他汀类药物延缓慢性肝病患者肝纤维化进展的荟萃分析

发布时间：2018-03-07 23:23

本文选题：他汀类药物　切入点：肝纤维化　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景和目的:肝纤维化是慢性肝病进展过程中重要的病理过程。他汀类药物具有改善肝脏脂质代谢、抗炎等作用,同时可以提高病毒性肝炎患者抗病毒疗效。而他汀类药物对慢性肝病患者不同的疾病进程影响,尚无明确结论。本研究通过荟萃分析探讨他汀类药物对慢性肝病患者发生明显肝纤维化、肝硬化、失代偿期肝硬化风险的影响,旨在阐明其在慢性肝病患者疾病进展中的作用。方法:本研究通过对 Pubmed/Medline,Embase,Cochrane Library 和 Ovid 数据库进行系统检索,并阅读相关综述及会议报告,筛选出所有与他汀类药物和慢性肝病患者疾病进程相关的临床研究。经过两名研究者分别独立阅读评判,纳入符合入组要求的研究。通过固定或随机效应模型,对入组研究的风险评估进行荟萃分析,以评估他汀类药物使用与慢性肝病患者肝纤维化进程的关系。结果:共16篇临床研究,合计123,938例患者被纳入该荟萃分析,其中7篇研究报告了他汀类药物与非酒精性脂肪性肝病(NAFLD)患者发生明显肝纤维化的关系,5篇研究报告了慢性病毒性肝炎患者中他汀类药物与发生肝硬化风险的关系,4篇研究报告了他汀类药物与肝硬化患者失代偿风险及死亡率的关系。荟萃分析结果显示:1.针对肝纤维化阶段,他汀类药物能够使NAFLD患者发生明显纤维化的概率降低28%(RR=0.72,95%CI:0.56-0.93,p=0.013),且能够提高NAFLD患者的长期生存率;2.针对肝硬化阶段,他汀类药物能够使慢性病毒性肝炎患者发生肝硬化的风险降低60%(RR=0.40,95%CI:0.39-0.42,p=0.000),且该作用呈剂量依赖性,他汀类药物每增加30累计定义每日剂量(cumulative Defined Daily Dose,cDDD),发生肝硬化的风险降低14%;3.针对肝硬化失代偿阶段,他汀类药物能够使肝硬化患者发生失代偿的风险降低54%(RR=0.46,95%CI:0.38-0.56,p=0.000),且能够降低肝硬化患者的死亡率。结论:他汀类药物能够降低慢性肝病患者发生肝纤维化及肝硬化的风险,并能够降低肝硬化失代偿的发生率,提高慢性肝病患者的长期生存率。
[Abstract]:Background and objective: hepatic fibrosis is an important pathological process in the progression of chronic liver disease. Statins have the effects of improving lipid metabolism and anti-inflammation of liver. At the same time, it can improve the antiviral effect in patients with viral hepatitis. And statins have different effects on the progression of chronic liver disease. In this study, we studied the effect of statins on the risk of liver fibrosis, cirrhosis and decompensated cirrhosis in patients with chronic liver disease by meta-analysis. Methods: the database of Pubmed / Medlinebase Cochrane Library and Ovid was searched systematically, and the related reviews and conference reports were read, the aim of this study was to elucidate its role in the progression of patients with chronic liver disease. All clinical studies related to statins and disease progression in patients with chronic liver disease were screened out. A meta-analysis of the risk assessment of the entry study was conducted to assess the relationship between statins use and the progression of hepatic fibrosis in patients with chronic liver disease. Results: in 16 clinical studies, 123,938 patients were included in the meta-analysis. Seven of the studies reported the relationship between statins and NAFLDs in patients with non-alcoholic fatty liver disease and 5 reported the association of statins with the risk of cirrhosis in patients with chronic viral hepatitis. Four studies reported the relationship between statins and decompensation risk and mortality in patients with liver cirrhosis. Statins can reduce the probability of significant fibrosis in patients with NAFLD by 28% RRR0. 7295% CI: 0. 56-0. 93p0. 013, and can improve the long-term survival rate of patients with NAFLD. Statins can reduce the risk of cirrhosis in patients with chronic viral hepatitis by reducing the risk of cirrhosis by 60% RRX 0.4095% and in a dose-dependent manner. The cumulative daily dose of statins for every 30 years of cumulative definition of the cumulative daily dose of Defined Daily dosedd was 14% lower than that of the patients with liver cirrhosis during the decompensation phase, and the risk of cirrhosis was reduced by 3% for the decompensative phase of cirrhosis. Statins can reduce the risk of decompensation in patients with liver cirrhosis and reduce the risk of liver fibrosis and cirrhosis in patients with chronic liver disease. It can reduce the incidence of liver cirrhosis decompensation and improve the long-term survival rate of patients with chronic liver disease.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575

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