慢性乙型肝炎病毒（HBV）感染髮展為肝細胞癌（HCC）的危險

StephenW

Risk factors for the development of hepatocellular carcinoma (HCC) in chronic hepatitis B virus (HBV) infection: a systematic review and meta-analysis
Cori Campbell  1 , Tingyan Wang  1 , Anna L McNaughton  1 , Eleanor Barnes  1 , Philippa C Matthews  1   2   3
Affiliations
Affiliations

    1
    Nuffield Department of Medicine, University of Oxford, Medawar Building, South Parks Road, Oxford, OX1 3SY, UK.
    2
    Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.
    3
    NIHR BRC, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.

    PMID: 33305479 DOI: 10.1111/jvh.13452

Abstract

Hepatocellular carcinoma (HCC) is one of the leading contributors to cancer mortality worldwide and is the largest cause of death in individuals with chronic hepatitis B virus (HBV) infection. It is uncertain how the presence of other metabolic factors and comorbidities influences HCC risk in HBV. Therefore we performed a systematic literature review and meta-analysis to seek evidence for significant associations. MEDLINE, Embase and Web of Science databases were searched from 1st January 2000 to 24th June 2020 for English studies investigating associations of metabolic factors and comorbidities with HCC risk in individuals with chronic HBV infection. We extracted data for meta-analysis and generated pooled effect estimates from a fixed-effects model. Pooled estimates from a random-effects model were also generated if significant heterogeneity was present. We identified 40 observational studies reporting on associations of diabetes mellitus (DM), hypertension, dyslipidaemia and obesity with HCC risk. Only DM had a sufficient number of studies for meta-analysis. DM was associated with >25% increase in hazards of HCC (fixed effects Hazards Ratio [HR] 1.26, 95% confidence interval (CI) 1.20-1.32, random effects HR 1.36, 95% CI 1.23-1.49). This association was attenuated towards the null in a sensitivity analysis restricted to studies adjusted for metformin use. In conclusion, in adults with chronic HBV infection, DM is a significant risk factor for HCC, but further investigation of how antidiabetic drug use and glycaemic control influence this association is needed. Enhanced screening of individuals with HBV and diabetes may be warranted.

Keywords: HCC; Hepatitis B virus; comorbidities; diabetes; hepatocellular carcinoma.

This article is protected by copyright. All rights reserved.

StephenW

慢性乙型肝炎病毒（HBV）感染发展为肝细胞癌（HCC）的危险因素：系统评价和荟萃分析
科里·坎贝尔1，王廷彦1，安娜·麦克诺顿1，埃莉诺·巴恩斯1，菲利普·马修斯1 2 3
隶属关系
隶属关系

    1个
    英国牛津OX1 3SY，牛津大学纳菲尔德分校，梅德瓦大厦，牛津南公园路。
    2
    牛津大学医院NHS基金会信托基金传染病与微生物学系，牛津约翰利拉德克利夫医院，牛津Headley Way，英国OX3 9DU。
    3
    NIHR BRC，约翰·拉德克利夫医院，Headley Way，牛津，英国OX3 9DU。

    PMID：33305479 DOI：10.1111 / jvh.13452

抽象

肝细胞癌（HCC）是世界范围内导致癌症死亡的主要原因之一，并且是慢性乙型肝炎病毒（HBV）感染者中最大的死亡原因。尚不确定其他代谢因子和合并症的存在如何影响HBV的HCC风险。因此，我们进行了系统的文献综述和荟萃分析，以寻找重要关联的证据。检索2000年1月1日至2020年6月24日的MEDLINE，Embase和Web of Science数据库，以研究慢性乙肝病毒感染者的代谢因素和合并症与HCC风险的关联的英语研究。我们提取了用于荟萃分析的数据，并从固定效应模型生成了合并效应估计。如果存在明显的异质性，也会从随机效应模型中汇总估计。我们确定了40项观察性研究，这些研究报告了糖​​尿病（DM），高血压，血脂异常和肥胖与HCC风险之间的关系。只有DM进行了足够的荟萃分析研究。 DM与HCC危险增加> 25％相关（固定效应危险比[HR] 1.26，95％置信区间（CI）1.20-1.32，随机效应HR 1.36，95％CI 1.23-1.49）。在仅限于针对二甲双胍使用进行了调整的研究的敏感性分析中，这种关联减弱为零。总之，在患有慢性HBV感染的成人中，DM是HCC的重要危险因素，但需要进一步研究抗糖尿病药物的使用和血糖控制如何影响这种关联。可能需要加强对HBV和糖尿病患者的筛查。

关键字：HCC；乙型肝炎病毒;合并症糖尿病;肝细胞癌。

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StephenW

https://www.medrxiv.org/content/10.1101/2020.08.21.20179234v1