摘要
目的系统评价他汀类药物与慢性病毒性肝炎进展为肝硬化、肝癌以及死亡风险之间的关系。方法计算机检索PubMed、The Cochrane Library、万方数据库、CNKI全文数据库及维普数据库,收集他汀类药物与慢性乙型及丙型病毒性肝炎患者预后关系的流行病学研究,采用Stata12.0统计软件对纳入的文献进行Meta分析。结果纳入10项研究,共计500 797例患者,均为队列研究,其中,与慢性乙型病毒性肝炎相关的研究共3篇,共100 012例患者,与慢性丙型病毒性肝炎相关的研究共7篇,共400 785例患者。研究组为应用他汀类药物的慢性病毒性肝炎患者,对照组未应用他汀类药物。Meta分析结果如下:(1)与对照组相比,他汀类药物治疗可使慢性乙型及丙型病毒性肝炎进展为肝硬化的风险降低72%(OR=0.28,95%CI 0.27～0.30,P<0.05),进展为肝癌的风险降低48%(OR=0.52,95%CI0.48～0.56,P<0.05),但与死亡的风险无明显相关(OR=0.92,95%CI0.76～1.11,P>0.05);(2)亚组分析显示,他汀类药物可使慢性乙型病毒性肝炎进展为肝癌风险降低46%(OR=0.54,95%CI 0.46～0.63,P<0.05);他汀类药物可使慢性丙型病毒性肝进展为肝硬化的风险降低72%(OR=0.28,95%CI 0.27～0.29,P<0.05),进展为肝癌的风险降低49%(OR=0.51,95%CI0.48～0.56,P<0.05)。结论他汀类药物可以明显降低慢性乙型及丙型病毒性肝炎进展为肝硬化及肝癌的风险,但对患者死亡无明显影响。
Objective To systematically evaluate the association between statin therapy and the risk of cirrhosis,hepatocellular carcinoma and mortality in patients with chronic viral hepatitis. Methods The PubMed,the Cochrane Library,Wanfang Database, Chinese Journal Full Text Database（ CKNI）, Database for Chinese Technical Periodical（ VIP） were searched for the studies in evaluating the effect of statins on chronic viral hepatitis. A meta-analysis was performed by using Stata 12. 0 software. Results Ten cohort studies involving 500 797 patients fulfilled the inclusion criteria, of which seven were articles related to chronic viral hepatitis C including 400 785 subjects,and the other three studies were articles related to chronic viral hepatitis B including 100 012 subjects. Among these cohort studies, study groups used statin therapy and control groups received no treatment. Meta-analysis results were as follows.（1） Chronic viral hepatitis patients with statin use were found to be associated with 72% reduced risk of cirrhosis（ OR =0. 28,95% CI 0. 27 ～0. 30,P〈0. 05） and 48% reduced risk of hepatocellular carcinoma（ OR = 0. 52.95% CI 0. 48 ～ 0. 56, P〈0. 05）, but there are no significant relationships between statin therapy and mortality（OR =0. 92,95% CI 0. 76 ～1. 11.P〈0. 05）.（2） Subgroup analysis suggested that statins can reduce the risk of hepatocellular carcinoma by 46% in chronic hepatitis B patients（ OR =0. 54,95% CI 0. 46 ～0. 63,P〈0. 05）and the risk of cirrhosis by 72% in chronic hepatitis C patients（ OR=0. 28,95% CI 0. 27 ～0. 29,P〈0. 05） and the risk of hepatocellular carcinoma by 49% in chronic hepatitis C patients（OR =0. 51,95% CI 0. 48 ～ 0. 56,P〈0. 05）. Conclusion Statin therapy can lower the risk of cirrhosis, hepatocellular carcinoma among chronic viral hepatitis patients,but there was no significant impact on the death of the patient
作者
郁冰清
李玉婷
汤绍辉
YU Bingqing, LI Yuting, TANG Shaohui(Department of Digestive, the First Affiliated Hospital of Jinan University,Guangdong Province,Guangzhou 510630,China)
出处
《疑难病杂志》
CAS
2018年第7期719-724,共6页
Chinese Journal of Difficult and Complicated Cases
