炎症性肠病合并非酒精性脂肪性肝病危险因素的Meta分析

Risk factors for the coexistence of inflammatory bowel disease and nonalcoholic fatty liver disease: A Meta-analysis

目的评估糖皮质激素、TNF药物、既往炎症性肠病(IBD)相关手术史是否为IBD合并非酒精性脂肪性肝病(NAFLD)的危险因素。方法通过检索Pubmed、Embase、the Cochrane library,以及万方、知网、维普数据库(检索时间跨度为建库至2018年10月),收集关于IBD合并NAFLD的危险因素的临床研究。根据纳入与排除标准,对纳入的文献进行总结和质量评价。采用Revman5. 2软件进行数据处理,异质性数据使用随机效应模型分析,同质性数据使用固定效应模型分析。结果共纳入7篇文献,共1645例患者。Meta分析结果表明,糖皮质激素不是IBD合并NAFLD的危险因素[比值比(OR)=1. 19,95%可信区间(95%CI):0. 90～1. 57,P=0. 23];抗TNF药物也不是IBD合并NAFLD的危险因素(OR=0. 86,95%CI:0. 65～1. 13,P=0. 27); IBD相关手术史为IBD合并NAFLD的危险因素(OR=1. 50,95%CI:1. 09～2. 05,P=0. 01)。结论糖皮质激素、抗TNF药物治疗IBD不是导致NAFLD发生的危险因素,IBD相关手术可能是导致NAFLD发生的危险因素。

Objective To investigate whether glucocorticoids,anti-tumor necrosis factor(anti-TNF)drugs,and a past history of surgical treatment of inflammatory bowel disease(IBD)are the risk factors for the coexistence of IBD and nonalcoholic fatty liver disease(NAFLD).Methods PubMed,Embase,Cochrane Library,Wanfang Data,CNKI,and VIP were searched for clinical trials of the coexistence of IBD and NAFLD published up to October 2018.The articles included were summarized and quality assessment was performed according to inclusion and exclusion criteria.RevMan 5.2 was used for data processing;the random effects model was used for data with heterogeneity,and the fixed effect model was used for data with homogeneity.Results A total of 7 articles were included,with 1645 patients.The meta-analysis showed that glucocorticoids might not be a risk factor for the coexistence of IBD and NAFLD(odds ratio(OR)=1.19,95%confidence interval(CI):0.90-1.57,P=0.23);anti-TNF drugs were not a risk factor for the coexistence of IBD and NAFLD(OR=0.86,95%CI:0.65-1.13,P=0.27);a past history of surgical treatment of IBD was a risk factor for the coexistence of IBD and NAFLD(OR=1.50,95%CI:1.09-2.05,P=0.01).Conclusion Glucocorticoids and anti-TNF drugs for the treatment of IBD may not increase the incidence rate of the coexistence of IBD and NAFLD,while surgical treatment for IBD may increase this incidence rate.