糖尿病与胆管细胞癌发病关系的meta分析

Diabetes mellitus and risk of cholangiocarcinoma: a meta-analysis

目的通过meta分析来评估糖尿病和胆管细胞癌之间的关系,确定糖尿病是否为胆管细胞癌危险因素,为以后临床预防及保健提供循证医学证据。方法我们对EMBASE,PubMed和Cochrane图书馆数据库进行了全面检索,确定从建库到2018年8月所有关于糖尿病和胆管细胞癌风险之间关系的所有文章。两名独立研究人员独自从研究中提取数据。使用纽卡斯尔-渥太华量表(NOS)评估纳入研究的质量。采用DerSimonian-Laird方法计算95%置信区间的相对危险度(RR)。RR值小于1表明暴露因子是疾病的保护性因子。相反,RR值大于1表明暴露因子是该疾病的危险因子。结果通过数据库检索,共识别出1985份记录,最终确认有25项研究符合纳入标准,包括19项病例对照和6项队列研究。荟萃分析显示,糖尿病增加了胆管细胞癌74%的风险(RR=1.74;95%可信区间1.52~2.00)。糖尿病也增加肝内胆管细胞癌86%的风险(RR=1.86;95%CI:1.63~2.13)和肝外胆管癌76%的风险(RR=1.76;95%CI:1.54~2.02)。在所有纳入的研究中均未发现明显的发表偏倚。结论在本系统评价和荟萃分析中,糖尿病与胆管细胞癌风险增加之间存在关联(包括肝内胆管细胞癌及肝外胆管细胞癌)。

Objective We conducted a systematic review and meta-analysis to evaluated the association between diabetes mellitus and cholangiocarcinoma.Methods We conducted a comprehensive search of the literature included in the EMBASE,PubMed, and Cochrane Library database before August 2018.The information were extracted from the included studies by two investigators work alone.The Newcastle-Ottawa Scale (NOS) scale was used to assess the quality of the included studies.The pooled relative risk (RR) with 95% confidence intervals (CI) were calculated by the DerSimonian-Laird method.The RRvalue greater than 1 indicates that the exposure factor is a protective factor for the disease.Conversely,the RRvalue of less than 1 indicates that the exposure factor is a risk factor for the disease.Results A total of 1985 records were identified through database searching,twenty-five studies were eventually considered to meet the inclusion criteria.The meta-analysis indicated that diabetes increased risk of CCA(RR= 1.74;95%CI 1.52 ~ 2.00).Diabetes mellitus was also associated with an 86%(RR= 1.86;95%CI:1.63 ~ 2.13) and a 76%(RR= 1.76;95%CI:1. 54 ~ 2.02) increased risk of ICC and ECC,respectively.No significant publication bias was seen in any of the enrolled studies.Conclusion Diabetes mellitus was considered a risk factor for cholangiocarcinoma by calculating the results of the meta-analysis,particularly in the ECC.