Association between Helicobacter pylori infection and inflammatory bowel disease: a meta-analysis and systematic review of the literature.
Association between Helicobacter pylori infection and inflammatory bowel disease: a meta-analysis and systematic review of the literature.
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DOI：
10.1002/ibd.21116
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发表时间：
2010-06
影响因子：
4.9
通讯作者：
Kao JY
中科院分区：
文献类型：
--
作者：
Luther J;Dave M;Higgins PD;Kao JY
流行病学数据表明幽门螺杆菌感染对自身免疫性疾病的发展具有保护作用。实验室数据说明H.幽门螺杆菌诱导免疫耐受和限制炎症反应的能力。许多观察性研究已经调查了H。幽门螺杆菌感染和炎症性肠病（IBD）。我们的目的是对这种关联进行系统回顾和荟萃分析。Medline、EMBASE、参考文献和会议摘要由2名独立评审员检索。在审查的369篇摘要中，详细审查了30篇有希望的文章。23项研究符合我们的入选标准（受试者N = 5903）。使用Stata 10.1中的metan命令进行荟萃分析。总体而言，27.1%的IBD患者有感染H的证据。pylori感染率为40.9%，而对照组为40.9%。估计的相对危险度H。IBD患者pylori感染率为0.64（95%可信区间[CI]：0.54-0.75）。纳入的研究存在显著异质性，IBD和H.幽门螺杆菌诊断、研究地点或研究人群年龄。这些结果表明H.幽门螺杆菌感染对IBD的发展。研究之间的异质性和发表偏倚的可能性限制了这一发现的确定性。进一步研究根除H. pylori对IBD发展的影响是有道理的。由于环境卫生和肠道菌群可能是强混杂因素，进一步的机制研究，在H。幽门螺杆菌小鼠模型也是必要的，以进一步确定这种负相关的机制。
Epidemiologic data suggest a protective effect of Helicobacter pylori infection against the development of autoimmune disease. Laboratory data illustrate H. pylori's ability to induce immune tolerance and limit inflammatory responses. Numerous observational studies have investigated the association between H. pylori infection and inflammatory bowel disease (IBD). Our aim was to perform a systematic review and meta-analysis of this association. Medline, EMBASE, bibliographies, and meeting abstracts were searched by 2 independent reviewers. Of 369 abstracts reviewed, 30 promising articles were reviewed in detail. Twenty-three studies met our inclusion criteria (subject N = 5903). Metaanalysis was performed with the metan command in Stata 10.1. Overall, 27.1% of IBD patients had evidence of infection with H. pylori compared to 40.9% of patients in the control group. The estimated relative risk of H. pylori infection in IBD patients was 0.64 (95% confidence interval [CI]: 0.54–0.75). There was significant heterogeneity in the included studies that could not be accounted for by the method of IBD and H. pylori diagnosis, study location, or study population age. These results suggest a protective benefit of H. pylori infection against the development of IBD. Heterogeneity among studies and the possibility of publication bias limit the certainty of this finding. Further studies investigating the effect of eradication of H. pylori on the development of IBD are warranted. Because environmental hygiene and intestinal microbiota may be strong confounders, further mechanistic studies in H. pylori mouse models are also necessary to further define the mechanism of this negative association.