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Chronic hepatitis D and hepatocellular carcinoma: A systematic review and meta-analysis of observational studies
Journal of Hepatology ( IF 26.8 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.jhep.2020.02.030
Dulce Alfaiate 1 , Sophie Clément 2 , Diana Gomes 1 , Nicolas Goossens 3 , Francesco Negro 4
Affiliation  

BACKGROUND & AIMS Chronic hepatitis D (CHD) is the most severe form of chronic viral hepatitis but its role in the development of hepatocellular carcinoma (HCC) remains debated. We conducted a systematic review and meta-analysis of epidemiological studies to examine whether CHD is associated with an increased risk of HCC. METHODS We searched Pubmed, Embase and Web of Science, as well as study references and conference proceedings. We considered cohort and case-control studies allowing the calculation of effect estimates for the association between CHD (exposure) and HCC (outcome) in comparison to chronic hepatitis B. Data extraction and quality evaluation (using the Newcastle-Ottawa Scale) were performed independently by two authors. Data were pooled using random-effects models. RESULTS Ninety-three studies (68 case-control studies including 22862 patients and 25 cohort studies including 75427 patients) were included. Twelve studies accounted for confounders, in either study design or analysis (ten of which were cohorts), and 11 cohorts were prospective. The overall analysis showed a significantly increased risk of hepatocellular carcinoma in patients with CHD, despite substantial study heterogeneity (pooled odds ratio 1.28; 95% CI 1.05-1.57; I2=67.0%). The association was particularly strong in the absence of heterogeneity for prospective cohort studies (pooled odds ratio 2.77; 95% CI 1.79-4.28; I2=0%), and studies with HIV-infected patients (pooled odds ratio 7.13; 95% CI 2.83-17.92; I2=0%). CONCLUSIONS We found a significantly higher risk of hepatocellular carcinoma in patients with chronic hepatitis D. Although further studies are needed to definitively exclude a potential bias due to antiviral treatments, our findings highlight the rationale for improved screening of hepatitis D virus infection in hepatitis B patients, and the urgent need of novel and effective antiviral therapies.

中文翻译:

慢性丁型肝炎和肝细胞癌:观察性研究的系统评价和荟萃分析

背景和目的 慢性丁型肝炎 (CHD) 是最严重的慢性病毒性肝炎,但其在肝细胞癌 (HCC) 发展中的作用仍存在争议。我们对流行病学研究进行了系统回顾和荟萃分析,以检查 CHD 是否与 HCC 风险增加有关。方法 我们检索了 Pubmed、Embase 和 Web of Science,以及研究参考文献和会议记录。我们考虑了队列和病例对照研究,允许计算与慢性乙型肝炎相比 CHD(暴露)和 HCC(结果)之间关联的效应估计值。数据提取和质量评估(使用纽卡斯尔-渥太华量表)是独立进行的由两位作者。使用随机效应模型合并数据。结果 共纳入 93 项研究(68 项病例对照研究,包括 22862 名患者和 25 项队列研究,包括 75427 名患者)。12 项研究在研究设计或分析中考虑了混杂因素(其中 10 项是队列),11 项队列是前瞻性的。总体分析显示,尽管研究存在很大的异质性(汇总比值比 1.28;95% CI 1.05-1.57;I2=67.0%),但 CHD 患者患肝细胞癌的风险显着增加。在前瞻性队列研究(汇总比值比 2.77;95% CI 1.79-4.28;I2=0%)和针对 HIV 感染患者的研究(汇总比值比 7.13;95% CI 2.83)没有异质性的情况下,这种关联性特别强-17.92;I2=0%)。结论 我们发现慢性丁型肝炎患者患肝细胞癌的风险显着更高。
更新日期:2020-09-01
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