切换至 "中华医学电子期刊资源库"
高级检索
中华消化病与影像杂志(电子版)

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:
全文 ( ) 下载PDF ( ) 导出引用
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/OL]. 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/OL]. 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
1
Patel T. Cholangiocarcinoma[J]. Nat Clin Pract Gastroenterol Hepatol, 2006, 3(1): 33-42.
2
Seyama Y, Makuuchi M. Current surgical treatment for bile duct cancer[J]. World J Gastroenterol, 2007, 13(10): 1505-1515.
3
Stroup DF, Berlin JA, Morton SC, et al.Meta-analysis of observational studies in epidemiology: a proposal for reporting.Meta-analysis Of Observational Studies in Epidemiology(MOOSE)group[J]. JAMA, 200, 283(15): 2008-2012.
4
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of non randomized studies in meta-analyses[J]. Euro J Epidemiol, 2010, 25(9): 603-605.
5
Obesity: preventing and managing the global epidemic.Report of a WHO consultation[J]. World Health Organ Tech Rep Ser, 2000, 894: 1-253.
6
Cochran WG.The combination of estimates from different experiments[J]. Biometrics, 1954, 10(1): 101-129.
7
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease[J]. J Natl Cancer Inst, 1959, 22(4): 719-748.
8
DerSimonian R, Laird N. Meta-analysis in clinical trials[J]. Control Clin Trials, 1986, 7(3): 177-188.
9
Egger M, Davey SG, Schneider M, et al.Bias in meta-analysis detected by a simple, graphical test[J]. Br Med J, 1997, 315(7109): 629-634.
10
Wolk A, Gridley G, Svensson M, et al.A prospective study of obesity and cancer risk(Sweden)[J]. Cancer Cause Control, 2001, 12(1): 13-21.
11
Samanic C, Gridley G, Chow WH, et al.Obesity and cancer risk among white and black United States veterans[J]. Cancer Cause Control, 2004, 15(1): 35-43.
12
Oh SW, Yoon YS, Shin SA.Effects of excess weight on cancer incidences depending on cancer sites and histologic findings among men: Korea National Health Insurance Corporation Study[J]. J Clin Oncol, 2005, 23(21): 4742-4754.
13
Samanic C, Chow WH, Gridley G, et al.Relation of body mass index to cancer risk in 362, 552 Swedish men[J]. Cancer Cause Control, 2006, 17(7): 901-909.
14
Ishiguro S, Inoue M, Kurahashi N, et al.Risk factors of biliary tract cancer in a large-scale population-based cohort study in Japan(JPHC study)；with special focus on cholelithiasis, body mass index, and their effect modification[J]. Cancer Cause Control, 2008, 19(1): 33-41.
15
Kato K, Akai S, Tominaga S, et al.A case-control study of biliary tract cancer in niigata prefecture, Japan[J]. Jpn J Cancer Res, 1989, 80(10): 932-938.
16
张学宏，高玉堂，Rashid A，等．身体质量指数及腰臀围比与胆道癌关系的探讨[J]．中国肿瘤临床，2005，32(4)：227-230.
17
Ahrens W, Timmer A, Vyberg M, et al.Risk factors for extrahepatic biliary tract carcinoma in men: Medical conditions and lifestyle: Results from a european multicentre case-control study[J]. Eur J Gastroenterol Hepatol, 2007, 19(8): 623-630.
18
Welzel TM, Graubard BI, El-Serag HB, et al.Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case-control study[J]. Clin Gastroenterol Hepatol, 2007, 5(10): 1221-1228.
19
Welzel TM, Mellemkjaer L, Gloria G, et al.Risk factors for intrahepatic cholangiocarcinoma in a low-risk population: a nationwide case-control study[J]. Int J Cancer, 2007, 120(3): 638-641.
20
Hsing AW, Sakoda LC, Rashid A, et al.Body size and the risk of biliary tract cancer: A population-based study in china[J]. Br J Cancer, 2008, 99(5): 811-815.
21
Grainge MJ, West J, Solaymani-Dodaran M, et al.The antecedents of biliary cancer: a primary care case-control study in the United Kingdom[J]. Br J Cancer, 2009, 100(1): 178-180.
