Jacobs Comprehensive MS Treatment and Research Center,, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
Institute of Medicine, Tribhuvan University, Maharajgunj, 44600, Nepal.
Neurol Sci. 2024 Jun;45(6):2539-2548. doi: 10.1007/s10072-024-07328-8. Epub 2024 Jan 20.
Numerous studies have proposed that Helicobacter pylori infection may possess a protective effect in terms of future risk of multiple sclerosis (MS), however is poorly evidenced. We performed a systematic review and meta-analysis to obtain the pooled results regarding the prevalence of H. pylori infection in persons with multiple sclerosis (pwMS) and healthy controls. A comprehensive database search was performed in PubMed, Embase, and medRxiv for all relevant literature published from the inception of the databases until the August 1, 2022. The retrieved articles were first screened by title and abstract, followed by full-text screening based on the pre-established eligibility criteria. The risk of bias was assessed using the ROBINS-I tool. Data on the seroprevalence of H. pylori in pwMS and healthy controls was extracted, and a meta-analysis was performed in Review Manager Version 5.4.1. Sub-group analysis was performed in accordance with the geographical distribution (Eastern and Western countries) and the method of detection of H. pylori infection enzyme-linked-immunoassay (ELISA), Immunofluorescence, Immunochromatography). Furthermore, sensitivity analyses and publication bias were determined. The preliminary database search retrieved a total of 822 studies. Seventeen case-control studies with a total of 2721 pwMS and 2245 controls were included as a final sample size for the meta-analysis. The overall risk of bias was moderate. Overall, the rate of H. pylori infection in pwMS was not significantly different than in healthy controls (OR: 0.79 (95% CI = 0.58-1.08); I = 79%, p = 0.14). Subgroup analysis revealed that the rate of H. pylori infection among PwMS was not significant in both Eastern and Western countries (OR: 0.75 (95% CI = 0.52-1.08); I = 81%, p = 0.12). In contrast, data revealed that the prevalence of H. pylori infection in pwMS was significantly lower than that of control based on studies utilizing ELISA assays detection (OR: 0.71 (95% CI = 0.50-1.00); I = 81%, p = 0.05), while no significant difference was seen on studies using other assays than ELISA (OR: 1.19 (95% CI = 0.81-1.77); I = 0%, p = 0.38). Our findings of statistically indifferent prevalence of H. pylori infection as compared between pwMS and healthy controls suggested the absence of protective effect for risk of MS following H. pylori infection.
许多研究表明，幽门螺杆菌（Helicobacter pylori）感染可能对多发性硬化症（multiple sclerosis，MS）的未来风险具有保护作用，但证据不足。我们进行了一项系统评价和荟萃分析，以获得有关 MS 患者（pwMS）和健康对照组中幽门螺杆菌感染患病率的汇总结果。在 PubMed、Embase 和 medRxiv 中全面检索了从数据库建立之初到 2022 年 8 月 1 日发表的所有相关文献。首先根据标题和摘要筛选检索到的文章，然后根据预先确定的纳入标准进行全文筛选。使用 ROBINS-I 工具评估偏倚风险。提取 pwMS 和健康对照组中幽门螺杆菌血清阳性率的数据，并在 Review Manager Version 5.4.1 中进行荟萃分析。根据地理分布（东部和西方国家）和幽门螺杆菌感染检测方法（酶联免疫吸附试验（ELISA）、免疫荧光法、免疫色谱法）进行亚组分析。此外，还进行了敏感性分析和发表偏倚的确定。初步数据库检索共检索到 822 项研究。最终纳入了 17 项病例对照研究，共 2721 名 pwMS 和 2245 名对照作为荟萃分析的最终样本量。总体偏倚风险为中度。总体而言，pwMS 中幽门螺杆菌感染的发生率与健康对照组无显著差异（OR：0.79（95%CI=0.58-1.08）；I=79%，p=0.14）。亚组分析显示，在东部和西部国家，pwMS 中幽门螺杆菌感染的发生率均无统计学意义（OR：0.75（95%CI=0.52-1.08）；I=81%，p=0.12）。相比之下，基于使用 ELISA 检测的研究表明，pwMS 中幽门螺杆菌感染的患病率明显低于对照组（OR：0.71（95%CI=0.50-1.00）；I=81%，p=0.05），而基于其他检测方法（OR：1.19（95%CI=0.81-1.77）；I=0%，p=0.38）的研究则未见显著差异。与健康对照组相比，pwMS 中幽门螺杆菌感染的患病率无统计学差异，这表明幽门螺杆菌感染后对 MS 风险没有保护作用。
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