功能性消化不良的十二指肠嗜酸性粒细胞和肥大细胞：病例对照研究的系统评价和荟萃分析。

Duodenal Eosinophils and Mast Cells in Functional Dyspepsia: A Systematic Review and Meta-Analysis of Case-Control Studies.

机构信息

Faculty of Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia; Department of Gastroenterology and Hepatology, Queensland, Australia; Department of Anatomical Pathology, Princess Alexandra Hospital, Queensland, Australia.

School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia.

出版信息

Clin Gastroenterol Hepatol. 2022 Oct;20(10):2229-2242.e29. doi: 10.1016/j.cgh.2022.01.014. Epub 2022 Feb 3.

DOI:10.1016/j.cgh.2022.01.014

PMID:35123088

Abstract

BACKGROUND & AIMS: This study explored the link between duodenal eosinophils and mast cells in patients with functional dyspepsia (FD). METHODS: MEDLINE (PubMed) and Embase electronic databases were searched until June 2021 for case-control studies reporting duodenal eosinophils and mast cells in FD. Pooled standardized mean difference (SMD), odds ratio, and 95% CIs of duodenal eosinophils and mast cells in FD patients and controls were calculated, using a random-effects model. RESULTS: Twenty-two case-control studies with 1108 FD patients and 893 controls were identified. Duodenal eosinophils (SMD, 1.29; 95% CI, 0.85-1.73; P = .0001) and mast cells (SMD, 2.11; 95% CI, 1.14-3.07; P = .0001) were increased in FD patients compared with controls. Substantial heterogeneity was found (I = 93.61, P = .0001; and I = 96.69, P = .0001, respectively) and visual inspection of funnel plots confirmed publication bias. Degranulation of duodenal eosinophils was significantly higher in FD patients compared with controls (odds ratio, 3.78; 95% CI, 6.76-4.48; P = .0001), without statistically significant heterogeneity. We conducted a sensitivity analysis for duodenal eosinophils, by including only high-quality studies, and the results remained unchanged (SMD, 1.73; 95% CI, 1.06-2.40; P = .0001), with substantial heterogeneity. Postinfectious FD patients had increased duodenal eosinophils compared with controls (SMD, 3.91; 95% CI, 1.32-6.51; P = .001) and FD patients without any history of infection (SMD, 1.42; 95% CI, 0.88-1.96; P = .001). Helicobacter pylori-negative FD patients had significantly higher duodenal eosinophils compared with controls (SMD, 3.98; 95% CI, 2.13-5.84; P = .0001), with substantial heterogeneity. No significant difference in duodenal eosinophils was seen according to FD subtypes. CONCLUSIONS: This meta-analysis suggests a link between duodenal microinflammation and FD. However, the quality of evidence is very low, largely owing to the unexplained heterogeneity and serious risk of publication bias in all comparative analyses. Thus, causality remains uncertain and further studies are required.

摘要

背景与目的：本研究旨在探讨功能性消化不良（FD）患者十二指肠嗜酸性粒细胞与肥大细胞之间的关系。

方法：检索 MEDLINE（PubMed）和 Embase 电子数据库，截至 2021 年 6 月，以获取报告 FD 患者十二指肠嗜酸性粒细胞和肥大细胞的病例对照研究。采用随机效应模型计算 FD 患者和对照组中十二指肠嗜酸性粒细胞和肥大细胞的标准化均数差值（SMD）、比值比（OR）和 95%置信区间（CI）。

结果：共纳入 22 项病例对照研究，涉及 1108 例 FD 患者和 893 例对照。与对照组相比，FD 患者的十二指肠嗜酸性粒细胞（SMD，1.29；95%CI，0.85-1.73；P =.0001）和肥大细胞（SMD，2.11；95%CI，1.14-3.07；P =.0001）增加。存在较大的异质性（I²=93.61，P =.0001；和 I²=96.69，P =.0001，分别），且漏斗图的直观检查证实存在发表偏倚。与对照组相比，FD 患者的十二指肠嗜酸性粒细胞脱颗粒明显更高（OR，3.78；95%CI，6.76-4.48；P =.0001），但无统计学意义的异质性。我们对十二指肠嗜酸性粒细胞进行了敏感性分析，仅纳入高质量研究，结果仍然不变（SMD，1.73；95%CI，1.06-2.40；P =.0001），但存在较大的异质性。与对照组相比，感染后 FD 患者的十二指肠嗜酸性粒细胞增加（SMD，3.91；95%CI，1.32-6.51；P =.001），且无任何感染史的 FD 患者（SMD，1.42；95%CI，0.88-1.96；P =.001）也是如此。与对照组相比，幽门螺杆菌阴性 FD 患者的十二指肠嗜酸性粒细胞显著升高（SMD，3.98；95%CI，2.13-5.84；P =.0001），且存在较大的异质性。根据 FD 亚型，十二指肠嗜酸性粒细胞无显著差异。

结论：本荟萃分析提示十二指肠微炎症与 FD 之间存在关联。然而，证据质量非常低，这主要归因于所有比较分析中未解释的异质性和严重的发表偏倚风险。因此，因果关系仍不确定，需要进一步研究。