Dardiotis Efthimios, Tsouris Zisis, Mentis Alexios-Fotios A, Siokas Vasileios, Michalopoulou Amalia, Sokratous Maria, Dastamani Metaxia, Bogdanos Dimitrios P, Deretzi Georgia, Kountouras Jannis
Department of Neurology, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
Department of Neurology, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
Clin Neurol Neurosurg. 2018 Dec;175:16-24. doi: 10.1016/j.clineuro.2018.09.039. Epub 2018 Oct 1.
The exact etiology of Parkinson's disease (PD) remains unclear. Some evidence supports Helicobacter pylori infection as a trigger or driving event, but detection and eradication of H. pylori are not part of PD management. The aims of this case-control study and meta-analysis were to determine (i) the prevalence of H. pylori infection in PD patients, (ii) associations between H. pylori infection and clinical status, and (iii) differences in motor status in PD patients before and after H. pylori eradication. A literature search was performed using the PubMed database. The prevalence of H. pylori infection in PD, its association with the unified Parkinson's disease rating scale (UPDRS), and the association of H. pylori eradication therapy with the UPDRS-III score were determined by calculating the odds ratios (OR) and the standardized mean differences (SMD) with 95% confidence intervals (CI). Fixed- and random-effects models were applied. Ten studies were included in the first meta-analysis (5043 PD patients, 23,449 HCs); H. pylori infection prevalence was higher in PD patients than in HCs [OR (95% CI): 1.47 (1.27, 1.70), P<0.00001]. In seven studies reporting UPDRS scores (150 H. pylori infected, 228 non-infected PD patients), there was a significant association between H. pylori infection and mean UPDRS scores [SMD (95% CI): 0.33 (0.12, 0.54), P = 0.003]. Regarding H. pylori eradication, in five studies (90 PD patients), there was a significant reduction in UPDRS-III scores after treatment [SMD (95% CI): 6.83 (2.29, 11.38), P = 0.003]. In conclusion, the present meta-analysis revealed a higher prevalence of H. pylori infection in PD patients suggesting that H. pylori may contribute to PD pathophysiology. In addition, the significantly lower UPDRS scores in non-infected PD patients and in patients after H. pylori eradication therapy demonstrate that the infection may deteriorate the clinical severity of the disease.
帕金森病（PD）的确切病因仍不清楚。一些证据支持幽门螺杆菌感染是引发或推动该疾病的因素，但检测和根除幽门螺杆菌并非PD治疗的一部分。本病例对照研究和荟萃分析的目的是确定：（i）PD患者中幽门螺杆菌感染的患病率；（ii）幽门螺杆菌感染与临床状况之间的关联；（iii）PD患者在根除幽门螺杆菌前后运动状态的差异。使用PubMed数据库进行文献检索。通过计算比值比（OR）和标准化平均差（SMD）以及95%置信区间（CI），确定PD患者中幽门螺杆菌感染的患病率、其与统一帕金森病评定量表（UPDRS）的关联以及幽门螺杆菌根除治疗与UPDRS-III评分的关联。应用固定效应模型和随机效应模型。首次荟萃分析纳入了10项研究（5043例PD患者，23449例健康对照）；PD患者中幽门螺杆菌感染的患病率高于健康对照[OR（95%CI）：1.47（1.27，1.70），P<0.00001]。在7项报告了UPDRS评分的研究中（150例幽门螺杆菌感染的PD患者，228例未感染的PD患者），幽门螺杆菌感染与平均UPDRS评分之间存在显著关联[SMD（95%CI）：0.33（0.12，0.54），P = 0.003]。关于幽门螺杆菌根除，在5项研究（90例PD患者）中，治疗后UPDRS-III评分显著降低[SMD（95%CI）：6.83（2.29，11.38），P = 0.003]。总之，本荟萃分析显示PD患者中幽门螺杆菌感染的患病率较高，提示幽门螺杆菌可能参与了PD的病理生理过程。此外，未感染的PD患者以及接受幽门螺杆菌根除治疗后的患者UPDRS评分显著降低，表明该感染可能会加重疾病的临床严重程度。
