College of Public Health, Zhengzhou University, Zhengzhou, China.
Key Laboratory of Tumor Epidemiology of Henan Province, Zhengzhou, China.
Epidemiol Rev. 2019 Jan 31;41(1):97-108. doi: 10.1093/epirev/mxz006.
Eradication of Helicobacter pylori colonization has been reported to affect the progression of gastric cancer. A comprehensive literature search was performed from 1997 to 2017 using electronic databases. All randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCT) evaluated the effect of H. pylori eradication on development of gastric cancer. Four RCTs and 9 non-RCTs were included (n = 40,740 participants; 321,269 person-years). Overall, H. pylori eradication therapy was associated with a significantly reduced risk of gastric cancer (incidence rate ratio (IRR) = 0.52, 95% confidence interval (CI): 0.41, 0.65). Results of mixed-effect Poisson regression meta-analysis were similar to those of traditional meta-analyses. In stratified analyses, the IRRs were 0.59 (95% CI: 0.41, 0.86) in RCTs and 0.48 (95% CI: 0.36, 0.64) in non-RCTs. The IRRs were 0.45 (95% CI: 0.34, 0.61) in patients and 0.63 (95% CI: 0.44, 0.90) in the general population. Moreover, the relative risk reduction was approximately 77% on the development of noncardiac gastric cancer with H. pylori eradication therapy in China. Attributable risk percentage and population attributable risk percentage for Chinese patients were 77.08% and 75.33%, respectively, and for Japanese patients were 57.80% and 45.99%, respectively. H. pylori eradication therapy reduces the risk of noncardiac gastric cancer development. The findings indicate the importance of early intervention with H. pylori eradication therapy from the perspective of epidemiology.
根除幽门螺杆菌定植已被报道会影响胃癌的进展。我们从 1997 年至 2017 年通过电子数据库进行了全面的文献检索。所有评估幽门螺杆菌根除对胃癌发展影响的随机对照试验（RCT）和非随机对照试验（non-RCT）均被纳入研究。共纳入 4 项 RCT 和 9 项 non-RCT（n = 40740 名参与者；321269 人年）。总体而言，幽门螺杆菌根除疗法与胃癌风险显著降低相关（发病率比（IRR）= 0.52，95%置信区间（CI）：0.41，0.65）。混合效应泊松回归荟萃分析的结果与传统荟萃分析的结果相似。在分层分析中，RCT 中的 IRR 为 0.59（95%CI：0.41，0.86），non-RCT 中的 IRR 为 0.48（95%CI：0.36，0.64）。在患者中的 IRR 为 0.45（95%CI：0.34，0.61），在一般人群中的 IRR 为 0.63（95%CI：0.44，0.90）。此外，在中国，幽门螺杆菌根除疗法可使非贲门胃癌的相对危险度降低约 77%。中国患者的归因风险百分比和人群归因风险百分比分别为 77.08%和 75.33%，日本患者的归因风险百分比和人群归因风险百分比分别为 57.80%和 45.99%。幽门螺杆菌根除疗法可降低非贲门胃癌的发病风险。这些发现从流行病学角度表明了早期进行幽门螺杆菌根除疗法干预的重要性。
