血清25(OH)D3水平與肝細(xì)胞癌相關(guān)性的Meta分析

武漢大學(xué)人民醫(yī)院消化內(nèi)科，湖北 武漢 430060

【Abstract】ObjectiveTo explore the relationship between 25-hydroxyvitamin D3 [25(OH)D3] levels and hepatocellular carcinoma (HCC).MethodsCochrane Library, PubMed, Web of Science, CBM, VIP, CNKI were searched (the duration of search was from the building of databases to Mar.2017), and both Chinese and English trials about the relationships between 25(OH)D3 levels and HCC were searched, and the references of those studies were also searched by hand. A Meta-analysis of 7 studies was performed which met the inclusion criteria.ResultsSeven studies (n=1 009) were finally included (346 cases in HCC group and 663 cases in control group). The results of Meta-analysis showed that 25(OH)D3 levels in patients with HCC were lower than those in the control group individuals (SMD=-2.78, 95%CI: -4.08--1.48,P<0.0001). The subgroup analysis of the different basic diseases of HCC showed that the patients in both HBV subgroup and HCV group had lower 25(OH)D3 levels in comparison with control group individuals (SMD=-1.02, 95%CI: -1.86--0.18,P=0.02;SMD=-4.46, 95%CI: -5.58--3.34,P<0.00001). The subgroup analysis, according to the different races of patients, showed that both Asian and Egyptian HCC patients had lower 25(OH)D3 levels in comparison with control group individuals (SMD=-0.88, 95%CI: -1.05--0.71,P<0.00001;SMD=-4.44, 95%CI: -5.09--3.80,P<0.00001).ConclusionThe 25(OH)D3 levels are lower in HCC patients than those in health controls. Due to the small sizes of sample, more high-quality and large sample studies are needed to verify.

【Keywords】 25-hydroxyvitamin D3; Hepatocellular carcinoma; Meta-analysis

肝細(xì)胞癌(hepatocellular carcinoma，HCC)是全球性健康問題，每年有超過700 000新發(fā)病例，其死亡率在全球腫瘤相關(guān)性死亡率中排第二。約80%的HCC患者出現(xiàn)于慢性丙肝和慢性乙肝肝硬化患者中，除了慢性丙型肝炎病毒(HCV)和慢性乙型肝炎病毒(HBV)感染，糖尿病、非酒精性脂肪肝炎、飲食攝入黃曲霉素均是患HCC的主要危險(xiǎn)因素。最近大量研究[3-5]發(fā)現(xiàn)，HCC患者血清25(OH)D3含量降低可能是HCC的危險(xiǎn)因素，但部分研究[6]與此結(jié)果不一致，因此，本系統(tǒng)評價(jià)旨在運(yùn)用循證醫(yī)學(xué)的原理和方法對相關(guān)的研究進(jìn)行Meta分析，以期為補(bǔ)充維生素D治療HCC提供理論依據(jù)。

1 資料與方法

1.1文獻(xiàn)檢索策略計(jì)算機(jī)檢索Cochrane Library、PubMed、Web of Science、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(CBM)、中文科技期刊數(shù)據(jù)庫(VIP)、中國期刊全文數(shù)據(jù)庫(CNKI)，以“hepatocellular carcinoma or liver cancer，Vitamin D or 25(OH)D3，肝細(xì)胞癌或肝癌，維生素D或25羥維生素D3”為文獻(xiàn)檢索詞。查找所有關(guān)于HCC與血清25(OH)D3水平的中英文臨床研究，檢索時(shí)限為建庫至2017年3月。

1.2納入及排除標(biāo)準(zhǔn)納入標(biāo)準(zhǔn)：(1)文獻(xiàn)為病例對照研究、隊(duì)列研究；(2)血清25(OH)D3水平在各文獻(xiàn)中均獲得；排除標(biāo)準(zhǔn)：(1)無健康對照組；(2)未提供HCC組和對照組血清25(OH)D3的平均數(shù)和標(biāo)準(zhǔn)差；(3)兩組測量血清25(OH)D3的方法不一致或重復(fù)發(fā)表的研究；(4)質(zhì)量較差及數(shù)據(jù)無法利用的文獻(xiàn)；(5)數(shù)據(jù)不充分且索取無果。

1.3文獻(xiàn)質(zhì)量評價(jià)由2名評價(jià)員(胡雪、馬靜靜)根據(jù)紐卡斯?fàn)?渥太華量表(NOS)[7]對納入的研究進(jìn)行質(zhì)量評價(jià)，不一致的地方通過討論達(dá)成一致。評價(jià)內(nèi)容包含人群選擇、可比性和暴露評價(jià)三個(gè)方面，具體評價(jià)標(biāo)準(zhǔn)如下：(1)疾病的定義和診斷(1分)；……