血清胆红素与代谢综合征和非酒精性脂肪性肝病的关系：系统评价和荟萃分析。
Association of Serum Bilirubin With Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis.
机构信息
First Department of Liver Disease, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing You'an Hospital, Capital Medical University, Beijing, China.
出版信息
Front Endocrinol (Lausanne). 2022 Jul 20;13:869579. doi: 10.3389/fendo.2022.869579. eCollection 2022.
OBJECTIVE
Metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD) are the leading chronic diseases worldwide. There are still many controversies about the association between serum bilirubin and MetS or NAFLD. This study aims to evaluate the association of serum total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL) with MetS and NAFLD.
METHODS
Multiple databases were searched for relevant studies until November 2021. Randomized controlled trials, cross-sectional and cohort studies evaluating the association between serum bilirubin levels and MetS or NAFLD were included.
RESULTS
Twenty-four cross-sectional and cohort studies with 101, 517 participants were finally analyzed. Fifteen studies and 6 studies evaluated the association between bilirubin and MetS or NAFLD in health screening population, respectively, while 3 studies evaluated the association between bilirubin and non-alcoholic steatohepatitis (NASH) in NAFLD patients. Random effect model analysis showed the inverse association between TBIL and MetS in male (95%CI=0.71-0.96) and gender-neutral (95%CI=0.61-0.91) group. However, no significant association was found in females. Notably, the inverse association between DBIL and MetS was noticed in male (95%CI=0.36-0.75), female (95%CI=0.16-0.58) and gender-neutral population (95%CI=0.67-0.92). IBIL level was inversely associated with MetS in females (95%CI=0.52-0.96), whereas no statistical correlation presented in males. TBIL was not statistically correlated with NAFLD in gender-neutral or male subgroup. Similarly, there were no association between DBIL or IBIL and NAFLD in gender-neutral subgroup. However, the negative correlation between DBIL and NAFLD existed in males (95%CI=0.76-0.96). In NAFLD patients, IBIL analysis showed an inverse association with NASH (95%CI=0.01-0.12).
CONCLUSION
Serum TBIL and DBIL levels, especially DBIL levels, assume an inverse correlation with MetS in healthy population. Serum IBIL is inversely associated with the onset and degree of NASH in NAFLD patients. Exogenous bilirubin supplement may be a potential strategy to assist in lowering the risk of developing MetS and NAFLD.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42021293349.
目的
代谢综合征（MetS）和非酒精性脂肪性肝病（NAFLD）是全球主要的慢性疾病。血清胆红素与 MetS 或 NAFLD 之间的关联仍存在许多争议。本研究旨在评估血清总胆红素（TBIL）、直接胆红素（DBIL）和间接胆红素（IBIL）与 MetS 和 NAFLD 的关系。
方法
检索了多个数据库，直到 2021 年 11 月，以获取相关研究。纳入了评估血清胆红素水平与 MetS 或 NAFLD 之间关系的随机对照试验、横断面和队列研究。
结果
最终分析了 24 项横断面和队列研究，共纳入 101517 名参与者。15 项研究和 6 项研究分别评估了胆红素与健康筛查人群中的 MetS 或 NAFLD 的关系，而 3 项研究评估了胆红素与 NAFLD 患者中的非酒精性脂肪性肝炎（NASH）的关系。随机效应模型分析显示，TBIL 与男性（95%CI=0.71-0.96）和性别中立（95%CI=0.61-0.91）人群中的 MetS 呈负相关。然而，在女性中未发现显著相关性。值得注意的是，DBIL 与 MetS 的负相关关系在男性（95%CI=0.36-0.75）、女性（95%CI=0.16-0.58）和性别中立人群（95%CI=0.67-0.92）中均得到了证实。IBIL 水平与女性的 MetS 呈负相关（95%CI=0.52-0.96），而男性则无统计学相关性。TBIL 在性别中立或男性亚组中与 NAFLD 无统计学相关性。同样，DBIL 或 IBIL 与性别中立亚组中的 NAFLD 也没有关联。然而，DBIL 与男性中的 NAFLD 呈负相关（95%CI=0.76-0.96）。在 NAFLD 患者中，IBIL 分析显示与 NASH 呈负相关（95%CI=0.01-0.12）。
结论
血清 TBIL 和 DBIL 水平，特别是 DBIL 水平，与健康人群中的 MetS 呈负相关。血清 IBIL 与 NAFLD 患者 NASH 的发生和严重程度呈负相关。外源性胆红素补充可能是降低 MetS 和 NAFLD 发病风险的潜在策略。
系统评价注册
https://www.crd.york.ac.uk/prospero/，标识符 CRD42021293349。
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