根除幽门螺杆菌预防胃癌
创作:Lexi 审核:Lexi 2020年04月13日
  • 调查幽门螺杆菌(H. pylori)阳性健康人和新生胃瘤患者,比较两类人群接受H. pylori根除治疗对随后胃癌发生的影响;
  • 纳入10组随机对照试验(RCTs),其中7组招募8323位健康对照,3组随机招募1841位新生胃瘤患者;
  • 根除治疗降低健康个体患胃癌概率,并降低胃癌死亡率,但不影响全因死亡率;
  • 若全球实施人群筛查和治疗,将获得8743815个伤残调整生命年(DALYs);
  • 根除治疗也可降低新生胃瘤患者患胃癌概率,但其不良事件报告不完整。
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Lexi
胃癌与幽门螺杆菌(H. pylori)感染密切相关。最新发表在Gut的荟萃分析研究了H. pylori感染的健康人和新生胃瘤患者,比较两类人群接受H. pylori根除治疗对随后胃癌发生的影响。研究发现根除H. pylori治疗可降低两类人群胃癌发生概率,与胃癌相关的死亡率也有所降低。
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Gut [IF:19.819]

Helicobacter pylori eradication therapy to prevent gastric cancer: systematic review and meta-analysis

幽门螺杆菌根除治疗用于预防胃癌:系统性综述和荟萃分析

10.1136/gutjnl-2020-320839

2020-03-23, Article

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Objectives: Gastric cancer is strongly associated with Helicobacter pylori (H. pylori). We conducted a previous systematic review and meta-analysis that suggested eradication therapy reduced future incidence of gastric cancer, but effect size was uncertain, and there was no reduction in gastric cancer-related mortality. We updated this meta-analysis, as more data has accumulated. We also evaluated impact of eradication therapy on future risk of gastric cancer in patients having endoscopic mucosal resection for gastric neoplasia.
Design: We searched the medical literature through February 2020 to identify randomised controlled trials (RCTs) examining effect of eradication therapy on subsequent occurrence of gastric cancer in healthy H. pylori-positive adults, and in H. pylori-positive patients with gastric neoplasia undergoing endoscopic mucosal resection. The control arm received placebo or no treatment. Follow-up was for ≥2 years. We estimated the relative risk (RR) number needed to treat (NNT), and evaluated the disability-adjusted life-years (DALYs) gained from screening from the meta-analysis.
Results: We identified 10 RCTs, seven recruited 8323 healthy individuals, and three randomised 1841 patients with gastric neoplasia. In healthy individuals, eradication therapy reduced incidence of gastric cancer (RR=0.54; 95% CI 0.40 to 0.72, NNT=72), and reduced mortality from gastric cancer (RR=0.61; 95% CI 0.40 to 0.92, NNT=135), but did not affect all-cause mortality. These data suggest that 8 743 815 DALYs (95% CI 5 646 173 to 11 847 456) would be gained if population screening and treatment was implemented globally. In patients with gastric neoplasia, eradication therapy also reduced incidence of future gastric cancer (RR=0.49; 95% CI 0.34 to 0.70, NNT=21). Adverse events were incompletely reported.
Conclusion : There is moderate evidence to suggest that H. pylori eradication therapy reduces the incidence of gastric cancer in healthy individuals and patients with gastric neoplasia in East Asian countries. There also appears to be a reduction in gastric cancer-related mortality.

First Authors:
Alexander Charles Ford

Correspondence Authors:
Paul Moayyedi

All Authors:
Alexander Charles Ford,Yuhong Yuan,Paul Moayyedi

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