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中华消化病与影像杂志(电子版) ›› 2017, Vol. 07 ›› Issue (02) : 60 -65. doi: 10.3877/cma.j.issn.2095-2015.2017.02.004

所属专题： 文献；

循证医学

肥胖与胆管癌相关性的Meta分析
李君山1, 韩天洁2, 聂晶1, 宫健1, 高新英1, 井夫春1, 王庆才1,†()   
  1. 1. 271000　山东省，泰安市中心医院消化内一科
    2. 271000　山东省，泰安市中心医院血液内科
  • 收稿日期:2016-08-03 出版日期:2017-04-01
  • 通信作者: 王庆才

Correlation of obesity and cholangiocarcinoma: a Meta analysis

Junshan Li1, Tianjie Han2, Jing Nie1, Jian Gong1, Xinying Gao1, Fuchun Ying1, Qingcai Wang1,†()   

  1. 1. First Department of Gastroenterology, Taian Central Hospital, Shandong Province, Taian 271000, China
    2. Department of Hematology, Taian Central Hospital, Shandong Province, Taian 271000, China
  • Received:2016-08-03 Published:2017-04-01
  • Corresponding author: Qingcai Wang
  • About author:
    Corresponding author: Wang Qingcai, Email:
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引用本文：

李君山, 韩天洁, 聂晶, 宫健, 高新英, 井夫春, 王庆才. 肥胖与胆管癌相关性的Meta分析[J]. 中华消化病与影像杂志(电子版), 2017, 07(02): 60-65.

Junshan Li, Tianjie Han, Jing Nie, Jian Gong, Xinying Gao, Fuchun Ying, Qingcai Wang. Correlation of obesity and cholangiocarcinoma: a Meta analysis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2017, 07(02): 60-65.

目的

评估超重或肥胖和胆管癌发病之间的关系。

方法　：

通过检索PubMed、Cochrane、Embase、中国生物医学文献数据库(CBM)，纳入研究肥胖与胆管癌发病风险的文章进行Meta分析。

结果

16研究符合纳入标准，其中包括5个队列和11个病例对照研究。与正常体重相比，体重超重(合并OR：1.20，95% CI：1.07～1.34)、肥胖(合并OR：1.66，95% CI：1.31～2.11)和过重(合并OR：1.33，95% CI：1.18～1.49)与胆管癌发病均显著相关。漏斗图显示无发表偏倚的证据。

结论　：

肥胖增加胆管癌的发病风险增加，还需要长期的队列研究进一步证实。

关键词: 胆管肿瘤, 超重, 肥胖症, 队列研究, 病例对照研究, Meta分析
Objective

To assess the association between overweight or obesity and the incidence of cholangiocarcinoma.

Methods

Using PubMed, Cochrane, EMBase and CBM databases, studies were included if they reported cholangiocarcinoma with respect to obesity or overweight.

Results

Sixteen studies met the inclusion criteria, which included five cohort and eleven case-control studies.Compared with normal weight, being overweight(pooled OR: 1.20, 95% CI: 1.07-1.34), obesity(pooled OR: 1.66, 95% CI: 1.31-2.11), and excess body weight(pooled OR: 1.33, 95% CI: 1.18-1.49)were significantly associated with cholangiocarcinoma.The funnel plot revealed no evidence for publication bias.

Conclusion

Obesity is associated with the increased risk of cholangiocarcinoma, which needs to be confirmed by long-term cohort studies.

