Is Helicobacter pylori infection associated with glycemic control in diabetics?
Is Helicobacter pylori infection associated with glycemic control in diabetics?
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DOI：
10.3748/wjg.v21.i17.5407
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发表时间：
2015-05-07
影响因子：
4.3
通讯作者：
Li, You-Ming
中科院分区：
文献类型：
--
作者：
Dai, Yi-Ning;Yu, Wei-Lai;Li, You-Ming
目的：探讨幽门螺杆菌（Helicobacter pylori，H.方法：计算机检索PubMed、科克伦图书馆、中国生物医学网络数据库和中文科技期刊，检索时间为2014 - 06。研究了H。幽门螺杆菌感染和血糖控制和/或根除治疗对糖尿病患者血糖控制的影响符合纳入标准。使用Review Manager软件版本5.2进行荟萃分析。结果指标以加权平均差异（WMD）和95%置信区间（CI）表示。统计异质性用Cochran Q检验和I-2 statistics.Results：共检索到21篇相关文献。对11项研究（513例糖尿病患者）的荟萃分析显示，H. pylori比H.幽门螺杆菌阳性的DM参与者（WMD = 0.43，95% CI：0.07-0.79; P = 0.02）。在儿童和青少年1型糖尿病（T1 DM）中，H。pylori感染与HbA 1c水平的相关性（WMD = 0.35，95% CI：0.05-0.64; P = 0.02），而2型糖尿病组差异无统计学意义（WMD = 0.51，95% CI：-0.63-1.65; P = 0.38）。对6项研究（325例T2 DM受试者）的荟萃分析显示，H.幽门螺杆菌阳性和H. pylori阴性者（WMD = 1.20，95%CI：0.17-2.23; P = 0.02）。螺杆菌根除在3个月的随访期内，幽门螺杆菌没有改善T2 DM参与者的血糖控制（HbA 1c降低：WMD =-0.03，95%CI = -0.14-0.08; P = 0.57;空腹血糖降低：WMD =-0.06，95%CI：-0.36-0.23; P = 0.68）。未再感染的T1 DM受试者血糖控制显著优于再感染者（HbA 1c：WMD = 0.72，95% CI：0.32-1.13：P = 0.00）。幽门螺杆菌感染与T1 DM患者血糖控制较差相关，但根除幽门螺杆菌可能不会在短期随访期内改善DM患者的血糖控制。
AIM: To investigate whether Helicobacter pylori (H. pylori) infection is associated with glycemic control and whether hyperglycemia is modified by eradication therapy.METHODS: The databases of PubMed, Cochrane Library, Chinese BioMedicine Web Base and Chinese Science and Technology Journals were searched from inception to June 2014. Studies examining the association between H. pylori infection and glycemic control and/or the effect of eradication treatment on glycemic control in diabetic humans were eligible for inclusion. Meta-analyses were conducted using the Review Manager software version 5.2. The outcome measures are presented as weighed mean differences (WMDs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed by the Cochran Q test and the I-2 statistic.RESULTS: A total of 21 relevant publications were identified. A meta-analysis of 11 studies with 513 patients with diabetes mellitus (DM) showed significantly lower glycosylated hemoglobin (HbA1c) levels in the H. pylori-negative than H. pylori-positive DM participants (WMD = 0.43, 95% CI: 0.07-0.79; P = 0.02). In children and adolescents with type 1 DM (T1DM), there was a positive association between H. pylori infection and HbA1c level (WMD = 0.35, 95% CI: 0.05-0.64; P = 0.02), but there was no difference in those with type 2 DM (T2DM, WMD = 0.51, 95% CI: -0.63-1.65; P = 0.38). A meta-analysis of six studies with 325 T2DM participants showed a significant difference in the fasting plasma glucose levels between H. pylori-positive and H. pylori negative participants (WMD = 1.20, 95% CI: 0.17-2.23; P = 0.02). Eradication of H. pylori did not improve glycemic control in the T2DM participants in a three-month follow-up period (HbA1c decrease: WMD = -0.03, 95% CI = -0.14-0.08; P = 0.57; fasting plasma glucose decrease: WMD = -0.06, 95% CI: -0.36-0.23; P = 0.68). Glycemic control was significantly better in T1DM participants who were not reinfected than in those who were reinfected (HbA1c: WMD = 0.72, 95% CI: 0.32-1.13: P = 0.00).CONCLUSION: H. pylori infection is associated with poorer glycemic control in T1DM patients, but eradication may not improve glycemic control in DM in a short-term follow-up period.