噻唑烷二酮类对2型糖尿病并发癌症风险的荟萃分析

Influence of oral thiazolidinediones on the concurrent cancer risk in patients with type 2 diabetes: a systematic review and meta-analysis

目的既往相关荟萃分析显示在2型糖尿病中,口服噻唑烷二酮类（TZDS）影响癌症发病率。此次荟萃分析检索相关TZDS对癌症发生率的文献,进一步阐明二者是否存在相关性。方法检索Pubmed及Embase数据库,研究是关于TZDS（吡格列酮,罗格列酮）对2型糖尿病患者癌症发病风险的文献,时限至2014年6月。并运用随机效应模型合并效应量。结果共纳入的文献39项,数据分析显示：TZDS能够显著减少大肠癌、肝癌、胃癌等的发病风险,效应量为RR（相对风险度）分别为：0.88,95%CI（可信区间）（0.78~0.97;I2=80.4%）、0.57,95%CI（0.40~0.73;I2=84.7%）、0.45,95%CI（0.25~0.65;I2=43.4%）;而对于胰腺癌,RR为：0.95,95%CI（0.71~1.20;I2=0%）;只有在膀胱癌中能显著增加膀胱癌的发病风险,RR为：1.18 95%CI（1.01~1.35;I2=61.2%）。结论口服TZDS显著减少大肠癌、肝癌及胃癌的发病风险;对于胰腺癌口服TZDS二者无明显相关性;对于膀胱癌,此类药物能明显增加其发病的风险。

Objective Several meta-analyses have suggested that oral thiazolidinediones（ TZDS）may influence the cancer incidence in patients with type 2 diabetes. In this meta-analysis we aim to clarify and quantify the effect of TZDS on the risk of cancer through summarizing all data with observational studies.Methods We searched the Medline / Pubmed,Embase databases. All observational studies about the oral TZDS（ pioglitazone,rosiglitazone） in patients with diabetes on the risk of cancer published up to June 2014 were included. Pooled effect estimates were derived using a random-effects meta-analysis model.Results Thirth-nine studies were included in this analysis. The results suggested oral TZDS could significantly decrease the incidence of colorectal cancer（ pooled RR： 0. 88,95% CI： 0. 78-0. 97; I2=80. 4%）,liver cancer（ pooled RR： 0. 57,95% CI： 0. 40-0. 73; I2= 84. 7%）,gastric cancer（ pooled RR：0. 45,95% CI： 0. 25-0. 65; I2= 43. 4%）. Oral TZDS had no effect on the incidence of pancreatic cancer（ pooled RR： 0. 95,95% CI： 0. 71-1. 20; I2= 0%）. Oral TZDS could only obviously increase the incidence of bladder cancer（ pooled RR： 1. 18,95% CI： 1. 01-1. 35; I2= 61. 2%）. Conclusion Oral TZDS can significantly decrease the incidence of colorectal,liver,gastric cancer,and obviously increase the incidence of bladder cancer,but has no effect on the incidence of pancreatic cancer.