Department of Neurosurgery, The First Affiliated Hospital of Xinxiang Medical University, Health Road No. 88, Weihui, Henan, People's Republic of China.
J Neurol. 2012 Dec;259(12):2527-37. doi: 10.1007/s00415-012-6558-7. Epub 2012 Jun 12.
Chronic infection of Helicobacter pylori (H. pylori) in ischemic stroke (IS) incidence has been previously studied in several publications; however, conflicting results have been reported. A meta-analysis was used to assess whether chronic infection of H. pylori was associated with risk of IS, and which of the following was more effective for predication of IS risk, antibody IgG of H. pylori (anti-H. pylori IgG), antibody IgG of cytotoxin-associated gene-A (anti-Cag A IgG) or the (13)C-urea breath test. We searched the databases of Medline and Embase, and latest update was January 1, 2012. Case-control studies were considered to be eligible. The odds ratio (OR) and 95 % confidence interval (95 % CI) were calculated using the random-effect model. A total of 13 studies including 4,041 participants were included in this meta-analysis. Of these studies, ten, four and four studies were for anti-H. pylori IgG, anti-Cag A IgG and the (13)C-urea breath test, respectively. Combined analysis indicated that positive anti-H. pylori IgG, anti-Cag A IgG and (13)C-urea breath test were significantly associated with increased risk of IS, respectively, and positive anti-Cag A IgG was more effective for predication of IS risk [OR (95 % CI) = 1.60 (1.21-2.11), P (heterogeneity) = 0.001 for positive versus negative anti-H. pylori IgG; 2.33 (1.76-3.09), P (heterogeneity) = 0.71 for positive versus negative anti-Cag A IgG and 1.65 (1.11-2.47), P (heterogeneity) = 0.17 for positive versus negative (13)C-urea breath test]. In addition, we found that positive anti-H. pylori IgG was closely associated with risk of IS caused by atherosclerosis and small artery disease, but not for cardioembolic IS. This meta-analysis indicated that chronic H. pylori infection was significantly associated with an increased risk of IS, especially for non-cardioembolic IS. Compared with anti-H. pylori IgG and the (13)C-urea breath test, anti-Cag A IgG seemed more effective for prediction of risk of IS.
先前已有多项出版物研究过幽门螺杆菌（H. pylori）慢性感染与缺血性中风（IS）发病之间的关系，但结果却存在争议。本项荟萃分析旨在评估 H. pylori 慢性感染与 IS 风险之间的相关性，并确定预测 IS 风险的最佳指标，即 H. pylori 抗体 IgG（抗-H. pylori IgG）、细胞毒素相关基因 A 抗体 IgG（抗-Cag A IgG）或 13C-尿素呼气试验。我们检索了 Medline 和 Embase 数据库，最新检索时间为 2012 年 1 月 1 日。病例对照研究被认为符合纳入标准。使用随机效应模型计算比值比（OR）及其 95%置信区间（95%CI）。本荟萃分析共纳入 13 项研究，共计 4041 例患者。其中，10 项、4 项和 4 项研究分别针对抗-H. pylori IgG、抗-Cag A IgG 和 13C-尿素呼气试验。综合分析表明，抗-H. pylori IgG、抗-Cag A IgG 和 13C-尿素呼气试验阳性均与 IS 风险增加显著相关，其中抗-Cag A IgG 对 IS 风险的预测效能更高[OR（95%CI）=1.60（1.21-2.11），抗-H. pylori IgG 阳性与阴性相比，P（异质性）=0.001；2.33（1.76-3.09），抗-Cag A IgG 阳性与阴性相比，P（异质性）=0.71；1.65（1.11-2.47），抗-Cag A IgG 阳性与阴性相比，P（异质性）=0.17]。此外，我们发现抗-H. pylori IgG 阳性与动脉粥样硬化和小动脉疾病导致的 IS 风险密切相关，但与心源性栓塞 IS 无关。本荟萃分析表明，H. pylori 慢性感染与 IS 风险增加显著相关，尤其是与非心源性栓塞 IS 相关。与抗-H. pylori IgG 和 13C-尿素呼气试验相比，抗-Cag A IgG 似乎对 IS 风险预测更为有效。
