HBV感染者HBs Ag、抗-HBs双阳性对肝细胞癌发生影响的Meta分析

Influence of dual positivity of HBsAg and anti-HBs on the development of hepatocellular carcinoma in patients with chronic hepatitis B: A Meta-analysis

目的探讨HBV感染者HBsAg、抗-HBs双阳状态对肝细胞癌(HCC)发生的影响。方法 检索PubMed、Embase、Cochrane Library英文数据库及中国知网、万方中文数据库1975年7月1日-2019年3月27日发表的有关血清HBsAg、抗-HBs双阳状态对HCC发生风险的文献。采用RevMan5.3和Stata11.2软件对纳入文献数据进行统计分析。对纳入的各研究进行异质性分析,如果各研究间存在显著异质性,则采用随机效应模型分析;若各研究间异质性不显著,则采用固定效应模型分析。比值比(OR)和相应的95%可信区间(95%CI)被用于评估HBsAg、抗-HBs双阳状态与HCC发生的关系。采用Begg漏斗图和Egger检验进行发表偏倚分析。通过每次去除一篇文献的敏感性分析方法评估Meta分析的质量和可信度。结果 最终纳入4篇文献,其中2项研究来自韩国人群,2项研究来自中国人群,共3042例患者。Meta分析结果显示,HBsAg、抗-HBs双阳状态与HCC发生之间无显著性关联(OR=1.46,95%CI:0.76~2.80, P =0.25)。基于国别的亚组分析显示,在韩国人群中,双阳状态与HCC发生之间存在显著性关联(OR=2.67,95%CI:1.61~4.43, P =0.000 1);而在中国人群中无显著性关联(OR=0.89,95%CI:0.48~1.64, P =0.70)。结论 HBsAg、抗-HBs双阳状态与HCC发生无明显关联,未来需更多研究证实这一可能。

Objective To investigate the influence of dual positivity of HBsAg and anti-HBs on the development of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) infection. Methods PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data were searched for articles on the influence of dual positivity of HBsAg and anti-HBs on the risk of HCC published from July 1, 1975 to March 27, 2019. RevMan5.3 and Stata11.2 were used for statistical analysis of data. A heterogeneity analysis was performed for the studies included;a random effects model was used in case of significant heterogeneity, and a fixed effects model was used in case of non-significant heterogeneity. Odds ratio (OR) and corresponding 95% confidence interval (CI) were used to investigate the association of dual positivity of HBsAg and anti-HBs with the development of HCC. Begg funnel plots were used to investigate publication bias. By removing one article each time, the sensitivity analysis was used to assess the quality and reliability of the Meta-analysis. Results A total of 4 articles were included, with 2 studies in the Korean population and 2 in the Chinese population, and there were 3042 patients in total. The meta-analysis showed that there was no significant association between dual positivity of HBsAg and anti-HBs and the development of HCC (OR=1.46, 95%CI: 0.76-2.80, P =0.25). A country-based subgroup analysis showed significant association between dual positivity of HBsAg and anti-HBs and the development of HCC in the Korean population (OR=2.67, 95%CI: 1.61-4.43, P =0.000 1), while no significant association was found in the Chinese population (OR=0.89, 95%CI: 0.48-1.64, P =0.70). Conclusion There is no significant association between dual positivity of HBsAg and anti-HBs and the development of HCC, and further studies are needed in future.