系统评价与荟萃分析：肝移植后原发性硬化性胆管炎复发的危险因素。
Systematic review with meta-analysis: risk factors for recurrent primary sclerosing cholangitis after liver transplantation.
机构信息
Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.
National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK.
出版信息
Aliment Pharmacol Ther. 2019 Mar;49(6):636-643. doi: 10.1111/apt.15148. Epub 2019 Feb 10.
BACKGROUND
After liver transplantation primary sclerosing cholangitis (PSC), the condition returns in the transplanted liver in a subset of patients (recurrent primary sclerosing cholangitis, rPSC).
AIM
To define risk factors for rPSC.
METHODS
We searched Pubmed, Embase, Web of Science, and Cochrane library for articles published until March 2018. Studies addressing risk factors for developing rPSC were eligible for inclusion. A random effects meta-analysis was conducted using hazard ratios (HR) as effect measure. Study quality was evaluated with the Newcastle Ottawa scale. Statistical analysis was performed using Cochrane Review Manager.
RESULTS
The electronic database search yielded 449 results. Twenty-one retrospective cohort studies met the inclusion criteria for the review; 14 were included in the meta-analysis. The final cohort included 2159 patients (age range 31-49 years, 68.8% male), of whom 17.7% developed rPSC. Colectomy before liver transplantation, HR 0.65 (95% CI: 0.42-0.99), cholangiocarcinoma before liver transplantation, HR 2.42 (95% CI: 1.20-4.86), inflammatory bowel disease, HR 1.73 (95% CI: 1.17-2.54), donor age, HR 1.24 (95% CI 1.0-1.45) per ten years, MELD score, HR 1.05 (95% CI: 1.02-1.08) per point and acute cellular rejection, HR of 1.94 (95% CI: 1.32-2.83) were associated with the risk of rPSC.
CONCLUSIONS
Multiple risk factors for rPSC were identified. Colectomy before liver transplantation reduced the risk of rPSC.
背景
在肝移植后，原发性硬化性胆管炎（PSC）在一部分患者（复发性原发性硬化性胆管炎，rPSC）的移植肝中再次出现。
目的
确定 rPSC 的危险因素。
方法
我们在 Pubmed、Embase、Web of Science 和 Cochrane 图书馆中搜索了截至 2018 年 3 月发表的文章。符合纳入标准的研究均探讨了发生 rPSC 的危险因素。使用危险比（HR）作为效应量进行随机效应荟萃分析。使用纽卡斯尔-渥太华量表评估研究质量。使用 Cochrane 评论经理进行统计分析。
结果
电子数据库搜索产生了 449 个结果。21 项回顾性队列研究符合综述的纳入标准；其中 14 项被纳入荟萃分析。最终队列纳入了 2159 例患者（年龄 31-49 岁，68.8%为男性），其中 17.7%发生了 rPSC。肝移植前结肠切除术，HR 0.65（95%CI：0.42-0.99），肝移植前胆管癌，HR 2.42（95%CI：1.20-4.86），炎症性肠病，HR 1.73（95%CI：1.17-2.54），供体年龄，HR 1.24（95%CI 1.0-1.45）每增加十年，MELD 评分，HR 1.05（95%CI 1.02-1.08）每增加 1 分，急性细胞排斥反应，HR 1.94（95%CI 1.32-2.83）均与 rPSC 的风险相关。
结论
确定了多个 rPSC 的危险因素。肝移植前结肠切除术降低了 rPSC 的风险。
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