Helicobacter pylori eradication cannot reduce the risk of gastric cancer in patients with intestinal metaplasia and dysplasia: evidence from a meta-analysis
Helicobacter pylori eradication cannot reduce the risk of gastric cancer in patients with intestinal metaplasia and dysplasia: evidence from a meta-analysis
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DOI：
10.1007/s10120-015-0462-7
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发表时间：
2016-01-01
期刊：
影响因子：
7.4
通讯作者：
Zhou, Zong-Guang
中科院分区：
文献类型：
--
作者：
Chen, Hai-Ning;Wang, Zhu;Zhou, Zong-Guang
幽门螺杆菌（H. pylori）根除对预防胃癌（GC）的作用存在争议。肠上皮化生（IM）似乎是癌前级联反应中的一个“不归路”。我们对随机对照试验（RCT）进行了荟萃分析，以说明这一问题。检索MEDLINE、EMBASE、科克伦图书馆，以查找截至2014年3月以任何语言发表的相关RCT。通过将参与者根据其基线诊断分为亚组，（正常、非萎缩性胃炎、萎缩性胃炎）和A组份/千日元IM（肠化生、发育不良），采用Mantel-Haenszel固定风险法，将每项研究中治疗组与对照组相比的GC相对风险（RR）合并，进行了效应模型和发表偏倚分析，共纳入8个随机对照试验的10个研究，共计7,955例受试者。H.与对照组相比，幽门螺杆菌治疗组显著降低了GC的风险，合并RR为0.64（95%CI，0.48-0.85）。非萎缩性胃炎、萎缩性胃炎（< IM）亚组分析结果相似（RR = 0.25，95%CI，0.08-0.81）。但在肠上皮化生、异型增生（千分之一日元IM）患者中未观察到这种差异（RR = 0.88，95%CI，0.59-1.31）。幽门螺杆菌治疗对胃癌的风险。
The effect of Helicobacter pylori (H. pylori) eradication on gastric cancer (GC) prevention is controversial. Intestinal metaplasia (IM) seems to be a "point of no return" in the precancerous cascade. We performed a meta-analysis of randomized controlled trials (RCTs) to illustrate this issue.The MEDLINE, EMBASE, Cochrane Library were searched for relevant RCTs that were published in any language up to March 2014. By dividing participants into subgroups based on their baseline diagnoses as group < IM (normal, non-atrophic gastritis, atrophic gastritis) and group a parts per thousand yenIM(intestinal metaplasia, dysplasia), the relative risk (RR) of GC in each study compared treatment group with control group were pooled using Mantel-Haenszel fixed-effect model and publication bias analyses were performed.Ten studies from eight RCTs were included in this analysis, for a total of 7,955 participants. H. pylori treatment compared with control significantly reduced the risk of GC, with a pooled RR of 0.64 (95 % CI, 0.48-0.85). Subgroup analysis for patients with non-atrophic gastritis, atrophic gastritis (< IM) yielded a similar results (RR = 0.25, 95 % CI, 0.08-0.81). But this difference was not observed in patients with intestinal metaplasia, dysplasia (a parts per thousand yenIM) (RR = 0.88; 95 % CI, 0.59-1.31).Our results suggested that patients with Intestinal metaplasia or dysplasia could not benefit from the H. pylori treatment on the risk of GC.