本文選題：他汀類藥物　切入點(diǎn)：肝纖維化　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的:肝纖維化是慢性肝病進(jìn)展過(guò)程中重要的病理過(guò)程。他汀類藥物具有改善肝臟脂質(zhì)代謝、抗炎等作用,同時(shí)可以提高病毒性肝炎患者抗病毒療效。而他汀類藥物對(duì)慢性肝病患者不同的疾病進(jìn)程影響,尚無(wú)明確結(jié)論。本研究通過(guò)薈萃分析探討他汀類藥物對(duì)慢性肝病患者發(fā)生明顯肝纖維化、肝硬化、失代償期肝硬化風(fēng)險(xiǎn)的影響,旨在闡明其在慢性肝病患者疾病進(jìn)展中的作用。方法:本研究通過(guò)對(duì) Pubmed/Medline,Embase,Cochrane Library 和 Ovid 數(shù)據(jù)庫(kù)進(jìn)行系統(tǒng)檢索,并閱讀相關(guān)綜述及會(huì)議報(bào)告,篩選出所有與他汀類藥物和慢性肝病患者疾病進(jìn)程相關(guān)的臨床研究。經(jīng)過(guò)兩名研究者分別獨(dú)立閱讀評(píng)判,納入符合入組要求的研究。通過(guò)固定或隨機(jī)效應(yīng)模型,對(duì)入組研究的風(fēng)險(xiǎn)評(píng)估進(jìn)行薈萃分析,以評(píng)估他汀類藥物使用與慢性肝病患者肝纖維化進(jìn)程的關(guān)系。結(jié)果:共16篇臨床研究,合計(jì)123,938例患者被納入該薈萃分析,其中7篇研究報(bào)告了他汀類藥物與非酒精性脂肪性肝病(NAFLD)患者發(fā)生明顯肝纖維化的關(guān)系,5篇研究報(bào)告了慢性病毒性肝炎患者中他汀類藥物與發(fā)生肝硬化風(fēng)險(xiǎn)的關(guān)系,4篇研究報(bào)告了他汀類藥物與肝硬化患者失代償風(fēng)險(xiǎn)及死亡率的關(guān)系。薈萃分析結(jié)果顯示:1.針對(duì)肝纖維化階段,他汀類藥物能夠使NAFLD患者發(fā)生明顯纖維化的概率降低28%(RR=0.72,95%CI:0.56-0.93,p=0.013),且能夠提高NAFLD患者的長(zhǎng)期生存率;2.針對(duì)肝硬化階段,他汀類藥物能夠使慢性病毒性肝炎患者發(fā)生肝硬化的風(fēng)險(xiǎn)降低60%(RR=0.40,95%CI:0.39-0.42,p=0.000),且該作用呈劑量依賴性,他汀類藥物每增加30累計(jì)定義每日劑量(cumulative Defined Daily Dose,cDDD),發(fā)生肝硬化的風(fēng)險(xiǎn)降低14%;3.針對(duì)肝硬化失代償階段,他汀類藥物能夠使肝硬化患者發(fā)生失代償?shù)娘L(fēng)險(xiǎn)降低54%(RR=0.46,95%CI:0.38-0.56,p=0.000),且能夠降低肝硬化患者的死亡率。結(jié)論:他汀類藥物能夠降低慢性肝病患者發(fā)生肝纖維化及肝硬化的風(fēng)險(xiǎn),并能夠降低肝硬化失代償?shù)陌l(fā)生率,提高慢性肝病患者的長(zhǎng)期生存率。
[Abstract]:Background and objective: hepatic fibrosis is an important pathological process in the progression of chronic liver disease. Statins have the effects of improving lipid metabolism and anti-inflammation of liver. At the same time, it can improve the antiviral effect in patients with viral hepatitis. And statins have different effects on the progression of chronic liver disease. In this study, we studied the effect of statins on the risk of liver fibrosis, cirrhosis and decompensated cirrhosis in patients with chronic liver disease by meta-analysis. Methods: the database of Pubmed / Medlinebase Cochrane Library and Ovid was searched systematically, and the related reviews and conference reports were read, the aim of this study was to elucidate its role in the progression of patients with chronic liver disease. All clinical studies related to statins and disease progression in patients with chronic liver disease were screened out. A meta-analysis of the risk assessment of the entry study was conducted to assess the relationship between statins use and the progression of hepatic fibrosis in patients with chronic liver disease. Results: in 16 clinical studies, 123,938 patients were included in the meta-analysis. Seven of the studies reported the relationship between statins and NAFLDs in patients with non-alcoholic fatty liver disease and 5 reported the association of statins with the risk of cirrhosis in patients with chronic viral hepatitis. Four studies reported the relationship between statins and decompensation risk and mortality in patients with liver cirrhosis. Statins can reduce the probability of significant fibrosis in patients with NAFLD by 28% RRR0. 7295% CI: 0. 56-0. 93p0. 013, and can improve the long-term survival rate of patients with NAFLD. Statins can reduce the risk of cirrhosis in patients with chronic viral hepatitis by reducing the risk of cirrhosis by 60% RRX 0.4095% and in a dose-dependent manner. The cumulative daily dose of statins for every 30 years of cumulative definition of the cumulative daily dose of Defined Daily dosedd was 14% lower than that of the patients with liver cirrhosis during the decompensation phase, and the risk of cirrhosis was reduced by 3% for the decompensative phase of cirrhosis. Statins can reduce the risk of decompensation in patients with liver cirrhosis and reduce the risk of liver fibrosis and cirrhosis in patients with chronic liver disease. It can reduce the incidence of liver cirrhosis decompensation and improve the long-term survival rate of patients with chronic liver disease.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575

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