根除幽门螺杆菌在异时性胃癌中预防作用的Meta分析

Preventive effect of Helicobacter pylori eradication on metachronous gastric cancer:a Meta-analysis

目的系统评价根除H.pylori能否降低异时性胃癌(metachronous gastric cancer,MGC)的发生。方法计算机检索Web of Science、PubMed、Cochrane Library、EmBase、中国知网、CBM、维普、万方数据库中根除H.pylori预防MGC的随机对照试验,检索时间从建库至2019年12月,并追查纳入文献的参考文献。由两名研究者按照纳入及排除标准独立筛选文献、提取资料、质量评价,对同质研究使用RevMan 5.2软件进行Meta分析。结果共纳入5项研究,共计1458例患者。Meta分析结果显示:对于早期胃癌(early gastric cancer,EGC)行内镜下切除术的患者,术后H.pylori根除组与H.pylori未根除组比较,MGC发生率差异有统计学意义(RR=0.45,95%CI:0.30~0.66,P<0.0001)。漏斗图结果显示图形对称性较好,存在发表偏倚可能性小。结论根除H.pylori可降低MGC的发生率,建议对EGC行内镜下治疗后患者积极根除H.pylori治疗。受纳入研究质量及数量的限制,上述结论尚需开展更多高质量随机对照试验加以验证。

Objective To investigate the relationship of H.pylori status on the development of metachronous gastric cancer(MGC).Methods The databases of Web of Science,PubMed,Cochrane Library,EmBase,CNKI,CBM,VIP and WanFang were searched(from database establishment to Dec.2019)to identity relevantly published studies about the effects of H.pylori eradication on the incidence of MGC after endoscopic resection of early gastric cancer(EGC).According to inclusion and exclusion criteria,two reviewers independently screened the literature,extracted data and quality evaluation.Statistical analysis was performed by RevMan 5.2 software.Results A total of 4 studies including 1458 patients were enrolled.Meta-analysis results showed:the incidence of MGC was significantly lower in H.pylori eradication group than that in H.pylori non-eradication group(RR=0.45,95%CI:0.30-0.66,P<0.0001).Funnel plot showed that the symmetry of the graph was good,and the possibility of publication bias was small.Conclusion Successful H.pylori eradication may be useful for the prevention of MGC after endoscopic resection of EGC.Thus,anti-H.pylori treatment should be considered for those patients with H.pylori infection after endoscopic resection.Due to limited quantity and quality of included studies,the above conclusions are needed to be validated by more high quality studies.