炎症性肠病患者英夫利西单抗相关肝损伤的Meta分析

Meta-analysis of Infliximab-Related Liver Injury in Patients with Inflammatory Bowel Disease

目的系统评价炎症性肠病(inflammatory bowel disease,IBD)患者使用英夫利西单抗(infliximab,IFX)后的肝损伤发生率。方法计算机检索PubMed、Embase、Web of Science数据库(均从建库开始至2022年2月28日),检索使用IFX者致肝损伤的临床研究相关文献,并手工检索IFX致肝损相关文献补充纳入研究,采用R软件进行发生率的合并,并做亚组分析。对数据进行异质性检验,以确定采用固定模型或随机模型进行率的合并分析。采用敏感性分析评价研究文献质量对结果的影响,并进行发表偏倚检测。结果共7篇文献入选,总肝损发生率为4%(95%CI:2%~7%)。IFX单用和联用致肝损伤发生率分别为4%(95%CI:1%~11%)和5%(95%CI:2%~13%),克罗恩病(Crohn’s disease,CD)患者和溃疡性结肠炎(Ulcerative Colitis,UC)患者用药后肝损伤发生率分别是3%(95%CI:1%~8%)和12%(95%CI:2%~30%)。结论英夫利西单抗用药者肝损伤的发生率较高,应加强临床用药监测。

OBJECTIVE To systematically evaluate the incidence of liver injury in patients with inflammatory bowel disease(IBD)treated with infliximab(IFX).METHODSSSearching PubMed,Embase,and Web of Science databases(all from the establishment of the database to February 28,2022),and relevant literature on clinical research of liver injury caused by IFX patients were searched and literature related to liver injury caused by IFX were manually searched to supplement the included studies,then using R software to merge the incidence rates and made subgroup analysis.Heterogeneity test was performed on the data to determine whether fixed model or random model was used for the combined analysis of rates.Sensitivity analysis was used to evaluate the impact of the quality of the study literature on the results and to test for publication bias.RESULTSSA total of 7 articles were included,with an overall incidence of liver injury of 4%(95%CI:2%-7%).the incidence of liver injury from IFX alone and in combination was 4%(95%CI:1%-11%)and 5%(95%CI:2%-13%)respectively.The incidence of liver injury following IFX administration was 3%(95%CI:1%-8%)and 12%(95%CI:2%-30%)in patients with Crohn's disease(CD)and ulcerative colitis(UC)respectively.CONCLUSIONThe incidence of liver injury associated with infliximab patients is relatively high and clinical monitoring of drug use should be strengthened.