细胞毒素相关蛋白A阳性的幽门螺杆菌感染与缺血性脑卒中及其亚型的关系的Meta分析  

Meta-analysis on relationship among Helicobacter pylori infection with positive Cytotoxin-associated gene-A and ischemia stroke and its subtypes

作　　者：杨旭[1] 高永俊[2] 李继来[1] 李新毅[2] 牛小媛[2] 宿英英[3] 

机构地区：[1]航天中心医院神经内科,北京100049 [2]山西医科大学第一医院神经内科 [3]首都医科大学附属宣武医院神经内科

出　　处：《临床神经病学杂志》2012年第2期96-100,共5页Journal of Clinical Neurology

基　　金：院级基金资助项目(200901);航天科工集团青年创新基金资助项目(200906)

摘　　要：目的探讨细胞毒素相关蛋白A(CagA)阳性的幽门螺杆菌感染与缺血性脑卒中(IS)及其亚型的关系。方法检索MEDLINE、EMbase、Cochrance Collaboration database、中国期刊全文数据库及维普中文科技期刊全文数据库,纳入相关的病例-对照研究的文献。采用RevMan5.0软件进行Meta分析;同时进行文献的异质性检验、敏感性分析以及发表偏倚分析。结果共纳入8篇相关文献,其中与大动脉硬化性脑卒中(LAA)相关文献5篇。Meta分析结果显示,CagA阳性菌株感染有增加IS发病风险的趋势(OR=2.31,95%CI:1.89～2.82,P<0.01),CagA阴性菌株感染亦与IS相关(OR=0.57,95%CI:0.47～0.70,P<0.01)。进一步分析显示,CagA阳性及阴性菌株均与LAA亚型相关(OR=2.87,95%CI:2.19～3.77,P<0.01;OR=0.51,95%CI:0.39～0.67,P<0.01)。对纳入的各文献中混杂因素进一步校正后再次合并OR总效应值显示,CagA阳性菌株感染与IS及LAA仍存在相关性(OR=2.36,95%CI:1.84～3.02,P<0.01;OR=3.10,95%CI:2.29～4.19,P<0.01)。异质性检验示CagA阳性菌株与IS及其亚型的研究不存在异质性(均I2=0%)。敏感性分析示结果较稳定。漏斗图分析示存在发表偏倚。结论 CagA阳性的幽门螺杆菌感染是IS的危险因素之一,尤其是LAA亚型。Objective To investigate the relationship among Helicobacter pylori（Hp） infection with positive Cytotoxin-associated gene-A（CagA） and ischemia stroke（IS） and its subtypes.Methods The relevant case-control studies at MEDLINE,EMbase,Cochrance Collaboration database,CNKI and VIP database were searched.Meta-analysis was performed for the included studies by RevMan5.0 software after strict screening.The performed heterogeneity test,sensitivity analysis and publication bias assessment were also carried out.Results Eight studies were included in this study,five of which were related with large artery atherosclerosis stroke（LAA）.The results of meta-analysis revealed that the CagA-positive strains had a trend of increasing the risk of IS（OR=2.31,95%CI： 1.89-2.82,P0.01）,and there was also association between CagA-negative strains and IS（OR=0.57,95%CI： 0.47-0.70,P0.01）.Furthermore,the results of meta-analysis revealed that both the CagA-positive strains and the CagA-negative strains were correlated with LAA subtype（OR=2.87,95%CI： 2.19-3.77,P0.01;OR=0.51,95%CI： 0.39-0.67,P0.01）.As a result of the diversity of etiological factor in case-control study,further studies were given after the standardization of the case group,then total effect was recalculated.The results showed that the association of CagA-positive strains with IS and LAA were still apparent（OR=2.36,95%CI： 1.84-3.02,P0.01;OR=3.10,95%CI： 2.29-4.19,P0.01）,respectively.Heterogeneity test found that there was no significant heterogeneity（all I2=0%）.Sensitivity analysis suggested that the results of meta-analysis were reliable.The funnel plot suggested that the presence of publication bias.Conclusion Hp infection with CagA-positive strains is one of the risk factors for IS,especially for the LAA subtype.

关 键 词：缺血性脑卒中 大动脉硬化性脑卒中 幽门螺杆菌 细胞毒素相关蛋白A META分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]