他汀类药物对慢性肝病肝细胞癌风险影响的Meta分析

Meta-analysis of the effects of statins on the risk of chronic liver disease and hepatocellular carcinoma

目的评价在慢性肝病患者中他汀类药物的应用与肝细胞癌风险的关系。方法检索PubMed、The Cochrane Library、Embase、Web of Science、维普、万方医学网、中国知网数据库。收集有关他汀类药物与慢性肝病患者肝癌发生风险的文献,检索截止时间为2020年2月。2名研究者独立进行文献筛选、提取数据、质量评价并校对,用RevMan5.3软件进行数据分析。采用I2结合χ^(2)检验评价异质性;采用漏斗图评估纳入文献的发表偏倚。结果共纳入12篇文献。他汀类药物的使用可显著降低慢性肝病患者的肝癌发病风险(OR=0.50,95%CI:0.43~0.58,P<0.01)。亚组分析显示在慢性乙型肝炎(OR=0.56,95%CI:0.47~0.66,P<0.01)及慢性丙型肝炎(OR=0.56,95%CI:0.45~0.71,P<0.01)患者中,他汀类药物均可降低肝癌的发病率;亲脂性他汀类药物降低慢性肝病进展至肝癌风险的效果显著(OR=0.48,95%CI:0.39~0.59,P<0.01),但亲水性他汀类药物并未降低慢性肝病进展为肝癌的发病率,差异无统计学意义(OR=0.64,95%CI:0.36~1.14,P=0.13)。结论他汀类药物可有效降低慢性肝病患者进展为肝癌的风险,包括慢性乙型、丙型病毒性肝炎患者。其中,亲脂性他汀类药物对慢性肝病进展为肝癌的预防作用显著,但亲水性他汀类药物作用不明显。

Objective To evaluate the relationship between the application of statins and the risk of hepatocellular carcinoma in patients with chronic liver disease.Methods PubMed,the Cochrane Library,EMBASE,Web of science,WeiPu,Wanfang Med online,and China National Knowledge Infrastructure database were searched.The literatures about statins and the risk of hepatocellular carcinoma in patients with chronic liver disease were collected,with a search deadline of February 2020.Two researchers independently conducted literature screening,data extraction,quality evaluation and proofreading.RevMan5.3 software was used for data analysis.The I2 combined withχ^(2) test was used to evaluate the heterogeneity.Funnel plots were used to evaluate the publication bias of the included literature.Results A total of 12 articles were included.Statins application had significantly reduced the risk of hepatocellular carcinoma in patients with chronic liver disease(OR=0.50,95%CI:0.43~0.58,P<0.01).Subgroup analysis showed that statins had reduced the incidence rate of hepatocellular carcinoma in patients with chronic hepatitis B(OR=0.56,95%CI:0.47~0.66,P<0.01)and chronic hepatitis C(OR=0.56,95%CI:0.45~0.71,P<0.01).Lipophilic statins had significantly reduced the risk of chronic liver disease development to hepatocellular carcinoma(OR=0.48,95%CI:0.39~0.59,P<0.01),but hydrophilic statins did not reduce the incidence rate of chronic liver disease development to hepatocellular carcinoma,and the difference was not statistically significant(OR=0.64,95%CI:0.36~1.14,P=0.13).Conclusion Statins can effectively reduce the risk of hepatocellular carcinoma development in patients with chronic liver disease,including chronic hepatitis B and C.Among them,the lipophilic statins have a significant preventive effect on the development of chronic liver disease to hepatocellular carcinoma,but hydrophilic statins have no obvious effect.