Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella, Italy.
Liver Int. 2024 Jul;44(7):1513-1525. doi: 10.1111/liv.15925. Epub 2024 Apr 3.
Recent observational studies examining the association between Helicobacter pylori infection and the risk of metabolic dysfunction-associated steatotic liver disease (MASLD) have reported conflicting results. We performed a meta-analysis to quantify the magnitude of the association between H. pylori infection and the risk of MASLD.
We systematically searched three large electronic databases to identify eligible observational studies (published up to 30 November 2023) in which liver biopsy, imaging methods or blood-based biomarkers/scores were used for diagnosing MASLD. Data from selected studies were extracted, and meta-analysis was performed using common and random-effects modelling. Statistical heterogeneity among published studies, subgroup analyses, meta-regression analyses and publication bias were assessed.
A total of 28 observational studies (24 cross-sectional and 4 longitudinal studies) were identified, including 231 291 middle-aged individuals of predominantly Asian ethnicity (~95%). Meta-analysis of cross-sectional studies showed that H. pylori infection was significantly associated with a small increase in the risk of prevalent MASLD (n = 24 studies; random-effects odds ratio 1.11, 95% CI 1.05-1.18; I = 63%). Meta-analysis of data from longitudinal studies showed that H. pylori infection was significantly associated with an increased risk of developing incident MASLD over a mean 5-year follow-up (n = 4 studies; random-effects odds ratio 1.20, 95%CI 1.08-1.33; I = 44%). Sensitivity analyses did not modify these results. The funnel plot did not reveal any significant publication bias.
H. pylori infection is associated with a mildly increased risk of prevalent and incident MASLD. Further well-designed prospective and mechanistic studies are required to better decipher the complex link between H. pylori infection and the risk of MASLD.
最近的观察性研究探讨了幽门螺杆菌感染与代谢功能障碍相关脂肪性肝病（MASLD）风险之间的关系，结果相互矛盾。我们进行了一项荟萃分析，以量化幽门螺杆菌感染与 MASLD 风险之间的关联程度。
我们系统地检索了三个大型电子数据库，以确定符合条件的观察性研究（截至 2023 年 11 月 30 日发表），这些研究使用肝活检、影像学方法或基于血液的生物标志物/评分来诊断 MASLD。从选定的研究中提取数据，并使用常见和随机效应模型进行荟萃分析。评估了发表研究之间的统计异质性、亚组分析、荟萃回归分析和发表偏倚。
共确定了 28 项观察性研究（24 项横断面研究和 4 项纵向研究），包括主要为亚洲血统的 231291 名中年个体（~95%）。横断面研究的荟萃分析表明，幽门螺杆菌感染与普遍 MASLD 的风险略有增加显著相关（n=24 项研究；随机效应比值比 1.11，95%CI 1.05-1.18；I=63%）。对来自 4 项纵向研究的数据的荟萃分析表明，幽门螺杆菌感染与平均 5 年随访期间发生 MASLD 的风险增加显著相关（n=4 项研究；随机效应比值比 1.20，95%CI 1.08-1.33；I=44%）。敏感性分析并未改变这些结果。漏斗图未显示出任何显著的发表偏倚。
幽门螺杆菌感染与普遍和新发 MASLD 的风险轻度增加相关。需要进一步进行精心设计的前瞻性和机制研究，以更好地阐明幽门螺杆菌感染与 MASLD 风险之间的复杂联系。
