戒烟对非酒精性脂肪性肝病患病率的影响：系统评价和荟萃分析。
Impact of smoking cessation on non-alcoholic fatty liver disease prevalence: a systematic review and meta-analysis.
机构信息
Institute of Digestive Diseases, Longhua Hospital, China-Canada Center of Research for Digestive Diseases (ccCRDD), Shanghai University of Traditional Chinese Medicine, Shanghai, China.
China Academy of Chinese Medical Sciences, Beijing, China.
出版信息
BMJ Open. 2023 Dec 10;13(12):e074216. doi: 10.1136/bmjopen-2023-074216.
OBJECTIVES
The negative effects of smoking on numerous cardiovascular and metabolic diseases have been widely acknowledged. However, the potential effect of smoking cessation is relatively unelucidated. The objective of this study is to explore whether the prevalence of non-alcoholic fatty liver disease (NAFLD) in former smokers differs from the prevalence in current smokers.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Four databases, that is, PubMed, Web of Science, Journal@Ovid and Scopus were searched from inception to 31 January 2023.
ELIGIBILITY CRITERIA
Population-based cross-sectional studies, including the baseline data of cohort studies with identified NAFLD diagnostic methods, and smoking status (current smoker or former smoker) of participants were included.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently extracted the data including cigarette smoking status, country/region of studies, NAFLD diagnostic methods, sex, the average age and body mass index (BMI) of NAFLD participants and assessed the risk of bias with Agency for Healthcare Research and Quality (AHRQ) methodology checklist. Risk ratio (RR) of NAFLD prevalence in former smokers was pooled using the random-effects model.
RESULTS
28 studies involving 4 465 862 participants were included. Compared with current smokers, the RR of overall NAFLD prevalence in former smokers was 1.13 (95% CI: 1.08 to 1.19, prediction interval: 0.92-1.39). This result persisted after adjustment for diagnostic methods, country/region, sex, age and BMI. Sensitivity analysis and risk of bias assessment indicated a stable conclusion.
CONCLUSIONS
NAFLD prevalence in former smokers was at least not lower than that in current smokers and was partially related to increased BMI after smoking cessation, indicating that smoking cessation was possibly not a protective factor against NAFLD. Although the meta-analysis based on cross-sectional studies cannot conclude the causal relationships between smoking cessation and NAFLD onset, the potential onset of NAFLD associated with smoking cessation should be highlighted.
PROSPERO REGISTRATION NUMBER
CRD42023394944.
目的
吸烟对许多心血管和代谢疾病的负面影响已得到广泛认可。然而，戒烟的潜在效果相对尚未阐明。本研究旨在探讨戒烟者中非酒精性脂肪性肝病（NAFLD）的患病率是否与吸烟者不同。
设计
系统评价和荟萃分析。
数据来源
从建库到 2023 年 1 月 31 日，我们检索了 4 个数据库，即 PubMed、Web of Science、Journal@Ovid 和 Scopus。
纳入标准
包括使用明确的 NAFLD 诊断方法的基于人群的横断面研究和队列研究的基线数据，以及参与者的吸烟状况（当前吸烟者或戒烟者）的研究。
数据提取和综合
两位审查员独立提取数据，包括吸烟状况、研究国家/地区、NAFLD 诊断方法、性别、NAFLD 参与者的平均年龄和体重指数（BMI）以及使用医疗保健研究和质量局（AHRQ）方法学检查表评估偏倚风险。使用随机效应模型汇总戒烟者中 NAFLD 患病率的风险比（RR）。
结果
共纳入 28 项研究，涉及 4465862 名参与者。与当前吸烟者相比，戒烟者中总体 NAFLD 患病率的 RR 为 1.13（95%CI：1.08 至 1.19，预测区间：0.92 至 1.39）。调整诊断方法、国家/地区、性别、年龄和 BMI 后，该结果仍然存在。敏感性分析和偏倚风险评估表明结论稳定。
结论
戒烟者中 NAFLD 的患病率至少不低于当前吸烟者，且部分与戒烟后 BMI 增加有关，这表明戒烟可能不是预防 NAFLD 的保护因素。尽管基于横断面研究的荟萃分析不能得出戒烟与 NAFLD 发病之间的因果关系结论，但应强调与戒烟相关的 NAFLD 发病的潜在风险。
前瞻性注册号
CRD42023394944。
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