肝硬化患者经颈静脉肝内门体分流术与肝细胞癌发生相关性的meta分析

摘要/Abstract

摘要： 目的评价肝硬化患者接受TIPS治疗与HCC的发生风险。方法检索建库至2021年9月PubMed、Embase、Cochrane Library、Web of Science、CNKI、万方、CBM和VIP数据库,纳入TIPS治疗与非TIPS治疗肝硬化患者HCC发生的随机对照研究、病例对照研究、队列研究以及横断面研究,根据Cochran系统评价方法提取文献资料,NOS量表或改良Jadad量表评价文献质量,采用RevMan5.3软件进行meta分析。结果最终纳入8项研究共1780例患者,其中TIPS治疗组755例,非TIPS治疗组1025例。采用随机效应模型合并分析结果显示,TIPS治疗患者与非TIPS治疗患者HCC发生率分别为13.64%(103/755)与13.56%(139/1025)。与非TIPS治疗患者相比,TIPS治疗不会增加HCC发生风险(OR: 1.65, 95% CI:0.69～2.06,P=0.52)。亚组分析显示:病毒性肝硬化超过或低于50%亚组及覆膜支架为主亚组中,TIPS治疗也不会增加HCC发生风险(均P>0.05);而裸支架为主亚组中,TIPS治疗组发生HCC的风险是非TIPS治疗组的1.57倍,差异有统计学意义(95% CI: 1.06～2.34,P=0.03)。结论随着覆膜支架广泛应用,TIPS不会增加肝硬化患者HCC的发生风险。

关键词: 经颈静脉肝内门体分流术, 肝细胞癌, 肝硬化, meta分析

Abstract: Objective To investigate the incidence of hepatocellular carcinoma (HCC) among liver cirrhosis patients whether treated by transjugular intrahepatic portal shunt (TIPS). Methods Randomized controlled trial, case control studies, chohort studies or cross-sectional study on HCC occurrence in TIPS group and non-TIPS group were retrieved from PubMed, Embase, Cochrane Library, Web of Science, CNKI, WANFANG, CBM and VIP databases. Literature was extracted according to Cochran systematic evaluation method, and NOS scale was used to evaluate literature quality and conduct statistical analysis. Meta-analysis was performed by RevMan5.3. Results A total of 8 studies involving 1,780 patients (755 in TIPS group and 1025 in non-TIPS group) were included. The results of random effects model showed that the incidence rates of HCC in the TIPS and non-TIPS groups were 13.64% (103/755) and 13.56% (139/1025) respectively. There was no significant difference between the 2 groups (OR: 1.65, 95%CI: 0.69 ~ 2.06; P=0.52). Subgroup analysis showed that in viral cirrhosis and mainly covered stents subgroups, there was no significant correlation between TIPS and the occurrence of HCC (P>0.05). However, in mainly bare stents subgroup, the risk of HCC was 1.57 times higher in the TIPS group than that in the non-TIPS group, and the difference was statistically significant (95%CI: 1.06 ~ 2.34, P=0.03). Conclusion Based on current researches, with the widespread application of covered stents in TIPS, the risk of HCC in patients with cirrhosis will not increase.

Key words: Portasystemic Shunt, Transjugular Intrahepatic, Hepatocellular carcinoma, Liver Cirrhosis, Meta-Analysis

慕之勇, 刘钰懿, 王军, 陈东风, 文良志. 肝硬化患者经颈静脉肝内门体分流术与肝细胞癌发生相关性的meta分析[J]. 肝脏, 2022, 27(9): 978-982.

MU Zhi-yong, LIU Yu-yi, WANG Jun, CHEN Dong-feng, WEN Liang-zhi. Correlation between transjugular intrahepatic portal shunt and hepatocellular carcinoma: A systematic review and meta-analysis[J]. Chinese Hepatolgy, 2022, 27(9): 978-982.

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