慢性乙型病毒性肝炎进展为原发性肝癌危险因素Meta分析

Meta-analysis of risk factors for progression of chronic hepatitis B to primary hepatocellular carcinoma

目的系统评估慢性乙型病毒性肝炎(chronic hepatitis B virus,CHB)进展为原发性肝癌的危险因素。方法检索中国知网、万方、维普、EBSCO、PubMed、Web of Science等数据库,搜集国内外公开发表的有关CHB进展为原发性肝癌危险因素的研究文献,检索时间为自建库至2022年4月6日。应用Stata/SE12.0软件对最终纳入文献数据进行统计分析。结果本研究共纳入文献23篇,中文文献16篇,英文文献7篇,病例组3219例,对照组10160例。Meta分析结果显示,年龄(>50岁)[加权均数差(weighted mean difference,WMD)=8.22,95%CI(3.21~13.22)]、性别(男性)(OR=2.36,95%CI:1.90~2.93)、饮酒史(OR=3.09,95%CI:2.58~3.70)、吸烟史(OR=1.60,95%CI:1.12~2.29)、肝癌家族史(OR=3.18,95%CI:2.18~4.64)、肝硬化家族史(OR=2.90,95%CI:1.55~5.39)、2型糖尿病(OR=2.92,95%CI:1.83~4.67)、脂肪肝(OR=3.04,95%CI:2.25~4.11)、发生肝硬化(OR=6.33,95%CI:4.50~8.91)、不良饮食习惯(OR=2.71,95%CI:2.11~3.48)、经济条件欠佳(OR=3.56,95%CI:2.33~5.45)、e抗原阳性(OR=2.18,95%CI:1.42~3.37)、e抗原阴性(OR=2.60,95%CI:2.03~3.34)、丙氨酸氨基转移酶升高(WMD=23.33,95%CI:6.84~37.82)、病毒突变(OR=2.55,95%CI:1.53~4.25)及乙肝脱氧核糖核酸阳性(OR=3.28,95%CI:2.30~4.67)是CHB进展为原发性肝癌的危险因素。结论CHB进展为原发性肝癌与宿主因素、既往疾病史、家族史、病毒学因素及肝功能指标变化有关,临床应加强对此类CHB患者的监测,早期识别并干预原发性肝癌的高危患者,降低乙肝相关肝癌的发生率及死亡率。

Objective To systematically evaluate the risk factors for the progression of chronic hepatitis B virus(CHB)to hepatocellular carcinoma(HCC).Methods Relevant studies published in China National Knowledge Infrastructure,Wanfang,VIP,EBSCO,PubMed,and Web of Science databases were searched by computer to collect literature on the progression of chronic hepatitis B as a risk factor for HCC published at home and abroad from the time of database construction to April 06,2022.Meta-analysis was performed by Stata/SE 12.0 software.Results Excluding literature that did not meet the inclusion criteria,the study ultimately included 23 research papers,16 in Chinese and 7 in English,with a total of 3219 cases in the case group and 10160 cases in the control group.Meta-analysis results showed that age(>50 years)[WMD=8.22,95%CI(3.21-13.22)],gender(male)(OR=2.36,95%CI:1.90-2.93),history of alcohol consumption[OR=3.09,95%CI(2.58-3.70)],history of smoking(OR=1.60,95%CI:1.12-2.29),family history of HCC(OR=3.18,95%CI:2.18-4.64),family history of liver cirrhosis(OR=2.90,95%CI:1.55-5.39),type 2 diabetes(OR=2.92,95%CI:1.83-4.67),fatty liver(OR=3.04,95%CI:2.25-4.11),liver cirrhosis(OR=6.33,95%CI:4.50-8.91),bad eating habits(OR=2.71,95%CI:2.11-3.48),poor economic condition(OR=3.56,95%CI:2.33-5.45),positive e antigen(OR=2.18,95%CI:1.42-3.37),negative e antigen(OR=2.60,95%CI:2.03-3.34),elevated alanine aminotransferase(WMD=23.33,95%CI:6.84-37.82),virus mutation(OR=2.55,95%CI:1.53-4.25)and positive HBV DNA(OR=3.28,95%CI:2.30-4.67)were risk factors for the progression of CHB to HCC.Conclusions The progression of CHB to HCC is related to host factors,previous disease history,family history,virological factors,and changes in liver function indicators.Clinicians should strengthen the monitoring of such CHB patients,early identify and intervene in high-risk patients for HCC,and reduce the incidence and mortality of HBV-related HCC.