Department of Clinical Epidemiology, Predictive Medicine and Public Health of the University of Porto Medical School, Porto, Portugal.
Eur J Cancer Prev. 2013 Jul;22(4):311-9. doi: 10.1097/CEJ.0b013e32835b69aa.
Helicobacter pylori infection is acquired predominantly during childhood. Childcare promotes interpersonal contact and may be an important determinant of infection. The aim was to quantify the association between childcare attendance and H. pylori infection in childhood or adolescence. PubMed was searched up to July 2012 to identify eligible studies. The DerSimonian and Laird method was used to compute summary odds ratio (OR) estimates and 95% confidence intervals (CIs); heterogeneity was quantified with the I statistic and explained through stratified analyses and metaregression. Sixteen studies compared participants attending childcare with those not exposed. The summary OR was 1.12 (95% CI: 0.82-1.52, I=77.4%). Summary estimates were similar for crude and adjusted estimates, and higher when the infection was evaluated in children of 3 years or younger (OR=2.00, 95% CI: 0.94-4.29, I=55.0%). Studies based on the detection of stool antigens yielded higher estimates (OR=2.65, 95% CI: 1.24-5.66, I=36.4%). Those conducted in settings with a high prevalence of H. pylori infection yielded stronger associations (OR=1.44, 95% CI: 0.94-2.20, I=74.3%). In multivariate metaregression, there was no significant association with any of these variables; taking them into account contributed to a reduction of I to 67%. The role of childcare as a risk factor for H. pylori infection is confirmed by our results, especially in settings with a high prevalence of infection. However, the association was moderate, and the effect of the type of childcare setting or the duration or the intensity of exposure was seldom addressed, leaving considerable scope for improving our understanding of how this modifiable exposure contributes towards H. pylori infection.
幽门螺杆菌感染主要发生在儿童时期。儿童保育促进人际接触，可能是感染的重要决定因素。目的是量化儿童保育与儿童或青少年幽门螺杆菌感染之间的关联。检索了PubMed 数据库，截至 2012 年 7 月，以确定符合条件的研究。使用 DerSimonian 和 Laird 方法计算汇总比值比（OR）估计值和 95%置信区间（CI）；使用 I 统计量量化异质性，并通过分层分析和元回归进行解释。16 项研究比较了参加儿童保育的参与者和未暴露于儿童保育的参与者。汇总 OR 为 1.12（95%CI：0.82-1.52，I=77.4%）。汇总估计值在未调整和调整后估计值中相似，并且在评估 3 岁或以下儿童的感染时更高（OR=2.00，95%CI：0.94-4.29，I=55.0%）。基于粪便抗原检测的研究得出了更高的估计值（OR=2.65，95%CI：1.24-5.66，I=36.4%）。在幽门螺杆菌感染流行率较高的环境中进行的研究得出了更强的关联（OR=1.44，95%CI：0.94-2.20，I=74.3%）。在多元元回归中，这些变量均与结果无显著关联；考虑这些因素有助于将 I 值降低至 67%。我们的结果证实了儿童保育作为幽门螺杆菌感染危险因素的作用，尤其是在感染流行率较高的环境中。然而，这种关联是中度的，而且儿童保育环境的类型、暴露的持续时间或强度的作用很少被提及，这为进一步了解这种可改变的暴露如何导致幽门螺杆菌感染提供了很大的空间。
