幽门螺杆菌感染与缺血性脑卒中及其亚型相关性Meta分析

目的对幽门螺杆菌(Hp)感染与缺血性脑卒中(IS)及其亚型的相关性进行Meta分析,探讨Hp感染是否为IS及其亚型的危险因素。方法计算机检索MEDLINE、EMBASE及Cochrance Collaboration database电子数据库,检索时限为1 995～2009年。由2名评价者对文献的质量进行评价,纳入相关的病例对照研究。采用Cochrane协作网提供的RevMan 5.0软件对纳入文献进行Meta分析,并进一步进行异质性检验、敏感性分析及偏倚评估。结果共纳入11篇相关文献,其中与IS相关9篇(病例组1575例,对照组1 720例),与大动脉粥样硬化性脑卒中(LAA)相关7篇(病例组510例,对照组944例)。异质性检验提示,Hp与IS及LAA的研究间均存在异质性(I~2=58%,I~2=60%)。病例组与对照组的Hp感染率差异存在统计学意义(OR=1.57,95%CI:1.23～1.99);Hp感染与LAA亦存在相关性(OR=2.24,95%CI:1.46～3.43)。敏感性分析提示结果稳定。漏斗图表明存在发表偏倚,提示缺少小样本的阴性结果文献。结论 Hp感染是IS的危险因素,且与LAA的相关性更为密切;病例对照研究论证强度较低,仍需更多大样本及前瞻性研究以证实Hp在IS及其亚型发病中的作用。

The relationship between Helicobacter pylori chronic infection and ischemic stroke subtypes:meta-analysis

Objective To conduct a meta-analysis of case-control studies for assessing association between Helicobacter pylori(Hp) and different types of ischemic stroke(IS) in order to explore whether Hp infection is the risk factor for IS and its subtypes.Methods MEDLINE,EMBASE and Cochrance Collaboration database with the time limit of 1995 to 2009 were searched.Meta-analyses were performed for case-control studies after strict screening.Heterogeneity test,sensitivity analysis and publication bias assessment were also performed.Results Eleven case-control studies were included-of which,9(1575 patients,1720 controls) were related to IS and 7 were related to large artery atherosclerotic stroke(LAA,510 patients,944 controls).The pooled OR was 1.57(95%CI:1.23—1.99).Patients with LAA had higher odds for Hp infection than controls(OR =2.24,95%CI:1.46—3.43) according to the seven studies.Random-effects model was adopted to perform heterogeneity test because of significant study heterogeneity(I~2= 58%, I~2=60%).Sensitivity analysis suggested the results of meta-analysis were reliable.However,the funnel plot suggested that the experimental results may be affected by bias,possibly resulting from lack of published studies reporting negative results in small-size sample.Conclusion Association between Hp and IS is significant and seems higher with LAA.Relation between Hp and IS needs to be further confirmed by future large sample and prospective investigations.