Thongtan Thanita, Deb Anasua, Vutthikraivit Wasawat, Laoveeravat Passisd, Mingbunjerdsuk Thammasak, Islam Sameer, Islam Ebtesam
Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Stop 9410, Lubbock, TX, 79430, USA.
Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, 55242, USA.
Indian J Gastroenterol. 2022 Apr;41(2):119-126. doi: 10.1007/s12664-021-01230-3. Epub 2022 Mar 22.
Despite the growing disease burden of non-alcoholic fatty liver disease (NAFLD), approved medical treatments to improve or prevent liver fibrosis are effective only in a small number of patients. Recent studies have found the new use of antiplatelet agents for antifibrotic benefits in NAFLD, but human studies are still limited. The goal of this meta-analysis was to combine the findings of existing relevant studies to investigate the effects of antiplatelet therapy in reducing or preventing advanced liver fibrosis in patients with NAFLD. We conducted a systematic literature search in PubMed, EMBASE, and Web of Science databases from inception to January 2021 to identify all original studies that investigated the use of antiplatelet agents in patients with NAFLD. We used the National Institutes of Health's quality assessment tool for observational cohort and cross-sectional studies to assess study quality and risk of bias. The primary outcome was the prevalence of advanced liver fibrosis stage 3-4. Data from each study was combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled odds ratio (OR) and 95% confidence intervals (CIs). Of the 2,498 studies identified, 4 studies involving 2,593 patients with NAFLD were included in this study (949 antiplatelet agent users and 1,644 non-antiplatelet agent users). The use of aspirin and/or P2Y12 receptor inhibitors was associated with a lower pooled OR of advanced liver fibrosis in patients with NAFLD (pooled OR = 0.66; 95% CI: 0.53-0.81, I = 0.0%; p < 0.001). This study focuses on the outcome of advanced liver fibrosis in patients with NAFLD. Our study is limited by the small number of studies that were included. Preliminary evidence from this meta-analysis suggests a protective association between antiplatelet therapy and the prevalence of advanced liver fibrosis in patients with NAFLD. Our findings support future research into repositioning an antiplatelet agent as a novel NAFLD treatment.
尽管非酒精性脂肪性肝病（NAFLD）的疾病负担日益加重，但已获批的用于改善或预防肝纤维化的药物治疗仅对少数患者有效。最近的研究发现抗血小板药物在NAFLD中具有抗纤维化益处的新用途，但人体研究仍然有限。这项荟萃分析的目的是综合现有相关研究的结果，以调查抗血小板治疗对减少或预防NAFLD患者晚期肝纤维化的效果。我们在PubMed、EMBASE和Web of Science数据库中进行了系统的文献检索，检索时间从数据库创建至2021年1月，以确定所有调查NAFLD患者使用抗血小板药物的原始研究。我们使用美国国立卫生研究院的观察性队列研究和横断面研究质量评估工具来评估研究质量和偏倚风险。主要结局是晚期肝纤维化3 - 4期的患病率。使用DerSimonian和Laird的随机效应、通用逆方差方法合并每项研究的数据，以计算合并比值比（OR）和95%置信区间（CI）。在确定的2498项研究中，本研究纳入了4项涉及2593例NAFLD患者的研究（949例抗血小板药物使用者和1644例非抗血小板药物使用者）。使用阿司匹林和/或P2Y12受体抑制剂与NAFLD患者晚期肝纤维化的合并OR较低相关（合并OR = 0.66；95% CI：0.53 - 0.81，I² = 0.0%；p < 0.001）。本研究关注NAFLD患者晚期肝纤维化的结局。我们的研究受到纳入研究数量较少的限制。这项荟萃分析的初步证据表明抗血小板治疗与NAFLD患者晚期肝纤维化患病率之间存在保护性关联。我们的研究结果支持未来将抗血小板药物重新定位为新型NAFLD治疗方法的研究。
