黄曲霉毒素作为肝硬化的一个风险因素：一项系统综述和荟萃分析。
Aflatoxins as a risk factor for liver cirrhosis: a systematic review and meta-analysis.
机构信息
Department of Pharmacology, School of Pharmacy, Haramaya University, P.O. Box 235, Harar, Ethiopia.
School of Medicine, University of Leeds, Leeds, UK.
出版信息
BMC Pharmacol Toxicol. 2020 Jun 1;21(1):39. doi: 10.1186/s40360-020-00420-7.
BACKGROUND
Liver cirrhosis is characterized by fibrosis and nodule formation in the liver, due to a chronic injury, and subsequent alteration of the normal architecture of the liver. Even though there is a huge effort to elucidate the possible etiologic factors of liver cirrhosis, a significant number of cases are cryptogenic, especially in Sub Saharan Africa, where there is a high burden of aflatoxin exposure. Aflatoxins are known to cause hepatocellular carcinoma, which share similar etiologic factors with liver cirrhosis. This study aimed to assess the association between aflatoxin exposure and the risk of liver cirrhosis.
METHODS
Relevant studies were identified through systematic searches conducted in Ovid MEDLINE, PubMed and Google Scholar. Also, by searching the references of retrieved articles. The abstracts and full text were screened for eligibility and the risk of bias was assessed for each study using Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies. The extracted data from included studies using Microsoft Excel were exported to Stata software version 15.0 for analyses. The overall pooled estimation of outcomes was calculated using a random-effects model of DerSimonian-Laird method at a 95% confidence level. The heterogeneity of studies was determined using I2 statistics. The presence of publication bias between studies was evaluated using the Begg's and Egger's tests and funnel plot. The protocol of this systematic review and meta-analysis was registered in the Prospero database with reference number ID: CRD42019148481.
RESULTS
A total of 5 studies published between the years 2005 and 2018 that met the pre-defined inclusion and exclusion criteria were included. The meta-analysis showed that a significant increase in the risk of liver cirrhosis is associated with aflatoxin exposure (unadjusted pooled odds ratio (OR) = 3.35, 95% CI: 2.74-4.10, p = 0.000; I = 88.3%, p = 0.000; adjusted OR = 2.5, 95% CI: 1.84-3.39, p = 0.000; I = 0%, p = 0.429).
CONCLUSIONS
The present meta-analysis suggests that aflatoxin exposure is associated with a higher risk of liver cirrhosis.
背景
肝硬化的特征是肝脏纤维化和结节形成，这是由于慢性损伤，随后改变了肝脏的正常结构。尽管人们已经做出了巨大的努力来阐明肝硬化的可能病因，但仍有相当数量的病例是隐匿性的，尤其是在撒哈拉以南非洲，那里存在着黄曲霉毒素暴露的高负担。黄曲霉毒素已知会导致肝细胞癌，而肝细胞癌与肝硬化有相似的病因。本研究旨在评估黄曲霉毒素暴露与肝硬化风险之间的关联。
方法
通过在 Ovid MEDLINE、PubMed 和 Google Scholar 中进行系统搜索，确定了相关研究。此外，还通过检索检索到的文章的参考文献来确定。对摘要和全文进行筛选，以确定每项研究的入选标准和偏倚风险，并使用 Joanna Briggs 研究所（JBI）的观察性研究批判性评价清单进行评估。使用 Microsoft Excel 从纳入研究中提取数据，并将数据导出到 Stata 软件版本 15.0 进行分析。使用 DerSimonian-Laird 方法的随机效应模型在 95%置信水平下计算总体汇总估计值。使用 I2 统计量确定研究之间的异质性。使用 Begg 和 Egger 检验和漏斗图评估研究之间是否存在发表偏倚。本系统评价和荟萃分析的方案已在 Prospero 数据库中注册，参考编号为 ID：CRD42019148481。
结果
共有 5 项发表于 2005 年至 2018 年的研究符合预先确定的纳入和排除标准。荟萃分析表明，黄曲霉毒素暴露与肝硬化风险显著增加相关（未经调整的汇总优势比（OR）=3.35，95%置信区间：2.74-4.10，p=0.000；I=88.3%，p=0.000；调整后的 OR=2.5，95%置信区间：1.84-3.39，p=0.000；I=0%，p=0.429）。
结论
本荟萃分析表明，黄曲霉毒素暴露与肝硬化风险增加相关。
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