高密度脂蛋白水平与肺癌关联性的Meta分析

Correlation between HDL-C Level and Lung Cancer: A Meta-analysis

目的 系统评价高密度脂蛋白（HDL-C）与肺癌的相关性。方法 计算机检索Pub Med、EBSCO、ISI Web of Science、The Cochrane Library（2015年8期）、VIP和CNKI数据库,搜集高密度脂蛋白胆固醇（HDL-C）与肺癌相关性的研究,检索时间均为建库至2015年9月23日。由2位评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果 共纳入15个研究,包括2 015例患者和15 505例对照。Meta分析结果显示,HDL-C水平与肺癌发病相关[SMD=–0.68,95%CI（–0.97,–0.40）,P=0.000]。亚组分析结果显示,不同临床分级[SMD（-Ⅱ）=–0.65,95%CI（–1.07,–0.23）,P=0.002;SMD（Ⅲ-Ⅳ）=–0.61、95%CI（–0.73,–0.50）,P=0.000]、不同病理类型（除非小细胞肺癌）[SMD（腺癌）=–0.76、95%CI（–1.13,–0.38）,P=0.000;SMD（鳞癌）=–1.51、95%CI（–2.47,–0.56）,P=0.010;SMD（小细胞肺癌）=–1.19、95%CI（–1.42,–0.95）,P=0.000]、不同研究质量评分[SMD（≥6分）=–0.60、95%CI（–0.89,–0.29）,P=0.000;SMD（〈6分）=–0.77、95%CI（–1.48,–0.06）,P=0.015]、不同研究例数[SMD（≥100例）=–0.48、95%CI（–0.80,–0.15）,P=0.004;SMD（〈100例）=–0.80、95%CI（–1.33,–0.27）,P=0.003]、吸烟[SMD=–1.47、95%CI（–2.51,–0.43）,P=0.006]以及亚洲地区[SMD=–0.92、95%CI（–1.21,–0.63）,P=0.000]肺癌的发病均与HDL-C水平相关。结论 HDL水平与肺癌发病相关,低水平HDL-C会增大肺癌的发生风险。鉴于纳入研究的局限性,上述结论尚需进一步开展更多大样本,且调整了吸烟状态的前瞻性队列研究加以验证。

Objective To systematically review the correlation between HDL-C level and lung cancer. Methods Such databases as PubMed, EBSCO, ISI Web of Science, The Cochrane Library （Issue 8, 2015）, VIP, and CNKI Data were electronically searched from inception to September 23th , 2015 to collect studies about the correlation between HDL level and lung cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 12.0 software. Results Fifteen studies involving 2 015 lung cancer patients and 15 505 controls were finally included. The results of meta-analysis showed that the total HDL-C level in the lung cancer group was lower than that in the control group （SMD= -0.68, 95%CI -0.97 to -0.40, P=0.000）. Further subgroup analysis showed that the incidence of lung cancer of different clinical classification （SMD Ⅰ-Ⅱ= -0.65, 95%CI -1.07 to -0.23, P=0.002; SMD Ⅲ-Ⅳ = -0.61, 95%CI -0.73 to -0.50, P=0.000）, different pathological types （the small cell lung cancer excluded） （SMD AC=-0.76, 95%CI -1.13 to -0.38, P=0.000; SMD sc= -1.51, 95%CI -2.47 to -0.56, P=0.010; SMD SCLC= -1.19, 95%CI -1.42 to -0.95, P=0.000）, different quality scores （SMD≥6 score=-0.60, 95%CI -0.89 to -0.29, P=0.000; SMD〈6 = -0.77, 95%CI -1.48 to -0.0, P=0.015）, the number of different studies （SMD≥ 100 cases= -0.48, 95%CI -0.80 to -0.15, P=0.004; SMD〈100 cases= -0.80, 95%CI - 1.33 to -0.27, P=0.003）, smoking （SMD= - 1.47, 95%CI -2.51 to -0.43, P=0.006） and Asia （SMD= -0.92, 95%CI -1.21 to -0.63, P=0.000） was correlated with the level of HDL-C.Conclusion The level of HDL-C is related to the incidence of lung cancer, and low HDL-C level may increase the risk of lung cancer. In view of the limitations of the studies, the above conclusions need a great many large samples and adjust the smoking status of the prospective cohort study at home and abroad to verify.