东方国家人群幽门螺杆菌感染与结直肠肿瘤相关性的meta分析

Relationship between Helicobacter pylori infection and colorectal neoplasm in eastern countries:a meta-analysis

目的采用meta分析方法对国内外已发表的有关东方国家人群中幽门螺杆菌(Hp)感染与结直肠肿瘤(包括增生性息肉、腺瘤、肠癌)的关系进行综合评价。方法对符合纳入标准的8篇文献用Review manager 5.2软件进行meta分析,选择OR值及95%CI作为meta分析指标。并做出倒漏斗图,对各研究结果进行异质性检验和效应值合并计算。结果纳入总样本量为5 385例,其中Hp阳性组为3 396例,Hp阴性组为1 989例;通过meta分析合并认为结果存在异质性(I2=83%,P<0.10)。因存在异质性,对肿瘤的类型(增生性息肉、腺瘤、肠癌)、不同的Hp检测方法进行亚组分析。1Hp感染不增加患增生性息肉、结直肠非进展性腺瘤、肠癌的风险(OR=0.73,95%CI=0.45～1.17;OR=1.35,95%CI=0.98～1.86;OR=1.09,95%CI=0.71～1.68),而增加了患结直肠腺瘤及进展性腺瘤的风险(OR=1.81,95%CI=1.31～2.49;OR=2.02,95%CI=1.38～2.96);2采用血清学抗体检测出的Hp感染可增加患结直肠肿瘤的风险(OR=1.49,95%CI=1.00～2.22);3采用非血清学抗体检测出的Hp感染无明显增加患肿瘤的风险(OR=1.35,95%CI=0.89～2.07)。结论 Hp感染可能增加了结直肠腺瘤及进展性腺瘤的发生风险,但无明显增加患肠癌的风险。

Objective Meta-analysis was used to evaluate the relationship between Helicobacter pylori（Hp）infection and colorectal neoplasm（including hyperplastic polyps,adenomas and colorectal cancer）in eastern countries.Methods To analyze eight references meeting eligibility criteria with reviewing manager 5.2software,we selected the ORand 95%CI as indicators of meta-analysis.A funnel geometry figure was made,and the heterogeneity inspection results and effect value were calculated.Results A total sample of 5 385 cases,including 3 396 cases in Hp positive group,1 989 cases in Hp negative group;Meta-analysis merger showed（I2=83%,P 0.10）.Due to the existence of heterogeneity,subgroup analysis about tumor type（hyperplastic polyps,adenomas and colorectal cancer）and detection methods were evaluated.1Hp infection did not increase the risk of occurrence of hyperplastic polyp,non-advanced adenoma,colorectal cancer（OR =0.73,95%CI=0.45-1.17;OR =1.35,95%CI=0.98-1.86,OR =1.09,95%CI=0.71-1.68）,but Hp infection increased the risk of colorectal adenoma and advanced adenoma（OR =1.81,95%CI =1.31-2.49,OR =2.02,95%CI =1.38-2.96）;2The serological antibody detection of Hp infection indicated an increasing risk of colorectal neoplasia（OR =1.49,95%CI =1.00-2.22）;3The non-serological antibody test showed no increasing risk of colorectal neoplasia（OR =1.35,95%CI =0.89-2.07）.Conclusion Hp infection may be a risk of colorectal advanced adenoma,but not of colorectal cancer.