幽門螺桿菌感染與腦梗死及其亞型關系的Meta分析_《中國循證醫學雜志》

作者：

于亮 ,  佟偉軍

蘇州大學醫學部放射醫學與公共衛生學院（江蘇蘇州 215123）;

關鍵詞：

腦梗死腦梗死亞型幽門螺桿菌 Meta 分析感染

DOI：

10.7507/1672-2531.20090107

視頻：

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目的　探討幽門螺桿菌（helicobacter pyloric，HP）感染是否是腦梗死的危險因素。
方法　計算機檢索MEDLINE、BIOSIS、VIP 和中國期刊全文數據庫，檢索時限為1997 年1 月至2007 年12 月，納入研究HP 和腦梗死關系的病例- 對照研究。經嚴格篩選后，采用Cochrane 協作網提供的RevMan 4.2 軟件對納入文獻進行Meta 分析。
結果　共納入12 篇文獻，包括1 693 例腦梗死患者和1 611 例對照。Meta 分析結果顯示腦梗死組和對照組HP 感染率差異有統計學意義［OR= 1.77，95%CI（1.38，2.28），P lt;0.0001］；而HP 與腦梗死亞型的Meta 分析結果顯示，HP 感染與大動脈粥樣硬化性腦卒中［OR= 3.65，95%CI（2.58，5.17）］和小動脈閉塞性腦卒中或腔隙性腦卒中的關聯性有統計學意義［OR=1.74，95%CI（1.30，2.34）］，但與心源性腦栓塞等亞型的關聯性無統計學意義［OR=1.08，95%CI（0.58，2.02）］。在調整危險因素后，HP 與腦梗死的關聯性消失［OR=1.22，95%CI（0.93，1.59）］。
結論　① 幽門螺桿菌感染是腦梗死的危險因素，但其與不同腦梗死亞型的相關程度不同，HP 感染與大動脈粥樣硬化性腦卒中的關聯性最強。② 幽門螺桿菌感染不是腦梗死的獨立危險因素，但需要大樣本的科學研究進一步證實。

引用本文： 于亮,佟偉軍. 幽門螺桿菌感染與腦梗死及其亞型關系的Meta分析. 中國循證醫學雜志, 2009, 09(5): 593-598. doi: 10.7507/1672-2531.20090107 復制

1.	pneumoniae and risk of ischemic stroke subtypes: Results from a population-based case-control study. Stroke, 2001, 32(10): 2253-2258.
2.	Zhang LF, Yang J, Hong Z, et al. Proportion of different subtypes of stroke in China. Stroke, 2003, 34(9): 2091-2096.
3.	Ameriso SF, Fridman EA, Leiguarda RC, et al. Detection of Helicobacter pylori in human carotid atherosclerotic plaques. Stroke, 2001, 32(2): 385-391.
4.	Markus HS, Mendall MA. Helicobacter pylori infection: a risk factor for ischaemic cerebrovascular disease and carotid atheroma. J Neurol Neurosurg Psychiatry, 1998, 64(1): 104-107.
5.	Masoud SA. Arami MA. Kucheki E. Association between infection with Helicobacter pylori and cerebral noncardioembolic ischemic stroke. Neurology India, 2005, 53(3): 303-306.
6.	Moayyedi P, Carter AM, Braunholtz D, et al. Helicobacter pylori infection in subjects with acute ischemic stroke. Dig Liver Dis, 2003, 35(1): 16-19.
7.	Majka J, Róg T, Konturek PC, et al. Influence of chronic Helicobacter pylori infection on ischemic cerebral stroke risk factors. Med Sci Monit, 2002, 8(10): CR675-684.
8.	段和力, 石麗霞, 陳迎春, 等. 幽門螺桿菌感染與腦出血及腦梗死的相關性分析. 華北煤炭醫學院學報, 2005, 7(5): 557-558.
9.	王東風, 徐寧, 周君同. 老年人腦梗死和心肌梗死與幽門螺旋桿菌感染的關系. 中華老年醫學雜志, 2001, 20(1): 53.
10.	劉琮蔚, 楊曉熹, 任藝, 等. 幽門螺旋桿菌感染與缺血性腦血管病的關系. 天津醫藥. 2004, 32(7): 430.
11.	Grau AJ, Buggle F, Lichy C, et al. Helicobacter pylori infection as an independent risk factor for cerebral ischemia of atherothrombotic origin. J Neurol Sci, 2001, 186(1-2): 1-5.
12.	Preusch MR, Grau AJ, Buggle F, et al. Association between cerebral ischemia and cytotoxin-associated gene-A-bearing strains of Helicobacter pylori. Stroke, 2004, 35(8): 1800-1804.
13.	Heuschmann PU, Neureiter D, Gesslein M, et al. Association between infection with Helicobacter pylori and Chlamydia.
14.	Park MH, Min JY, Koh SB, et al. Helicobacter pylori infection and the CD14 C(-260)T gene polymorphism in ischemic stroke. Thrombosis Research, 2006, 118(6): 671-677.
15.	劉信榮, 段和力, 周波, 等. 幽門螺桿菌感染與腦梗死相關性初探. 中國綜合臨床, 2003, 19(7): 614-616.
16.	Lichtenstein MJ, Mulow CD, Elwood PC. Guidelines for reading case-control study. J Chron Dis, 1987, 40(9): 893-895.
17.	Wang KJ, Wang RT. Meta-analysis on the epidemiology of Helicobacter pylori infection in China. Zhonghua Liu Xing Bing Xue Za Zhi, 2003, 24(6): 443-446.
18.	Pasceri V, Patti G, Cammarota G, et al. Virulent strains of Helicobacter pylori and vascular diseases: a meta-analysis. Am Heart J, 2006, 151(6): 1215-1222.
19.	Danesh J, Collins PR. Chronic infections and coronary heart disease: is there a link? Lancet, 1997, 350(9075): 430–436.
20.	Phull PS, Gower JD, Price AB, et al. Alpha-tocopherol antioxidant levels in chronic gastritis: correlation with mucosal neutrophil infiltration. Gut, 1993, 34(suppl 1): T133.
21.	Hansen PS, Go MF, Varming K, et al. Proinflammatory activation of neutrophils and monocytes by Helicobacter pylori in patients with different clinical presentations. Infect Immun, 1999, 67(6): 3171-3174.
22.	Grau AJ, Buggle F, Heindl S, et al. Recent infection as a risk factor for cerebrovascular ischemia. Stroke, 1995, 26(3): 373-379.
23.	Glynn J. Helicobacter pylori and the heart. Lancet, 1994, 344(8916):146.

