急性胃肠炎与肠易激综合征发病风险相关性的Meta分析

Association between Acute Gastrointestinal Infection and Irritable Bowel Syndrome: A Meta-Analysis

目的 系统评价急性胃肠炎与肠易激综合征（IBS）发病的相关性。方法 计算机检索The Cochrane Library（2013年第8期）、PubMed、EMbase、WebofScience、CBM、CNKI、VIP和WanFang Data，收集急性胃肠炎与肠踢激综合征发病风险相关性的前瞻性队列研究，检索时限均为从各数据库建库至2013年8月。由2位研究并按照纳入与排除标准独立筛选文献、提取资料并评价方法学质量后，采用RevMan 5.2软件进行Meta分析、结果共纳人11个队列研究，包括6274例观察对象：根据不同的随访时间行亚组分析，Meta分析结果显示：与未感染的健康志愿荇相比.急性胃肠炎患者在3个月、6个月、12个月、2～3年时，IBS发病风险增高[3个月：RR=6.46.95％CI（1.85，22.58）.P=0.003；6个月：RR=4.68，95％CI（2.07，10.60），P=0.0002；12个月：RR=4.95，95％CI（2.90，8.45），P〈0.00001；2～3年：RR=3.11，95％CI（2.72，3.56），P〈0.000011，但随访第5年，两组IBS发病风险无明显差异[RR=1.69，95％CI（0.68，4.24），P=0.26]。结论急性胃肠炎患者患病后3年内与IBS的发病具有一定相关性，其中性别、急性期腹泻持续天数、急性期脓血便和急性期腹部痉挛等因素可能是重要的诱发因素。在第5年时与IBS发病无相关性。鉴于纳入研究数量和样本量较少，上述结论尚需开展前瞻性研究进一步验证。

Objective To systematically review the correlation between acute gastrointestinal infection and IBS. Methods Literature search was performed in the Cochrane Library （Issue 8, 2013）, PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data to collect the prospective cohort studies about association between acute gastrointestinal infection and IBS, from inception to August 2013. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality using NOS, and then Meta analysis was conducted using RevMan 5.2 software. Results A total of 11 cohort studies involving 6 274 patients were included. According to the different follow-up times for subgroup analysis, the results of meta-analysis showed that, compared with the healthy volunteers who did not expose the acute gastrointestinal infection, the patients with acute gastroenter[tis had a increase risk of irritable bowel syndrome within 3 months, 6 months, 12 months, and 2-3 years （3 months： RR=6.46, 95%CI 1.85 to 22.58, P=0.003; 6 months： RR=4.68, 95%CI 2.07 to 10.60, P=0.000 2; 12 months： RR=4.95, 95%CI 2.90 to 8.45, P〈0.000 01; 2-3 years： RR=3.11, 95%CI 2.72 to 3.56, P〈0.000 01）. However, after the fifth year of acute gastroenteri- tis, there was no statistical significance in the risk of irritable bowel syndrome between the two groups （RR=l.69, 95%CI 0.68 to 4.24, P=0.26）. Conclusion Acute gastrointestinal infection within 3 years after onset was associated with the risk of IBS. Sex, diarrhea duration, bloody purulent stools and abdominal cramps at acute stage are important risk factors of intriguing the occurrence of post-infectious IBS. The acute gastrointestinal infection and IBS are not associated in the fifth year; however, more high-quality trials are needed for further verifying the aforementioned conclusion.