血清总胆固醇与胃癌发病风险的关系:系统评价和meta分析

Relation between serum total cholesterol and risk of gastric cancer:a systematic review and meta-analysis

目的系统评价和meta分析血清总胆固醇(total cholesterol,TC)水平与胃癌发病风险之间的关系。方法检索PubMed、Embase、Web of Science和Cochrane Library这四大数据库中关于TC水平与胃癌发病风险之间关系的相关研究,时间从建库至2023年3月5日。由两名独立评审员进行文献检索、识别和筛选工作,并进行质量评估和数据提取。通过单独排除每项研究进行敏感性分析,同时以研究类型、研究地区、总样本量、胃癌样本量、随访时间、性别、饮酒和吸烟作为分层条件进行亚组分析。结果meta分析中共纳入12项研究,总计5143671名参与者和40551例胃癌患者。meta分析结果显示,有9项研究报道血清TC水平升高降低胃癌发病风险[OR(95%CI)为0.91(0.85,0.98)],有5项研究报道血清TC水平降低增加胃癌发病风险[OR(95%CI)为1.93(1.17,3.18)];亚组分析结果显示,在队列研究、总样本量(≥400000)和胃癌样本量(≥1000)更大、更长随访时间(≥10年)及饮酒和吸烟的研究中均发现血清TC水平升高降低胃癌发病风险[分别为0.89(0.87,0.92)、0.90(0.87,0.94)、0.90(0.87,0.93)、0.86(0.82,0.90)、0.90(0.87,0.93)和0.90(0.87,0.93)],与整体结果一致,而且在性别亚组中发现,血清TC水平升高时胃癌发病风险在男女之间无统计学意义的差异。结论本系统评价和meta分析结果提示,血清TC水平在135~294 mg/dL(3.49~7.62 mmol/L)范围内时,血清TC水平可能是胃癌发病的保护因素,反之当血清TC水平降低时胃癌发病的风险则可能增加,且这种变化是一个长期且隐匿的过程。

Objective To conduct a systematical evaluation and meta-analysis of the relation between serum total cholesterol(TC)level and the risk of gastric cancer.Methods The PubMed,Embase,Web of Science,and Cochrane Library databases were searched from inception to March 5,2023.Two independent reviewers performed the literature search,identification,and screening,as well as performed the quality assessment and data extraction.Results A total of 12 studies with 5143671 participants and 40551 patients with gastric cancer were included in the meta-analysis.The results of meta analysis showed that 9 studies reported that the elevated serum TC level decreased the risk of gastric cancer[OR(95%CI)was 0.91(0.85,0.98)],and 5 studies reported that the decreased serum TC level increased the risk of gastric cancer[OR(95%CI)was 1.93(1.17,3.18)].Also the results of the subgroup analyses showed that the decreased serum TC level increased the risk of gastric cancer in the studies with cohort study,larger overall sample sizes and gastric cancer sample sizes,with longer duration of follow-up,and in those with habits of alcohol and smoking[0.89(0.87,0.92),0.90(0.87,0.94),0.90(0.87,0.93),0.86(0.82,0.90),0.90(0.87,0.93),and 0.90(0.87,0.93),respectively],which was consistent with the overall results.In contrast,there was no statistical difference in the relation between the elevated serum TC level decreased the risk of gastric cancer between male and female patients in the gender subgroup.Conclusions The results of this systematical evaluation and meta-analysis suggest that serum TC level[135–294 mg/dL(3.49–7.62 mmol/L)]may be a protective factor for gastric carcinogenesis.The risk of gastric carcinogenesis may be increased when serum TC level decreases,and this change is a long-term and insidious process.