中国人群肝癌发病危险因素病例对照研究的meta分析

目的 对中国人群肝癌发病危险因素的病例对照研究进行综合定量分析，为肝癌的防控和卫生决策提供理论依据。方法 系统地检索Pubmed、中国知网、万方数据库、中国医院知识仓库发表的中国人群肝癌影响因素的病例对照研究，检索自数据库建立到2021年5月1日的所有中英文文献。用纽卡斯尔-渥太华量表评价文献质量，用R 4.0.2软件进行meta分析。结果 共检索文献1799篇，根据纳入与排除标准筛选，最终有53篇病例-对照研究纳入系统评价。meta分析结果显示，肝癌的危险因素按照其关联性由强到弱依次为:HBV感染、肝病史、精神因素、HCV感染、癌症家族史、糖尿病、食用霉变食物、饮酒、吸烟、饮用不洁水源，合并 OR值最高为9.79（95%CI:7.93~11.65），最低为1.32（95%CI:1.08~1.56）。饮茶为保护因素，合并OR值为0.28（95%CI:0.17~0.39）。敏感性分析、发表偏倚检验与剪补法分析结果显示，本研究纳入的文献整体上敏感性低，发表偏倚控制较好。结论 病毒感染、肝病史、饮酒等不健康生活方式为我国人群肝癌发病的危险因素，饮茶为保护因素。建议积极接种乙肝疫苗，改变不良饮食习惯和生活方式，加强肝癌的早预防、早发现、早诊断、早治疗。

Meta-analysis of case-control studies on risk factors for liver cancer in the Chinese population

Objective To conduct a comprehensive quantitative analysis of case-control studies on the risk factors of liver cancer in the Chinese population, and to provide a theoretical basis for the prevention and control of liver cancer and healthcare decision-making. Methods A systematic search of published case-control studies on the risk factors of liver cancer in Chinese populations in PubMed, China National Knowledge Infrastructure, Wanfang Data and Chinese Hospital Knowledge Warehouse was performed to retrieve all Chinese and English works from database inception to May 1st, 2021. The Newcastle-Ottawa scale was used to evaluate the quality of the literature, and R 4.0.2 software was used for meta-analysis. Results A total of 1 799 articles were retrieved and screened according to the inclusion and exclusion criteria, leaving 53 case-control studies for our systematic review. Results of the meta-analysis showed the risk factors for liver cancer, in descending order by strength of association, to be as follows: hepatitis B virus infection, history of liver disease, mental factors, hepatitis C virus infection, family history of cancer, diabetes, consumption of moldy food, alcohol consumption, smoking and consumption of unclean water, with the highest and lowest combined odds ratios (ORs) of 9.79 (95%CI: 7.93-11.65) and 1.32 (95%CI: 1.08-1.56), respectively. Consumption of tea was a protective factor for liver cancer in the Chinese population, with a combined OR of 0.28 (95%CI: 0.17-0.39). Results of sensitivity, publication bias and trim-and-fill analyses showed that the overall sensitivity of the studies included was low, and publication bias was well controlled. Conclusion Unhealthy lifestyle factors such as viral infection, history of liver disease and alcohol consumption are risk factors, while tea consumption is found to be a protective factor for the development of liver cancer in the Chinese population. Active inoculation of hepatitis B vaccine, changing bad eating and lifestyle habits, and strengthening the early prevention, detection, diagnosis and treatment of liver cancer are recommended.