慢性乙型肝炎合并非酒精性脂肪性肝病对肝细胞癌发生及全因死亡影响的meta分析

摘要/Abstract

摘要： 目的探讨慢性乙型肝炎(CHB)合并非酒精性脂肪性肝病(NAFLD)对肝细胞癌(HCC)发生及全因死亡的影响。方法检索建库至2021年12月在中国知网(CNKI)、万方中文数据库、中国生物医学文献数据库(CBM)、维普中文数据库以及Pubmed、Cochrane、Embase英文数据库发表的相关文献,并辅以手工检索参考文献的方法进行文献补充。采用RevMan5.3和Stata16.0统计软件对纳入文献数据进行meta分析。对纳入的各项研究进行统计分析,若异质性显著,则采用随机效应模型;若异质性不显著,则采用固定效应模型。相对危险度(RR)及其95%可信区间(95%CI)用于评估NAFLD与CHB患者发生HCC及全因死亡的关系,并进行发表偏倚检测及敏感性分析。结果共纳入9篇文献,其中NAFLD对CHB患者HCC发生风险影响的相关文献8篇,NAFLD对CHB患者全因死亡影响的相关文献3篇。结果显示,与CHB组相比,CHB合并NAFLD组患者HCC发生风险增加(RR=1.93, 95%CI: 1.05-3.55, P=0.04),但两组全因死亡风险(RR=1.38, 95%CI: 0.34-5.69, P=0.65)无显著差异。结论在CHB患者中,NAFLD会增加HCC发生风险,而对全因死亡风险无明显影响,未来需要更多大样本、高质量、多中心的队列研究进一步证实。

关键词: 慢性乙型肝炎, 非酒精性脂肪性肝病, 肝细胞癌, 全因死亡, meta分析

Abstract: Objective To investigate chronic hepatitis B (CHB) combined with nonalcoholic fatty liver disease (NAFLD) on hepatocellular carcinoma (HCC) and all-cause mortality. Methods Literature search was conducted in CNKI, Wanfang Chinese Database, China Biomedical Literature Database (CBM), VIP Chinese Database and Pubmed, Cochrane, Embase English Database from the establishment of the database to December 2021, as well as the related literatures supplemented by manual reference search. RevMan5.3 and Stata16.0 were used for meta-analysis. Statistical analysis was performed for all the included studies. The random effect model was used if the heterogeneity was significant; The fixed effect model was used if the heterogeneity was not significant. The relative risk (RR) and its 95% confidence interval (95%CI) were used to investigate the association of NAFLD with the development of HCC and all-cause mortality in CHB patients, and the publication bias test and sensitivity analysis were carried out. Results A total of 9 literatures were included, 8 were about the influence of NAFLD on the risk of HCC in CHB patients and 3 were about the influence of NAFLD on all-cause mortality in CHB patients. The results showed that compared with the CHB group, the CHB combined with NAFLD group had a higher risk of HCC (RR=1.93, 95%CI: 1.05-3.55, P=0.04), but the risk of all-cause mortality in the two groups (RR=1.38, 95%CI: 0.34-5.69, P=0.65) was not significantly different. Conclusion In CHB patients, NAFLD increases the risk of HCC, but has no significant effect on the risk of all-cause mortality. More large-sample, high-quality, multicenter cohort studies are needed in the future.

Key words: Chronic hepatitis B, Nonalcoholic fatty liver disease, Hepatocellular carcinoma, All-cause mortality, Meta-analysis

苏佩华, 魏梦平, 赵彩彦. 慢性乙型肝炎合并非酒精性脂肪性肝病对肝细胞癌发生及全因死亡影响的meta分析[J]. 肝脏, 2023, 28(3): 299-304.

SU Pei-hua, WEI Meng-ping, ZHAO Cai-yan. Influence on chronic hepatitis B combined with nonalcoholic fatty liver disease on the development of hepatocellular carcinoma and all-cause mortality: A meta-analysis[J]. Chinese Hepatolgy, 2023, 28(3): 299-304.

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