胃食管反流病与一系列疾病的关联：系统评价和荟萃分析的伞状综述。
Associations between gastro-oesophageal reflux disease and a range of diseases: an umbrella review of systematic reviews and meta-analyses.
机构信息
Graduate School, Jiang Xi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China.
Department of Administration, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China.
出版信息
BMJ Open. 2020 Dec 30;10(12):e038450. doi: 10.1136/bmjopen-2020-038450.
OBJECTIVE
Numerous meta-analyses have revealed the association between gastro-oesophageal reflux disease (GORD) and a range of diseases; however, the certainty of the evidence remains unclear. This study aimed to summarise and assess the certainty of evidence derived from meta-analyses.
METHODS
Embase, PubMed, Web of Science, Cochrane Databases of Systematic Reviews, CNKI and Wangfang databases from their inception to 22 February 2020 were queried for systematic reviews and meta-analyses on the association between GORD and various diseases. The methodological quality of the included studies was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), and evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Statistical analysis was conducted using Stata V.15.
RESULTS
Ten publications with associations between GORD and different types of diseases were included. There was high heterogeneity (I >75%) among seven independent meta-analyses. Evidence for publication bias in two independent meta-analyses was also observed. According to the AMSTAR 2 approach, the methodological quality was high for 20% of meta-analyses, moderate for 10%, low for 40% and critically low for 30%. Based on GRADE approach, the certainty of evidence was high for the association between GORD and higher risk of chronic obstructive pulmonary disease (COPD) exacerbation (OR 5.37; 95% CI 2.71 to 10.64) and higher prevalence of oesophageal adenocarcinoma (OR 4.57; 95% CI 3.89 to 5.36), and it was moderate for the association between GORD and higher chronic rhinosinusitis prevalence (OR 2.16; 95% CI 1.37 to 3.48).
CONCLUSION
The association between GORD and a range of diseases was extensively studied, and our findings revealed a high certainty of evidence of the association between GORD and an increased risk of COPD exacerbation as well as increased prevalence of oesophageal adenocarcinoma. Further investigations using systematic reviews and meta-analyses of high methodological quality that include prospective large cohort studies and adjusted confounders are warranted.
PROSPERO REGISTRATION NUMBER
CRD42019122264.
目的
大量的荟萃分析揭示了胃食管反流病（GORD）与一系列疾病之间的关联；然而，证据的确定性仍不清楚。本研究旨在总结和评估荟萃分析得出的证据的确定性。
方法
从建库至 2020 年 2 月 22 日，检索 Embase、PubMed、Web of Science、Cochrane 系统评价数据库、中国知网（CNKI）和万方数据库，以获取关于 GORD 与各种疾病之间关联的系统评价和荟萃分析。使用评估系统评价工具（AMSTAR 2）评估纳入研究的方法学质量，并使用推荐评估、制定与评价（GRADE）系统评估证据确定性。使用 Stata V.15 进行统计分析。
结果
纳入了 10 项关于 GORD 与不同类型疾病之间关联的研究。其中 7 项独立荟萃分析存在高度异质性（I >75%）。还观察到两项独立荟萃分析存在发表偏倚的证据。根据 AMSTAR 2 方法，20%的荟萃分析方法学质量较高，10%为中等，40%为低，30%为极低。根据 GRADE 方法，GORD 与慢性阻塞性肺疾病（COPD）加重风险增加（OR 5.37；95%CI 2.71 至 10.64）和食管腺癌患病率增加（OR 4.57；95%CI 3.89 至 5.36）之间的关联具有高度确定性，而 GORD 与慢性鼻-鼻窦炎患病率增加（OR 2.16；95%CI 1.37 至 3.48）之间的关联具有中度确定性。
结论
广泛研究了 GORD 与一系列疾病之间的关联，我们的研究结果表明，GORD 与 COPD 加重风险增加以及食管腺癌患病率增加之间存在高度关联的证据具有高度确定性。需要使用具有较高方法学质量的系统评价和荟萃分析，包括前瞻性大队列研究和调整混杂因素，进一步进行研究。
PROSPERO 注册号：CRD42019122264。
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