only lead to chronic hepatitis,liver cirrhosis and other liver damage,but also affect renal function through immune mediators,and HBV-related glomerular disease became an important reason why end-stage renal disease and renal replacement therapy happened in chronic hepatitis B patients.The risk of chronic kidney disease was closely related with age,diabetes,hypertension and obesity,of which incidence was increasing as the aging population in china,for the long-term goal of hepatitis B treatment,therefore,how to make antiviral programs for the paitiets with CKD or(and)its risk factors was already an important proposition.The evidence of Ldt can significantly improve estimated GFR(eGFR)was very adequate but the effects on eGFR of entecavir was contradict with each other in different studies,therefore,this systematic review was conducted and aimed to solve this issue.【Objective】To evaluate the effect of entecavir on eGFR in antiviral-na?ve patients with chronic hepatitis B after one year treatment.【Methods】1.PubMed,EMBASE,Cochrane Library,National Knowledge Infrastructure(CNKI),Wanfang Database and VIP database were retrieved.2.The inclusion criteria were developed and under the guidance of the inclusion and exclusion criteria the literatures were screened.3.The imformation was extracted from finally included literatures.4.The methodological quality of the literatures was assesed by the Cochrane collaboration’s tool for assesing risks of bias and the NOS(The Newcastle-Ottawa Scale)for RCTs and non-RCTs respectively.5.The intervention effects were Meta analysed by RevMan5.3 and qualitative analysis was conducted when the literatures didn’t meet requirement of Meta analysis.【Results】1.After carefully screening,finally 11 studies met the inclusion criteria and were included in the meta-analysis.The overall methodological quality of the literatures is of good.2.6 studies were used to compare the effects of entecavir and telbivudine on eGFR after 1 year treatment and the result of Meta-analysis showed that standardized mean difference [95% confidence interval(CI)] between group entecavir and group telbivudine was-0.31 [-0.45,-0.17].3.11 studies were used to compare the eGFR difference between after and before 1 year entecavir therapy and the result of Meta-analysis showed that standardized mean difference[95%CI] between group after treatment and group before treatment was 0.04 [-0.14,0.22].4.The result of Meta-analysis of non-RCTs subgroup consisting of 7 studies showed that the overall standardized mean difference and 95% CI were-0.13 [-0.21,-0.04],the result of Meta-analysis of the RCTs subgroup consisting of 4 studies showed that the overall standardized mean difference and its 95% CI were 0.27 [-0.27,0.80].5.The result of Meta-analysis of the MDRD subgroup of the seven studies showed that the overall standardized mean difference and its 95% CI were-0.12 [-0.20,-0.03] and the result of Meta-analysis of non-MDRD subgroup consisting of four studies showed that the overall standardized mean difference and 95% CI were 0.20 [-0.35,0.75].6.One study showed that the non-antiviral cohort and entecavir cohort eGFR,which was based on MDRD equation,decreased by 0.692 ml / min / 1.73 m~2 and 0.002 ml / min / 1.73 m~2 respectively after one year treatment.【Conclusions】1.In improving patients’ eGFR,entecavir was inferior to telbivudine.2.Patients’ eGFR tend to decrease after 1 year treatment of entecavir.3.Entecavir can buffer the rate of eGFR decrease in the patients with chronic hepatitis B. |
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