Table_4_Liver fibrosis prevalence and risk factors in patients with psoriasis: A systematic review and meta-analysis.pdf

BackgroundPatients with psoriasis are more likely than matched controls in the general population to have advanced liver fibrosis; however, our understanding of these patients is limited. There is currently no systematic evaluation of the prevalence and risk factors of liver fibrosis in psoriasis patients.
ObjectiveTo evaluate the prevalence of psoriasis patients who are at high or low risk for advanced liver fibrosis and determine the risk factors for developing liver fibrosis.
MethodsElectronic searches were conducted using the PubMed, Embase, Scopus, and Cochrane Library databases from the dates of their inception till May 2022, using the PubMed, Embase, Scopus, and Cochrane Library databases. Any observational study describing the prevalence and/or risk factors for liver fibrosis in patients with psoriasis was included.
ResultsPatients with psoriasis at high risk for advanced liver fibrosis had a pooled prevalence of 9.66% [95% confidence interval (CI): 6.92–12.75%, I2 = 76.34%], whereas patients at low risk for advanced liver fibrosis had a pooled prevalence of 77.79% (95% CI: 73.23–82.05%, I2 = 85.72%). Studies that recruited methotrexate (MTX)-naïve patients found a lower prevalence of advanced liver fibrosis (4.44, 95% CI: 1.17–9.22%, I2 = 59.34%) than those that recruited MTX-user cohorts (12.25, 95% CI: 6.02–20.08%, I2 = 82.34%). Age, sex, BMI, PASI score, psoriasis duration, MTX cumulative dose, and the prevalence of obesity, MTX users, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were not identified as sources of heterogeneity by meta-regression analysis. The pooled odds ratios for age >50 years, BMI > 30, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were 2.20 (95% CI: 1.42–3.40, I2 = 0%), 3.67 (95% CI: 2.37–5.68, I2 = 48.8%), 6.23 (95% CI: 4.39–8.84, I2 = 42.4%), 2.82 (95% CI: 1.68–4.74, I2 = 0%), 3.08 (95% CI: 1.90–4.98, I2 = 0%), and 5.98 (95% CI: 3.63–9.83, I2 = 17%), respectively.
ConclusionApproximately 10% of the population with psoriasis is at high risk for advanced liver fibrosis, while 78% are at low risk. Patients over the age of 50 with obesity, diabetes, hypertension, dyslipidemia, and/or metabolic syndrome have an increased risk of developing liver fibrosis, necessitating monitoring.
Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022303886], identifier [CRD42022303886].

背景 与普通人群中的匹配对照个体相比，银屑病（psoriasis）患者发生进展性肝纤维化的风险更高，但目前学界对这类患者的认知仍较为有限。目前尚无针对银屑病患者肝纤维化的患病率及危险因素开展的系统性评估。
目的 评估进展性肝纤维化高低风险人群中银屑病患者的占比，并明确银屑病患者发生肝纤维化的危险因素。
方法 本研究检索PubMed、Embase、Scopus及Cochrane Library数据库自建库至2022年5月的相关文献，纳入所有阐述银屑病患者肝纤维化患病率及/或危险因素的观察性研究。
结果 进展性肝纤维化高风险银屑病患者的合并患病率为9.66%[95%置信区间（confidence interval, CI）：6.92%~12.75%，I²=76.34%]；而低风险患者的合并患病率为77.79%（95% CI：73.23%~82.05%，I²=85.72%）。针对初治甲氨蝶呤（methotrexate, MTX）患者的研究显示，其进展性肝纤维化患病率（4.44%，95% CI：1.17%~9.22%，I²=59.34%）低于纳入甲氨蝶呤使用者队列的研究（12.25%，95% CI：6.02%~20.08%，I²=82.34%）。经Meta回归分析，年龄、性别、体质量指数（body mass index, BMI）、银屑病面积与严重程度指数（Psoriasis Area and Severity Index, PASI）评分、银屑病病程、甲氨蝶呤累积剂量，以及肥胖、甲氨蝶呤使用者、糖尿病、高血压、血脂异常及代谢综合征的患病率均未被识别为异质性来源。年龄＞50岁、BMI＞30、糖尿病、高血压、血脂异常及代谢综合征的合并比值比（odds ratio, OR）分别为2.20（95% CI：1.42~3.40，I²=0%）、3.67（95% CI：2.37~5.68，I²=48.8%）、6.23（95% CI：4.39~8.84，I²=42.4%）、2.82（95% CI：1.68~4.74，I²=0%）、3.08（95% CI：1.90~4.98，I²=0%）及5.98（95% CI：3.63~9.83，I²=17%）。
结论 约10%的银屑病患者存在进展性肝纤维化高风险，而78%的患者处于低风险。年龄超过50岁、合并肥胖、糖尿病、高血压、血脂异常及/或代谢综合征的银屑病患者发生肝纤维化的风险升高，需对该类患者进行临床监测。
系统评价注册信息 [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022303886]，标识符：CRD42022303886。