Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, Florida.
J Evid Based Med. 2018 Nov;11(4):272-277. doi: 10.1111/jebm.12317. Epub 2018 Nov 5.
Chronic hepatitis C virus (HCV) infection is one of the most common chronic liver diseases. Several risk factors for the progression of liver fibrosis among these patients have been identified. Use of cannabis could be another risk factor, but the results from epidemiological studies remain inconclusive.
Comprehensive literature review was conducted using MEDLINE and EMBASE databases through December 2017 to identify studies that compared the risk of advanced liver fibrosis among HCV-infected patients who use and who do not use cannabis. Effect estimates from each study were extracted and combined together using the random-effect, generic inverse variance method of DerSimonian and Laird.
A total of three cohort studies with 898 participants met the eligibility criteria and were included in the meta-analysis. The risk of advanced liver fibrosis among HCV-infected patients who use cannabis was numerically higher than those who do not use cannabis, although the result did not achieve statistical significance (pooled odds ratio, 1.77; 95% confidence interval, 0.78-4.02). The statistical heterogeneity was high with an I of 75%.
This meta-analysis showed that the risk of advanced liver fibrosis among HCV-infected patients who use cannabis was higher than those who do not use cannabis, but the result was not statistically significant. Further studies are required to better characterize the risk.
慢性丙型肝炎病毒（HCV）感染是最常见的慢性肝脏疾病之一。已经确定了这些患者中肝纤维化进展的几个危险因素。使用大麻可能是另一个危险因素，但来自流行病学研究的结果仍不确定。
通过 MEDLINE 和 EMBASE 数据库进行全面的文献综述，检索截至 2017 年 12 月比较使用和不使用大麻的 HCV 感染患者中晚期肝纤维化风险的研究。从每项研究中提取效应估计值，并使用 DerSimonian 和 Laird 的随机效应、通用倒数方差法合并在一起。
共有 3 项队列研究，涉及 898 名参与者，符合纳入标准并纳入荟萃分析。使用大麻的 HCV 感染患者中晚期肝纤维化的风险高于不使用大麻的患者，但结果未达到统计学意义（合并优势比，1.77；95%置信区间，0.78-4.02）。统计异质性很高，I²为 75%。
这项荟萃分析表明，使用大麻的 HCV 感染患者中晚期肝纤维化的风险高于不使用大麻的患者，但结果无统计学意义。需要进一步的研究来更好地描述风险。
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