非酒精性脂肪性肝病患者患痴呆或认知障碍的风险：一项系统评价和荟萃分析。
Risk of dementia or cognitive impairment in non-alcoholic fatty liver disease: A systematic review and meta-analysis.
作者信息
Wang Luping, Sang Bowen, Zheng Zuyan
机构信息
Department of Acupuncture and Massage, Heilongjiang University of Traditional Chinese Medicine, Harbin, China.
Department of Acupuncture, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China.
出版信息
Front Aging Neurosci. 2022 Sep 20;14:985109. doi: 10.3389/fnagi.2022.985109. eCollection 2022.
OBJECTIVES
To investigate whether non-alcoholic fatty liver disease (NAFLD) increases the risk of dementia or cognitive impairment.
METHODS
A systematic search of the literature in the PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, and Web of Science databases was conducted, covering the period from the inception of each database to 22 May 2022. Statistical analysis of non-alcoholic fatty liver disease and the risk of cognitive impairment or dementia based on data extracted from each article was performed using Stata software v. 16.0. The quality of this study was assessed using the Newcastle-Ottawa Scale (NOS) for assessing the quality of cohort and case-control studies and the American Agency for Healthcare Research and Quality (AHRQ) methodology checklist for assessing the quality of cross-sectional studies. Funnel plots and the Egger's test were used to assess publication bias.
RESULTS
We included 7 studies comprising 891,562 individuals from 6 countries, which were published between 2020 and 2022. The pooling analysis showed that a history of NAFLD was associated with cognitive impairment [odds ratio (OR) = 1.44; 95% CI: 1.17-1.78; heterogeneity ( ) = 0%; = 0.001]. A history of NAFLD was not associated with an increased risk of all-cause dementia (OR = 1.03; 95% CI: 0.97-1.09; = 84.7%; = 0.341) or Alzheimer disease (OR = 0.95; 95% CI: 0.83-1.09; = 61.0%; = 0.489). In contrast, NAFLD was associated with an obvious reduction of the risk of vascular dementia (OR = 0.88; 95% CI: 0.79-0.98; = 0.0%; = 0.020). In the subgroup analysis, male and female patients with NAFLD showed an equal risk of dementia or cognitive impairment. The risk of dementia or cognitive impairment in the cross-sectional study (OR = 1.49; 95% CI: 1.19-1.88; = 0.0%; = 0.001) was slightly higher than that in the retrospective cohort (OR = 1.03; 95% CI: 0.97-1.09; = 84.3%; = 0.294).
CONCLUSIONS
NAFLD was associated with an increased risk of cognitive impairment and a decreased risk of vascular dementia. More studies are needed to clarify the pathophysiological mechanism underlying the association between NAFLD and dementia or cognitive impairment.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42022334492.
目的
研究非酒精性脂肪性肝病（NAFLD）是否会增加患痴呆症或认知障碍的风险。
方法
对PubMed、医学文摘数据库（EMBASE）、考克兰图书馆和科学网数据库中的文献进行系统检索，涵盖各数据库建库至2022年5月22日的时间段。使用Stata软件v. 16.0对从每篇文章中提取的数据进行非酒精性脂肪性肝病与认知障碍或痴呆症风险的统计分析。本研究的质量使用纽卡斯尔-渥太华量表（NOS）评估队列研究和病例对照研究的质量，以及美国医疗保健研究与质量局（AHRQ）方法检查表评估横断面研究的质量。使用漏斗图和埃格检验评估发表偏倚。
结果
我们纳入了7项研究，共891,562名来自6个国家的个体，这些研究发表于2020年至2022年之间。汇总分析表明，NAFLD病史与认知障碍相关[比值比（OR）= 1.44；95%置信区间（CI）：1.17 - 1.78；异质性（I²）= 0%；P = 0.001]。NAFLD病史与全因痴呆症风险增加无关（OR = 1.03；95% CI：0.97 - 1.09；I² = 84.7%；P = 0.341）或阿尔茨海默病无关（OR = 0.95；95% CI：0.83 - 1.09；I² = 61.0%；P = 0.489）。相反，NAFLD与血管性痴呆风险明显降低相关（OR = 0.88；95% CI：0.79 - 0.98；I² = 0.0%；P = 0.020）。在亚组分析中，患有NAFLD的男性和女性患者患痴呆症或认知障碍的风险相同。横断面研究中痴呆症或认知障碍的风险（OR = 1.49；95% CI：1.19 - 1.88；I² = 0.0%；P = 0.001）略高于回顾性队列研究（OR = 1.03；95% CI：0.97 - 1.09；I² = 84.3%；P = 0.294）。
结论
NAFLD与认知障碍风险增加和血管性痴呆风险降低相关。需要更多研究来阐明NAFLD与痴呆症或认知障碍之间关联的病理生理机制。
系统评价注册
https://www.crd.york.ac.uk/prospero/#recordDetails，标识符：CRD42022334492。
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