阿司匹林对病毒性肝炎患者肝癌发生率影响的Meta分析

朱顺; 李志国; 李硕; 曹旭; 李晓斌; 李小科; 叶永安

doi:10.3969/j.issn.1001-5256.2021.05.024

阿司匹林对病毒性肝炎患者肝癌发生率影响的Meta分析

DOI: 10.3969/j.issn.1001-5256.2021.05.024

朱顺¹,
李志国²,
李硕¹,
曹旭¹,
李晓斌¹,
李小科^1, ,,
叶永安^1, ,

1.
北京中医药大学东直门医院脾胃病科，北京 100700
2.
北京市丰台中西医结合医院消化科，北京 100072

基金项目:

国家科技重大专项“十三五”课题 (2018ZX10725-505-001);

国家自然科学基金青年科学基金项目 (81804033);

北京中医药大学科研创新团队项目 (2019-JYB-TD-009)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：朱顺、李志国、李晓斌负责设计研究，资料分析，撰写论文；朱顺、李硕、曹旭参与检索文献，数据提取，修改论文；李小科、叶永安负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

作者简介:
朱顺(1995—)，男，主要从事中医药治疗慢性肝病方面的研究

通信作者:
李小科，lixiaoke@vip.163.com

叶永安，yeyongan@vip.163.com

中图分类号: R512.6; R735.7
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- 文章访问数: 476
- HTML全文浏览量: 196
- PDF下载量: 59
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-23
- 录用日期: 2020-11-23
- 出版日期: 2021-05-20

Effect of aspirin on the incidence rate of liver cancer in patients with viral hepatitis: A Meta-analysis

Shun ZHU¹,
Zhiguo LI²,
Shuo LI¹,
Xu CAO¹,
Xiaobin LI¹,
Xiaoke LI^{1
, ,},
Yongan YE^{1
, ,}

1.
Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
2.
Department of Gastroenterology, Fengtai Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100072, China

摘要

摘要: 目的评价阿司匹林的使用对病毒性肝炎患者肝癌发生率的影响。方法检索PubMed、Web of Science、Cochrane Library英文数据库，收集建库至2020年7月15日关于病毒性肝炎患者使用阿司匹林与肝癌发生率的研究。选择风险比(HR)和95%CI作为汇总指标。用RevMan 5.3进行Meta分析、对不能合并的数据采用描述性分析。结果共纳入9篇文献，涉及132 066例病毒性肝炎患者。结果表明使用阿司匹林的病毒性肝炎患者肝癌发生率降低31%(HR=0.69，95%CI: 0.65~0.74，P＜0.000 01)；4项研究报道了消化道出血发生率，表明使用阿司匹林未显著增加病毒性肝炎患者消化道出血风险(P＞0.05)。结论接受阿司匹林治疗可能有利于降低病毒性肝炎患者肝癌发生率，未显著增加包括肝硬化人群在内的消化道出血风险，对于减少肝癌的发生可能具有积极意义，但该临床现象背后的机制尚不明确，且仍需更多临床观察以验证其安全性和有效性。
- 肝炎, 病毒性, 人 /
- 阿司匹林 /
- 癌, 肝细胞 /
- Meta分析(主题)
Abstract: Objective To evaluate the effect of the use of aspirin on the incidence rate of liver cancer in patients with viral hepatitis. Methods English databases including PubMed, Web of Science, and Cochrane Library were searched for studies on the use of aspirin and the incidence rate of liver cancer in patients with viral hepatitis published up to July 15, 2020. Hazard ratio (HR) and 95% confidence interval (CI) were selected as pooled indicators. RevMan 5.3 was used to perform the Meta-analysis, and a descriptive analysis was performed for data that could not be pooled. Results Nine studies were included, involving 132 066 patients with viral hepatitis. The results showed that the incidence rate of liver cancer was reduced by 31% in the patients with viral hepatitis who were treated with aspirin (HR=0.69, 95% CI: 0.65-0.74, P < 0.000 01). Four studies reported the incidence rate of gastrointestinal bleeding, suggesting that the use of aspirin did not significantly increase the risk of gastrointestinal bleeding in patients with viral hepatitis(P > 0.05). Conclusion Aspirin therapy may help to reduce the incidence rate of liver cancer in patients with viral hepatitis and does not significantly increase the risk of gastrointestinal bleeding in such patients and the patients with liver cirrhosis. Aspirin may have a positive significance in reducing liver cancer, but the mechanism behind this clinical phenomenon remains unclear, and therefore, more clinical observation studies are needed to verify its safety and efficacy.
- Hepatitis, Viral, Human /
- Aspirin /
- Carcinoma, Hepatocellular /
- Meta-Analysis as Topic

