幽门螺杆菌感染与胰岛素抵抗水平关系的Meta分析

Meta-analysis of relationship between Helicobacter pylori infection and level of insul in resistance

目的:通过Meta分析探讨幽门螺杆菌(Helicobacter pylori,H.pylori)感染与胰岛素抵抗(insulin resistance,IR)水平的关系.方法:检索国内外各大类型数据库自建库至2015-7发表的有关H.pylori感染与胰岛素抵抗关系的文献.由2名研究人员独立提取资料并评价纳入文献的质量,采用Revman5.3软件进行Meta分析.结果:纳入7篇参考文献共9项研究,总样本量3097例,其中H.pylori(+)1718例.Meta分析结果:H.pylori(+)组与H.pylori(-)组胰岛素抵抗水平之间差异有统计学意义(WMD=0.38,95%CI:0.13-0.64,P<0.05).亚组分析显示:在年龄均数<45岁人群中,H.pylori(+)组与H.pylori(-)组胰岛素抵抗水平之间差异有统计学意义(WMD=0.63,95%CI:0.40-0.86,P<0.05),在年龄均数≥45岁组,则无统计学意义;在胃组织活检组H.pylori(+)人群与H.pylori(-)人群胰岛素抵抗水平之间差异有统计学意义(WMD=0.70,95%CI:0.46-0.94,P<0.05),而在血清H.pylori-IgG抗体检测组差异无统计学意义;在体质量指数(body mass index,BMI)<25 kg/m^2组,H.pylori(+)人群与H.pylori(-)人群胰岛素抵抗水平之间差异有统计学意义(WMD=0.72,95%CI:0.49-0.96,P<0.05),而在BMI≥25 kg/m^2组差异则无统计学意义;在亚洲组,H.pylori(+)人群与H.pylori(-)人群胰岛素抵抗水平之间差异有统计学意义(WMD=0.66,95%CI:0.44-0.87,P<0.05),而在美洲组差异无统计学意义.发表偏倚分析和敏感性分析结果证实上述Meta分析结果是稳定和可靠的.结论:H.pylori感染和胰岛素抵抗水平升高具有相关性.

AIM：To investigate the association between Helicobacter pylori（H.pylori） infection and level of insulin resistance（IR）.METHODS：The articles on the association of H.pylori with IR level were retrieved by searching databases from the inception of each database to July 2015.Data extraction and quality assessment were completed by two authors.Meta-analysis was performed using RevMan 5.3 software.RESULTS：Seven papers with nine studies were included for meta-analysis.A total of3097 patients,including 1718 H.pylori（＋）subjects,were involved.The results of Metaanalysis showed that there was a significant difference in insulin resistance levels between patients with H.pylori infection and those without in the overall population（WMD =0.38,95%CI：0.13-0.64,P〈0.05）.Subgroup analysis indicated that the significant difference in insulin resistance levels between patients with H.pylori infection and those without existed in patients aged 〈45 years（WMD=0.63,95%CI：0.40-0.86,P〈0.05）,those who underwent endoscopic biopsy（WMD=0.70,95%CI：0.46-0.94,P〈0.05）,those who had a body mass index（BMI）25 kg/m^2（WMD=0.72,95%CI：0.49-0.96,P〈0.05）,and Asian patients（WMD=0.66,95%CI：0.44-0.87,P〈0.05）,but not in patients aged≥45 years,those who underwent serum H.pylori-IgG antibody testing,those who had a BMI ≥ 25 kg/m^2,or American patients.The results of publication bias and sensitivity analysis confirmed the reliability and stability of this Meta-analysis.CONCLUSION：H.pylori infection is associated with elevated insulin resistance.