Key words: Bile duct neoplasms, Overweight, Obesity, Cohort study, Case-control study, Meta-analysis
表1 纳入Meta分析16篇文献的特征
作者/发表时间/国家 病例数(男性/女性) 对照组或队列人数(男性/女性) BMI(kg/m2)划分标准 Odds Ratio(95% CI) 文献质量评分 匹配方式
Men Women
队列研究 ? ? ? ? ? ? ?
Wolk, et al. (2001) Sweden[10] ECC: 10 (3/7) 28，129(8165/ 19，964) <25.0 6(0.5～7.6) 1.7(0.7～3.4) 8 Age, sex, hypertension; diabetes; osteoarthritis
25.0～29.9
≥30.0
Samanic, et al.(2004) USA[11] ECC：White men: 375Black men: 76 White men:366 8486/Black men：832 214 Non-obeseObese White men：1.36(0.92～2.02)Black men：2.24(1.03～4.89) NA 7 Age, calendar year
Oh, et al.(2005) Korea[12] CC: 517 781，283 men 18.5～22.9 1.0 NA 7 Age, area of residence, smoking, exercise, alcohol
23.0～24.9 1.22(0.99～1.5)
25.0～26.9 1.4(1.11～1.78)
27.0～29.9 1.24(0.87～1.75)
≥30.0 1.64(0.73～3.7)
Samanic, et al. (2006) Sweden[13] CC：39 362，552 men 18.5～24.9 1.14(0.56-2.32) NA 7 Age, smoking
25.0～29.9 3.78(1.59-8.96)
≥30.0 ?
Ishiguro, et al. (2008)Japan[14] ECC: 235 (129/106) 101，868 (48，681/ 53，187) ≤22.9 1.00 1.00 7 Age, sex
23.0～24.9 1.09(0.71～1.68) 0.85(0.51～1.41)
25.0-26.9 1.14(0.68-1.92) 0.98(0.56-1.71)
≥27.0 1.62(0.93-2.84) 1.19(0.69-2.04)
kiyoshi, et al.(1989)Japan[15] CC：84(46/38) 168(92/76) Non-obeseObese Men and Women5.13(2.25～11.68) ? 8 Age, sex, liver diseases
Zhang, et al. (2005) China[16] ECC：14 (80/69) 1205 ≤23 20～29Y Women 8 Age, sex, diabetes
23.0～24.9 Men 1.0
≥25 1.0 0.52(0.21～1.31)
≤23 1.76(0.67～4.65) 1.44(0.34～6.11)
23.0～24.9 1.16(0.16～8.24) Women
≥25 30～39Y 1.0
? Men 0.66(0.31～1.42)
? 1.0 0.77(0.32～1.87)
? 0.84(0.37～1.86) ?
? 0.77(0.22～2.73) ?
Ahrensa, et al. (2006) Germany[17] CC: 153 1421 18.5－<25 1.0 ? 7 age, country and history of gallstones
<18.5 －
25－<27 1.3(0.77～2.21)
27－<30 1(0.57～1.74)
30＋ 1.39(0.7～2.77)
Welzel, et al. (2006) USA[18] ICC: 764 (355/409) 3056 (1420/1636) Non-obese Men and Women ? 8 Age, sex, chronic liver diseases
Obese 2.05(0.75～5.58)
Welzel, et al. (2007) USA[19] ECC: 549 (280/269) 102782 (37，143/ 65，639) Non-obese Men and Women ? 8 Age, sex, race, smoking
ECC: 1.1(0.7～1.8)
ICC: 535 (257/278) Obese ICC: 1.7(1.1～2.6)
? ? ? ?
Hsing, et al. (2008) China[20] ECC：191 (99/92) 959 (373/586) <18.5 0.52(0.24～1.13) ? 7 Age, Sex. education
18.5～22.9 1
23.0～24.9 0.99(0.71～1.37)
≥25 ?
Grainge, et al. (2009) UK[21] CC: 372 5760 <25.0 Men and Women ? 8 Smoking, diabetes mellitus, cirrhosis, viral hepatitis
25.0～30.0 1.00
≥30.0 1.33(0.97～1.82)
? 1.52(1.03～2.24)
Welzel, et al. (2011) USA[22] ICC：743 (353/393) 195，9 53 (71，158/ 12，4795) Non-obese Men and Women 1.71(1.30～2.23) ? 8 Age, sex, race, geographic region
Obese
Chaiteerakij, et al. (2013) USA[23] ICC：612 (421/191) 594 (291/303) Non-obese Men and Women 0.9(0.7～1.2) ? 8 Age, sex, race, hepatitis B
Obese
Lee et al.(2015) Korea[24] ECC：193 552 <25.0 Men and Women ? 7 Age, sex，hepatitis B
ECC: 0.91
ICC: 83 ≥25 (0.59～1.4)
ICC: 1.0(0.56～1.8)
Kinoshita，et al. (2016)Japan[25] ICC：34 (19/15) 69(44/25) <25.0 Men and Women ? 7 Age, sex, smoking
≥25 1.0
1.39(0.446～4.14)
表2 体质量指数与胆管癌发病风险Meta分析及亚组分析
组别 研究数目 Adjusted Odds Ratio(95% CI) P值
所有研究 ? ? ?
? 超重 9 1.20(1.07～1.34) 0.002
? 肥胖 10 1.66(1.31～2.11) <0.001
? 过重 16 1.33(1.18～1.49) <0.001
男性 ? ? ?
? 超重 5 1.32(1.12～1.55) 0.001
? 肥胖 4 1.89(1.29～2.76) 0.001
? 过重 7 1.40(1.22～1.61) <0.001
女性 ? ? ?
? 超重 2 1.04(0.74～1.48) 0.804
? 肥胖 1 1.70(0.77～3.75) 0.188
? 过重 3 1.13(0.82～1.55) 0.450
亚洲 ? ? ?
? 超重 6 1.17(1.03～1.33) 0.014
? 肥胖 2 2.89(0.95～8.85) 0.062
? 过重 7 1.22(1.04－1.44) 0.018
非亚洲 ? ? ?
? 超重 3 1.28(0.94～1.75) 0.121
? 肥胖 8 1.53(1.22～1.91) <0.001
? 过重 9 1.44(1.21－1.71) <0.001
队列研究 ? ? ?
? 超重 3 1.29(1.11～1.51) 0.001
? 肥胖 4 1.77(1.32～2.38) <0.001
? 过重 5 1.38(1.21－1.59) <0.001
病例对照研究 ? ? ?
? 超重 6 1.06(0.88～1.28) 0.550
? 肥胖 6 1.56(1.12～2.17) 0.008
? 过重 10 1.28(1.07～1.53) 0. 008
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