HTML全文

图 1 文献筛选流程

下载: 全尺寸图片幻灯片

图 2 使用阿司匹林与肝癌发生率的Meta分析结果

下载: 全尺寸图片幻灯片

表 1 Meta分析纳入文献的基本特征

纳入研究	地区	研究类型	随访时间	阿司匹林使用定义	随访人数	人群
Simon等^[21](2020)	瑞典	队列研究	中位随访期7.9年	低剂量(75 mg或160 mg)，≥90 DDDs	50 275	HBV/HCV
Liao等^[22](2020)	中国台湾	队列研究	最长随访期≥12年	NA	3822	HCV
Wu等^[23](2020)	中国台湾	队列研究	最长随访期≥5年	≥90 DDDs	9417	HCV
Lee等^[24](2020)	中国台湾	队列研究	最长随访期≥5年	规律用药≥90 d	7434	HCV
Lee等^[25](2019)	中国台湾	队列研究	最长随访期≥5年	规律用药≥90 d	10 615	HBV
Simon等^[26](2019)	瑞典	队列研究	中位随访期8.5年	剂量＜162 mg且≥30 DDDs	18 368	HBV/HCV
Du等^[27](2019)	中国	队列研究	中位随访期4.5年	术后7 d内开始服用，剂量为100 mg/d且持续≥1年	264	HBV/HCV
Hwang等^[28](2018)	韩国	队列研究	中位随访期4年	≥30 DDDs	31 528	病毒性肝炎
Lee等^[29](2017)	韩国	队列研究	中位随访期38.5个月	100 mg/d，使用时间≥6个月	343	HBV

纳入研究	是否包含肝硬化人群		是否抗病毒治疗	匹配或调整变量	报告结局	NOS评分
Simon等^[21](2020)	是。对照组14.2%，阿司匹林组13.6%		是。对照组31.7%，阿司匹林组29.2%	倾向性评分；2~8	①②	9
Liao等^[22](2020)	是。NA		否	倾向性评分；1、2、5~7	①	9
Wu等^[23](2020)	是。NA		是。对照组5.4%，阿司匹林组5.5%	倾向性评分；1、2、4~8	①	NA
Lee等^[24](2020)	是。对照组15.1%，阿司匹林组16.0%		是。对照组4.7%，阿司匹林组5.4%	倾向性评分；1、2、4~8	①②	9
Lee等^[25](2019)	是。对照组17.1%，阿司匹林组17.1%		是。对照组15.8%，阿司匹林组15.8%	倾向性评分；1~3、5~8	①②	9
Simon等^[26](2019)	NA		NA	倾向性评分；NA	①	NA
Du等^[27](2019)	是。对照组100%，阿司匹林组100%		NA	NA	①	7
Hwang等^[28](2018)	NA		NA	1、2、7、8	①	8
Lee等^[29](2017)	是。阿司匹林组12.2%		否	倾向性评分；1、5、8	①②	8
注：调整变量1~8分别为1，年龄；2，性别；3，抗HBV治疗；4，抗HCV治疗；5，肝硬化；6，其他药物(如二甲双胍、他汀类等具有潜在化学预防肝癌药物)；7，合并症；8，其他。报告结局包括①肝癌发生率；②消化道出血发生率。DDDs，限定日剂量。NA, 未提及。

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表 2 亚组分析

亚组	研究数目	HR(95%CI)	P值	I²值(%)	P值
地域
东方^{[22-25, 27-29]}	7	0.67(0.58~0.78)	＜0.000 1	50	0.04
西方^{[21, 26]}	2	0.68(0.62~0.74)	＜0.000 1	0	0.63
肝炎类型
HBV^{[25, 29]}	2	0.49(0.19~1.27)	0.14	70	0.07
HCV^[22-24]	3	0.72(0.59~0.87)	＜0.000 1	60	0.08
混合病例^{[21, 26-28]}	4	0.67(0.62~0.73)	＜0.000 1	20	0.28
人群
抗病毒治疗^[23-25]	3	0.68(0.42~1.09)	0.11	46	0.16
肝硬化^{[23-25, 27]}	4	0.77(0.58~1.02)	0.07	53	0.09
匹配或调整变量
抗病毒治疗^{[21, 23-25]}	4	0.73(0.67~0.78)	＜0.000 1	0	0.49
肝硬化^{[21-25, 29]}	6	0.71(0.66~0.76)	＜0.000 1	46	0.10

下载: 导出CSV

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