胃食管反流症状与Barrett食管关系的Meta分析

Relationship between symptoms of gastroesophageal reflux and Barrett 's esophagus: a Meta-analysis

目的 探讨胃食管反流（gastroesophageal reflux,GER）症状与Barrett食管（Barrett’s esophagus,BE）的关系。方法 计算机检索Pub Med、Web of Science、Cochrane Library、EMbase、MD Consult、CNKI、Wan Fang Data和CBM等国内外数据库,检索时间均从建库至2013年6月,查找GER症状与BE发病关系的病例对照研究,由于病例组（BE组）和对照组（非BE组）的来源不同,故将高质量的样本设计即病例组和对照组均来源于未经内镜检查的研究志愿者标记为“A型设计”,而以具临床指征而经内镜检查的患者为来源的样本设计标记为“B型设计”,将BE来源于具有临床指征而行内镜检查者而对照组来源于未经内镜检查的研究志愿者的设计标记为“A/B型设计”。由两位研究者按照纳入与排除标准进行资料提取和质量评价后,采用Rev Man 5.1软件对各研究进行数据合并与分析。结果 共纳入27个研究,合计1 481例BE患者和38 419例非BE患者。其中16个研究为“B型设计”,7个研究为“A型设计”,剩余4个研究为“A/B型设计”。Meta分析结果显示总的GER症状与BE关系的OR=2.45（95%CI：1.55-3.87,P=0.0001）,但结果具有明显异质性（P〈0.00001,I2=89%）。对BE长度和样本设计进行分层分析后发现,在“B型设计”研究中GER症状与短节段BE（SSBE）关系的OR=1.70（95%CI：0.85-3.39,P=0.014）,而与长节段BE（LSBE）关系的OR=2.07（95%CI：0.75-5.73,P=0.016）;在“A型设计”研究中按BE长度分层解决了异质性问题,GER症状与LSBE关系的OR=5.38（95%CI：2.22-13.04,P=0.0002）,与SSBE关系的OR=1.10（95%CI：0.74-1.65,P=0.64）。结论 Meta分析结果显示在高质量研究中,GER症状增加LSBE发病风险,而与SSBE无明显相关性。GER症状可作为预测LSBE的一个可靠指标。

Objective To evaluate the relationship between symptoms of gastroesophageal reflux （GER） and Bar- rett＇s esophagus （BE） by Meta-analysis. Methods Databases such as PubMed, Web of Science, Cochrane Library, EMbase, MD Consult, CNKI, WanFang data and CBM were searched from the date of their establishment to Jan. 2013 to collect the case control studies on the relationship between symptoms of GER and BE. Since the origins of case group （BE） and control group （non-Barrett＇ s esophagus） were different, the highest-quality sampling design was designed a priori by both cases and controls identified among unselected research volunteers （ ＂design type A＂ ） rather than by pa- tients selected for endoscopy for clinical indications （＂design type B＂）. The remaining studies identified cases of BE from patients undergoing endoscopy for clinical indication and controls among patients without known BE （＂ design type A/B＂ ）. Two researchers independently selected studies, extracted data and assessed the quality according to the inclu- sive and exclusive criteria. RevMan 5.1 software was used for heterogeneity test and pooled OR calculation. Results Twenty-seven literatures met the criteria were enrolled in the Metaanalysis, in which 1 481 cases were BE patients and 38 419 were controls. Of these, 16 studies used ＂design type B＂, 7 studies used the ＂design type A＂ and the remaining 4 studies used ＂design type A/B＂ The summary odds ratio （OR） for the association between GERD and BE was 2.45 （95% CI： 1.55-3.87, P = 0. 0001 ）, but the results were very heterogeneous （P 〈 0. 00001, 12 = 89% ）. When stratied by BE length and sampling design, GER was related with SSBE （OR = 2.07, 95% CI： 0. 85-3.39,P =0. 014） , and stronger related with LSBE （ OR =2.07, 95% CI： 0. 75-5.73, P =0. 016） in design type B. In the research, stratifying by length of BE resolved the heterogeneity and showed a strong association between GERD and LSBE （OR = 5.38, 95% CI： 2.22-13.04, P =0.0002） and no association between GER and SSBE （fixed effects OR = 1. 10, 95% CI： 0. 74- 1.65, P = 0.64） in design type A. Conclusion In the highest-quality studies, GER symptoms are not associated with SSBE, but increased the odds of LSBE. GERD symptoms can serve as a reliable predictor of LSBE, but not SSBE.