Imawana Rabbiaatul Addawiyah, Smith Daniel Robert, Goodson Michaela Louise
Medical Research Department, Faculty of Medical Sciences, Newcastle University Medicine Malaysia.
Ann Gastroenterol. 2020 Sep-Oct;33(5):485-494. doi: 10.20524/aog.2020.0507. Epub 2020 Jun 6.
The current literature suggests a protective benefit of ( infection against inflammatory bowel disease (IBD). Here we assessed whether this effect varied by IBD subtype-Crohn's disease (CD) or ulcerative colitis (UC)-and geographic region: East Asia, Europe (non-Mediterranean) or Mediterranean region.
A database search was performed up to July 2019 inclusive for all studies that compared infection in IBD patients vs. non-IBD controls. The relative risk (RR) was used to quantify the association between IBD and , and the effects were combined across studies using a mixed-effects meta-regression model, which included IBD subtype and geographic region as categorical moderator variables.
Our meta-regression model exhibited moderate heterogeneity (I=48.74%). Pooled RR depended on both region (P=0.02) and subtype (P<0.001). Pooled RRs were <1 for all subtype and region combinations, indicative of a protective effect of H. pylori against IBD. The pooled RR was 28% (9%, 50%; P=0.001) greater for UC vs. CD and 43% (4%, 96%; P=0.02) greater for Mediterranean countries vs. East Asia. The pooled RR was 18% (-13%, 60%; P=0.48) greater for Europe vs. East Asia and 21% (-13%, 68%; P=0.42) greater for Mediterranean vs. Europe, though these differences were not statistically significant.
The protective effect of on IBD varied by both subtype (more protection against CD vs. UC) and region (East Asia more protected than Mediterranean regions). Variation due to these effects could provide insight into IBD etiology.
当前文献表明幽门螺杆菌（H. pylori）感染对炎症性肠病（IBD）具有保护作用。在此，我们评估了这种效应是否因IBD亚型（克罗恩病（CD）或溃疡性结肠炎（UC））以及地理区域（东亚、欧洲（非地中海地区）或地中海地区）而异。
截至2019年7月，对所有比较IBD患者与非IBD对照者幽门螺杆菌感染情况的研究进行数据库检索。相对风险（RR）用于量化IBD与幽门螺杆菌之间的关联，并且使用混合效应元回归模型对各研究结果进行合并，该模型将IBD亚型和地理区域作为分类调节变量。
我们的元回归模型显示出中度异质性（I = 48.74%）。合并RR取决于区域（P = 0.02）和亚型（P < 0.001）。所有亚型和区域组合的合并RR均<1，表明幽门螺杆菌对IBD具有保护作用。UC的合并RR比CD高28%（9%，50%；P = 0.001），地中海国家的合并RR比东亚高43%（4%，96%；P = 0.02）。欧洲的合并RR比东亚高18%（-13%，60%；P = 0.48），地中海地区比欧洲高21%（-13%，68%；P = 0.42），尽管这些差异无统计学意义。
幽门螺杆菌对IBD的保护作用因亚型（对CD的保护作用比对UC更强）和区域（东亚比地中海地区受保护程度更高）而异。这些效应导致的差异可为IBD病因学提供见解。
