Huang J Q, Sridhar S, Chen Y, Hunt R H
Department of Medicine, McMaster University Medical Center, Hamilton, Ontario, Canada.
Gastroenterology. 1998 Jun;114(6):1169-79. doi: 10.1016/s0016-5085(98)70422-6.
BACKGROUND & AIMS: Reports in the literature regarding the relationship of Helicobacter pylori infection to gastric cancer are conflicting. The aim of this study was to identify the source of heterogeneity between studies.
Meta-analysis of cohort or case-control studies with age- and/or sex-matched controls, providing raw data on H. pylori infection detected by serology, was used.
A fully recursive literature search identified 19 qualified studies with 2491 patients and 3959 controls. Test for homogeneity found a significant difference in odds ratio between patients with early and advanced gastric cancer (6.35 vs. 2.13; P = 0.01), patients with cardiac and noncardiac gastric cancer (1.23 vs. 3.08; P = 0.003), and population- and hospital-based controls (2.11 vs. 1.49; P < 0.001). The summary odds ratio for gastric cancer in H. pylori-infected patients is 1.92 (95% confidence interval [CI], 1.32-2.78), 2.24 (95% CI, 1.15-4.4), and 1.81 (95% CI, 1.16-2.84) for all studies, cohort, and case-control studies, respectively. H. pylori-infected younger patients have a higher relative risk for gastric cancer than older patients with odds ratios decreasing from 9.29 at age < or = 29 years to 1.05 at age > or = 70 years. H. pylori infection is equally associated with the intestinal or diffuse type of gastric cancer.
H. pylori infection is a risk factor for gastric cancer. The heterogeneity of reported results is caused by differences in the selection of controls, patient age, and the site and stage of gastric cancer.
文献中关于幽门螺杆菌感染与胃癌关系的报道相互矛盾。本研究旨在确定研究之间异质性的来源。
采用对队列研究或病例对照研究进行荟萃分析的方法，这些研究设置了年龄和/或性别匹配的对照组，并提供了通过血清学检测幽门螺杆菌感染的原始数据。
全面的递归文献检索确定了19项合格研究，涉及2491例患者和3959例对照。同质性检验发现，早期和晚期胃癌患者之间的优势比存在显著差异（6.35对2.13；P = 0.01），贲门癌和非贲门癌患者之间（1.23对3.08；P = 0.003），以及基于人群和基于医院的对照组之间（2.11对1.49；P < 0.001）。在所有研究、队列研究和病例对照研究中，幽门螺杆菌感染患者患胃癌的汇总优势比分别为1.92（95%置信区间[CI]，1.32 - 2.78）、2.24（95%CI，1.15 - 4.4）和1.81（95%CI，1.16 - 2.84）。幽门螺杆菌感染的年轻患者患胃癌的相对风险高于老年患者，优势比从年龄≤29岁时的9.29降至年龄≥70岁时的1.05。幽门螺杆菌感染与肠型或弥漫型胃癌同样相关。
幽门螺杆菌感染是胃癌的一个危险因素。报告结果的异质性是由对照组的选择、患者年龄以及胃癌的部位和分期差异所致。
