一项针对幽门螺杆菌定植与乳糜泻相关性的系统评价和荟萃分析。
A systematic review and meta-analysis for association of Helicobacter pylori colonization and celiac disease.
机构信息
Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
出版信息
PLoS One. 2021 Mar 3;16(3):e0241156. doi: 10.1371/journal.pone.0241156. eCollection 2021.
BACKGROUND AND OBJECTIVES
Based on some previous observational studies, there is a theory that suggests a potential relationship between Helicobacter pylori (H. pylori) colonization and celiac disease (CeD); however, the type of this relationship is still controversial. Therefore, we aimed to conduct a systematic review and meta-analysis to explore all related primary studies to find any possible association between CeD and human H. pylori colonization.
DATA SOURCES
Studies were systematically searched and collected from four databases and different types of gray literature to cover all available evidence. After screening, the quality and risk of bias assessment of the selected articles were evaluated.
SYNTHESIS METHODS
Meta-analysis calculated pooled odds ratio (OR) on the extracted data. Furthermore, heterogeneity, sensitivity, subgroups, and publication bias analyses were assessed.
RESULTS
Twenty-six studies were included in this systematic review, with a total of 6001 cases and 135512 control people. The results of meta-analysis on 26 studies showed a significant and negative association between H. pylori colonization and CeD (pooled OR = 0.56; 95% CI = 0.45-0.70; P < 0.001), with no publication bias (P = 0.825). The L'Abbé plots also showed a trend of having more H. pylori colonization in the control group. Among subgroups, ORs were notably different only when the data were stratified by continents or risk of bias; however, subgroup analysis could not determine the source of heterogeneity.
CONCLUSIONS
According to the meta-analysis, this negative association might imply a mild protective role of H. pylori against celiac disease. Although this negative association is not strong, it is statistically significant and should be further considered. Further investigations in both molecular and clinic fields with proper methodology and more detailed information are needed to discover more evidence and underlying mechanisms to clear the interactive aspects of H. pylori colonization in CeD patients.
SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO): CRD42020167730 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167730.
背景和目的
基于一些先前的观察性研究，有理论认为幽门螺杆菌（H. pylori）定植与乳糜泻（CeD）之间存在潜在关系；然而，这种关系的类型仍存在争议。因此，我们旨在进行系统评价和荟萃分析，以探索所有相关的原始研究，以发现 CeD 与人类 H. pylori 定植之间可能存在的关联。
数据来源
从四个数据库和不同类型的灰色文献中系统地搜索和收集研究，以涵盖所有可用证据。筛选后，对选定文章的质量和偏倚风险进行评估。
综合方法
对提取的数据进行荟萃分析，计算合并的优势比（OR）。此外，还评估了异质性、敏感性、亚组和发表偏倚分析。
结果
本系统评价共纳入 26 项研究，共纳入 6001 例病例和 135512 例对照人群。对 26 项研究进行荟萃分析的结果显示，H. pylori 定植与 CeD 之间存在显著的负相关关系（合并 OR = 0.56；95%CI = 0.45-0.70；P < 0.001），且无发表偏倚（P = 0.825）。L'Abbé 图也显示对照组中 H. pylori 定植的趋势。在亚组分析中，仅当按大陆或偏倚风险分层时，OR 差异显著；然而，亚组分析无法确定异质性的来源。
结论
根据荟萃分析，这种负相关可能暗示 H. pylori 对乳糜泻有轻度的保护作用。虽然这种负相关并不强，但具有统计学意义，值得进一步考虑。需要在分子和临床领域进行进一步的研究，采用适当的方法和更详细的信息，以发现更多的证据和潜在机制，以阐明 H. pylori 定植与 CeD 患者之间的相互作用。
系统评价注册号（PROSPERO）：CRD42020167730 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167730.
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