22
Welzel TM, Graubard BI, Zeuzem S, et al.Metabolic syndrome increases the risk of primary liver cancer in the United States: a study in the SEER-Medicare database[J]. Hepatology, 2011, 54(2): 463-471.
23
Chaiteerakij R, Yang JD, Harmsen WS, et al.Risk factors for intrahepatic cholangiocarcinoma: association between metformin use and reduced cancer risk[J]. Hepatology, 2013, 57(2): 648-655.
24
Lee BS, Park EC, Park SW, et al.Hepatitis b virus infection, diabetes mellitus, and their synergism for cholangiocarcinoma development: A case-control study in Korea[J]. World J Gastroenterol, 2015, 21(2): 502-510.
25
Kinoshita M, Kubo S, Tanaka S, et al.The association between non-alcoholic steatohepatitis and intrahepatic cholangiocarcinoma: A hospital based case-control study[J]. J Surg Oncol, 2016, 113(7): 779-783.
26
Renehan AG, Zwahlen M, Minder C, et al.Insulin-like growth factor(IGF)-I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis[J]. Lancet, 2004, 363(9418): 1346-1353.
27
Renehan AG, Frystyk J, Flyvbjerg A. Obesity and cancer risk: the role of the insulin-IGF axis[J]. Trends Endocrinol Metab, 2006, 17(8): 328-336.
28
Parsi MA.Obesity and cholangiocarcinoma[J]. World J Gastroenterol, 2013, 19(4): 457-462.
29
Meng F, Yamagiwa Y, Ueno Y, et al.Over-expression of interleukin-6 enhances cell survival and transformed cell growth in human malignant cholangiocytes[J]. J Hepatol, 2006, 44(6): 1055-1065.
30
Okada K, Shimizu Y, Nambu S, et al.Interleukin-6 functions as an autocrine growth factor in a cholangiocarcinoma cell line[J]. J Gastroenterol Hepatol, 1994, 9(5): 462-467.
31
Shaffer EA.Gallstone disease: Epidemiology of gallbladder stone disease.Best practice & research[J]. Clin Gastroenterol, 2006, 20(6): 981-996.
[1] 蚁淳, 袁冬生, 熊学军. 系统免疫炎症指数与骨密度降低和骨质疏松的关联[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 609-617.
[2] 李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[3] 吴姗姗, 潘裕民, 刘晋, 张劲松, 乔莉. 睡眠呼吸暂停综合征患者静脉血栓栓塞症发生率的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 312-317.
[4] 向韵, 卢游, 杨凡. 全氟及多氟烷基化合物暴露与儿童肥胖症相关性研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 569-574.
[5] 徐楠, 杨云川, 周迟, 马翔, 鲁正, 崔培元. 脾动脉结扎在肝门胆管癌行大范围肝切除中的临床作用研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 271-274.
[6] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[7] 杨波, 胡旭, 何金艳, 谢铭. 腹腔镜袖状胃切除术管胃固定研究现状[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 452-455.
[8] 吉顺富, 汤晓燕, 徐进. 腹腔镜近端胃癌根治术中拓展胃后间隙在肥胖患者中的应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 393-396.
[9] 玉素江·图荪托合提, 韩琦, 麦麦提艾力·麦麦提明, 黄旭东, 王浩, 克力木·阿不都热依木, 艾克拜尔·艾力. 腹腔镜袖状胃切除或联合食管裂孔疝修补术对肥胖症合并胃食管反流病的中期疗效分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 501-506.
[10] 刘见, 杨晓波, 何均健, 等. 应用电钩三孔法腹腔镜袖状胃切除术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(06): 363-364.
[11] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[12] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[13] 龚财芳, 赵俊宇, 游川. 围手术期肠内营养在肝癌肝切除患者中有效性及安全性的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 551-556.
[14] 王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[15] 周倩妹, 王宪娥, 徐筱, 老慧琳, 赵欣悦, 胡菁颖. 多元化系统护理对老年人群牙周健康指标影响的系统评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 500-506.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号