1. pneumoniae and risk of ischemic stroke subtypes: Results from a population-based case-control study. Stroke, 2001, 32(10): 2253-2258.
2. Zhang LF, Yang J, Hong Z, et al. Proportion of different subtypes of stroke in China. Stroke, 2003, 34(9): 2091-2096.
3. Ameriso SF, Fridman EA, Leiguarda RC, et al. Detection of Helicobacter pylori in human carotid atherosclerotic plaques. Stroke, 2001, 32(2): 385-391.
4. Markus HS, Mendall MA. Helicobacter pylori infection: a risk factor for ischaemic cerebrovascular disease and carotid atheroma. J Neurol Neurosurg Psychiatry, 1998, 64(1): 104-107.
5. Masoud SA. Arami MA. Kucheki E. Association between infection with Helicobacter pylori and cerebral noncardioembolic ischemic stroke. Neurology India, 2005, 53(3): 303-306.
6. Moayyedi P, Carter AM, Braunholtz D, et al. Helicobacter pylori infection in subjects with acute ischemic stroke. Dig Liver Dis, 2003, 35(1): 16-19.
7. Majka J, Róg T, Konturek PC, et al. Influence of chronic Helicobacter pylori infection on ischemic cerebral stroke risk factors. Med Sci Monit, 2002, 8(10): CR675-684.
8. 段和力, 石麗霞, 陳迎春, 等. 幽門螺桿菌感染與腦出血及腦梗死的相關性分析. 華北煤炭醫學院學報, 2005, 7(5): 557-558.
9. 王東風, 徐寧, 周君同. 老年人腦梗死和心肌梗死與幽門螺旋桿菌感染的關系. 中華老年醫學雜志, 2001, 20(1): 53.
10. 劉琮蔚, 楊曉熹, 任藝, 等. 幽門螺旋桿菌感染與缺血性腦血管病的關系. 天津醫藥. 2004, 32(7): 430.
11. Grau AJ, Buggle F, Lichy C, et al. Helicobacter pylori infection as an independent risk factor for cerebral ischemia of atherothrombotic origin. J Neurol Sci, 2001, 186(1-2): 1-5.
12. Preusch MR, Grau AJ, Buggle F, et al. Association between cerebral ischemia and cytotoxin-associated gene-A-bearing strains of Helicobacter pylori. Stroke, 2004, 35(8): 1800-1804.
13. Heuschmann PU, Neureiter D, Gesslein M, et al. Association between infection with Helicobacter pylori and Chlamydia.
14. Park MH, Min JY, Koh SB, et al. Helicobacter pylori infection and the CD14 C(-260)T gene polymorphism in ischemic stroke. Thrombosis Research, 2006, 118(6): 671-677.
15. 劉信榮, 段和力, 周波, 等. 幽門螺桿菌感染與腦梗死相關性初探. 中國綜合臨床, 2003, 19(7): 614-616.
16. Lichtenstein MJ, Mulow CD, Elwood PC. Guidelines for reading case-control study. J Chron Dis, 1987, 40(9): 893-895.
17. Wang KJ, Wang RT. Meta-analysis on the epidemiology of Helicobacter pylori infection in China. Zhonghua Liu Xing Bing Xue Za Zhi, 2003, 24(6): 443-446.
18. Pasceri V, Patti G, Cammarota G, et al. Virulent strains of Helicobacter pylori and vascular diseases: a meta-analysis. Am Heart J, 2006, 151(6): 1215-1222.
19. Danesh J, Collins PR. Chronic infections and coronary heart disease: is there a link? Lancet, 1997, 350(9075): 430–436.
20. Phull PS, Gower JD, Price AB, et al. Alpha-tocopherol antioxidant levels in chronic gastritis: correlation with mucosal neutrophil infiltration. Gut, 1993, 34(suppl 1): T133.
21. Hansen PS, Go MF, Varming K, et al. Proinflammatory activation of neutrophils and monocytes by Helicobacter pylori in patients with different clinical presentations. Infect Immun, 1999, 67(6): 3171-3174.
22. Grau AJ, Buggle F, Heindl S, et al. Recent infection as a risk factor for cerebrovascular ischemia. Stroke, 1995, 26(3): 373-379.
23. Glynn J. Helicobacter pylori and the heart. Lancet, 1994, 344(8916):146.

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