根除幽门螺杆菌对胃黏膜癌前病变的影响的Meta分析

Effects of the Eradication of Helicobacter Pylori on Gastric Mucosal Precancerous Lesion:A Meta-analysis

目的探讨根除幽门螺杆菌(Hp)对萎缩性胃炎、肠化生等癌前病变的逆转效用。方法全面检索1984年至2008年底国内外生物医学期刊发表的根除Hp对胃黏膜癌前病变影响的临床研究文献及学术会议的交流论文,共6个随机对照试验524例患者进入本系统评价。采用胃黏膜组织学评分、组织学变化作为观察指标。结果(1)Hp根除组胃黏膜萎缩程度改善率显著高于对照组(OR=0.27,95%CI0.17～0.46,P=0.000);但胃黏膜肠化生改善率在Hp根除组和对照组之间无显著差异(OR=0.55,95%CI0.28～1.08,P=0.082);(2)Hp根除组Hp根除后胃窦部、胃体、胃底部黏膜的活动性炎症、慢性炎症以及萎缩评分均显著低于对照组(P<0.01),但各部位黏膜的肠化生评分改善在Hp根除组和对照组之间无显著差异(P>0.05)。结论本Meta分析表明,根除Hp可改善慢性萎缩性胃炎的萎缩程度,活动性炎症和慢性炎症程度,但是对胃黏膜肠化生的改善不明显。

Objective To evaluate the reversing effects of the eradication of helicobacter pylori（Hp） on gastric mucosal precancerous lesions, especially on chronic atrophy gastritis （CAG） and intestinal metaplasia（IM）. Methods We coundcuted a global literature seaeh in the electronic databases about the effect of Hp eradication on the mucosal precancerous lesions from 1984 to 2008 ,complemented by hand searching of references. Finally, there were 6 randomized controlled trials which included 542 patients met the inclusion criteria. Gastric mucosal histolgy score, histology change were assessed. Results （ 1 ） Mueosal atrophy of CAG could be reduced by the eradication of Hp（OR =0. 27,95%CI0. 17 ～0. 46, P =0. 000） ;but there was no significant difference on the change of intestinal metaplasia between Hp eradication group and control group（ OR = 0. 55,95% CI 0. 28 ～ 1.08, P =0. 082）. （2）The score of mucosal acute inflammation,chronic inflammation and atrophy of CAG that local in antral ,body and fundic after the eradication of Hp were lower than control group（ P 〈0.01 ） ,but there was no significant difference on the change of intestinal metaplasia score .between eradication group and control group（ P 〉 0. 05 ）. Conclusion This Meta-analysis show that mucosal atrophy, acute inflammation and chronic inflammation of CAG can be reduced or even reversed by the eradication of Hp, but the intestinal metaplasia of gastric mucosa can not be reversed.