【摘要】 目的丙型肝炎病毒(HCV)感染可导致肝纤维化、肝硬化,甚至肝癌(HCC)。而慢性丙型肝炎(CHC)患者中合并糖尿病(DM)对HCC发生率的影响目前尚不明确,本文综合评价CHC患者合并DM对HCC发生率的影响。方法本研究通过中国知网、万方数据库、维普数据库、Pubmed、Embase等文献检索平台对CHC患者合并DM对HCC发生率影响的相关研究进行检索。然后进行文献筛选、质量评价,纳入符合标准的队列研究文献,进行数据提取及统计分析,选择随机效应模型,合并效应量为相对危险度(RR),并进行敏感性分析、异质性检验及发表偏倚的检测。结果最终共有9篇队列研究的文献入选,共纳入11 855例CHC患者,DM组共1 058例,非DM组共10 797例。DM组和非DM组HCC的发生率差别有统计学意义(RR=2.674,95%CI=1.800~3.974,P=0.000),异质性较大(P=0.000,I2=86.2%);按研究对象是否合并肝硬化进行亚组分析,当研究对象全部为肝硬化患者时,合并效应量差异无统计学意义(95%CI=0.689~1.580,P=0.842),同时异质性显著下降(I2=40.8%,P=0.194);当研究对象全部为未合并肝硬化患者时,合并效应量差异有统计学意义(95%CI=2.341~6.101,P=0.000),异质性也显著下降(I2=42.2%,P=0.188)。敏感性分析结果表明综合分析纳入文献所得数据后得到的结果相对较稳定,发表偏倚检测结果也在允许范围内(Harbord法95%CI=-1.582823~10.18881,P=0.130;95%CI=-409.0079~382.1317,P=0.939)。结论在CHC合并肝硬化患者中,合并DM对HCC发生率无影响;而在单纯CHC患者中,合并DM可增加HCC的发生率。DM可能是通过影响CHC患者发生肝硬化的过程影响HCC发生率的。更多还原

【Abstract】 Objective Hepatitis C virus infection can lead to liver fibrosis,liver cirrhosis,and even liver cancer.The influence of diabetes mellitus(DM)in patients with chronic hepatitis C on the incidence of hepatocarcinoma(HCC)is not clear.The effect of chronic hepatitis C(CHC)patients with DM on the incidence of HCC was studied.Methods This study searched CNKI,Wanfang database,CQVIP,Pubmed,Embase and other literature retrieval platform for related studies of the effect of CHC patients with DM on the incidence of HCC.This study included the literature that was in line with the standards of the cohort study by literature selection,quality assessment;Then,data extraction and statistical analysis were carried out.This study selected the random effects model,with the combined effect amount being relative risk(RR);the sensitivity analysis,heterogeneity and publication bias detection were also conducted.Results A total of nine cohort studies were selected,including 11 855 CHC patients,with 1 058 in DM group and10 797 in non-DM group.The incidences of HCC in group DM and non-DM were of statistical significance(RR =2.674,95%CI =1.800-3.974,P =0.000),and the heterogeneity was big(P =0.000,I~2=86.2%).Subgroup analysis was conducted according to whether the subjects were complicated with cirrhosis.When the subjects were all patients with cirrhosis,the amount of combined effect was of no statistical significance(95%CI =0.689-1.580,P =0.842),while the heterogeneity decreased significantly(I~2=40.8%,P =0.194);When all the subjects were free from liver cirrhosis,the amount of combined effect was statistically significant(95%CI =2.341-6.101,P =0.000),and heterogeneity also decreased significantly(I~2=42.2%,P =0.188).The results of sensitivity analysis showed that the results were relatively stable,the results of publication bias were within allowed band(Harbord:95%CI =-1.582823-10.18881,P =0.130;95%CI=-409.0079-382.1317,P =0.9391).Conclusion Among CHC patients with cirrhosis,there is no significant difference in the incidence of HCC in cirrhosis patients with DM;while in patients with CHC,merging DM can increase the incidence of HCC.DM may affect the incidence of HCC by affecting the process of liver cirrhosis in patients with CHC.更多还原