银屑病患者肝纤维化的患病率及危险因素：一项系统评价和荟萃分析。
Liver fibrosis prevalence and risk factors in patients with psoriasis: A systematic review and meta-analysis.
作者信息
Yongpisarn Tanat, Namasondhi Amornrut, Iamsumang Wimolsiri, Rattanakaemakorn Ploysyne, Suchonwanit Poonkiat
机构信息
Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Front Med (Lausanne). 2022 Dec 15;9:1068157. doi: 10.3389/fmed.2022.1068157. eCollection 2022.
BACKGROUND
Patients with psoriasis are more likely than matched controls in the general population to have advanced liver fibrosis; however, our understanding of these patients is limited. There is currently no systematic evaluation of the prevalence and risk factors of liver fibrosis in psoriasis patients.
OBJECTIVE
To evaluate the prevalence of psoriasis patients who are at high or low risk for advanced liver fibrosis and determine the risk factors for developing liver fibrosis.
METHODS
Electronic searches were conducted using the PubMed, Embase, Scopus, and Cochrane Library databases from the dates of their inception till May 2022, using the PubMed, Embase, Scopus, and Cochrane Library databases. Any observational study describing the prevalence and/or risk factors for liver fibrosis in patients with psoriasis was included.
RESULTS
Patients with psoriasis at high risk for advanced liver fibrosis had a pooled prevalence of 9.66% [95% confidence interval (CI): 6.92-12.75%, = 76.34%], whereas patients at low risk for advanced liver fibrosis had a pooled prevalence of 77.79% (95% CI: 73.23-82.05%, = 85.72%). Studies that recruited methotrexate (MTX)-naïve patients found a lower prevalence of advanced liver fibrosis (4.44, 95% CI: 1.17-9.22%, = 59.34%) than those that recruited MTX-user cohorts (12.25, 95% CI: 6.02-20.08%, = 82.34%). Age, sex, BMI, PASI score, psoriasis duration, MTX cumulative dose, and the prevalence of obesity, MTX users, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were not identified as sources of heterogeneity by meta-regression analysis. The pooled odds ratios for age >50 years, BMI > 30, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were 2.20 (95% CI: 1.42-3.40, = 0%), 3.67 (95% CI: 2.37-5.68, = 48.8%), 6.23 (95% CI: 4.39-8.84, = 42.4%), 2.82 (95% CI: 1.68-4.74, = 0%), 3.08 (95% CI: 1.90-4.98, = 0%), and 5.98 (95% CI: 3.63-9.83, = 17%), respectively.
CONCLUSION
Approximately 10% of the population with psoriasis is at high risk for advanced liver fibrosis, while 78% are at low risk. Patients over the age of 50 with obesity, diabetes, hypertension, dyslipidemia, and/or metabolic syndrome have an increased risk of developing liver fibrosis, necessitating monitoring.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022303886], identifier [CRD42022303886].
背景
银屑病患者比普通人群中匹配的对照组更易出现晚期肝纤维化；然而，我们对这些患者的了解有限。目前尚无对银屑病患者肝纤维化患病率及危险因素的系统评估。
目的
评估银屑病患者中晚期肝纤维化高风险和低风险的患病率，并确定发生肝纤维化的危险因素。
方法
使用PubMed、Embase、Scopus和Cochrane图书馆数据库，从其创建之日至2022年5月进行电子检索。纳入任何描述银屑病患者肝纤维化患病率和/或危险因素的观察性研究。
结果
晚期肝纤维化高风险的银屑病患者合并患病率为9.66%[95%置信区间（CI）：6.92 - 12.75%，I² = 76.34%]，而晚期肝纤维化低风险的患者合并患病率为77.79%（95% CI：73.23 - 82.05%，I² = 85.72%）。招募未使用甲氨蝶呤（MTX）患者的研究发现晚期肝纤维化患病率（4.44，95% CI：1.17 - 9.22%，I² = 59.34%）低于招募使用MTX患者队列的研究（12.25，95% CI：6.02 - 20.08%，I² = 82.34%）。通过Meta回归分析，年龄、性别、体重指数（BMI）、银屑病面积和严重程度指数（PASI）评分、银屑病病程、MTX累积剂量以及肥胖、MTX使用者、糖尿病、高血压、血脂异常和代谢综合征的患病率均未被确定为异质性来源。年龄>50岁、BMI>30、糖尿病、高血压、血脂异常和代谢综合征的合并比值比分别为2.20（95% CI：1.42 - 3.40，I² = 0%）、3.67（95% CI：2.37 - 5.68，I² = 48.8%）、6.23（95% CI：4.39 - 8.84，I² = 42.4%）、2.82（95% CI：1.68 - 4.74，I² = 0%）、3.08（95% CI：1.90 - 4.98，I² = 0%）和5.98（95% CI：3.63 - 9.83，I² = 17%）。
结论
约10%的银屑病患者有晚期肝纤维化高风险，78%为低风险。50岁以上患有肥胖、糖尿病、高血压、血脂异常和/或代谢综合征的患者发生肝纤维化的风险增加，需要进行监测。
系统评价注册
[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022303886]，标识符[CRD42022303886]。
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