Saturday, January 21, 2012

The Relationship between Helicobacter Pylori and Ischemic Stroke as Well as Its Subtypes: A Case-Control Study

Helicobacter pylori (English pronunciation: /ˌhɛlɨkɵˈbæktər pɪˈlɔraɪ/; H. pylori), previously named Campylobacter pyloridis, is a Gram-negative, microaerophilic bacterium found in the stomach. It was identified in 1982 by Barry Marshall and Robin Warren, who found that it was present in patients with chronic gastritis and gastric ulcers, conditions that were not previously believed to have a microbial cause. It is also linked to the development of duodenal ulcers and stomach cancer. However, over 80 percent of individuals infected with the bacterium are asymptomatic
http://www.res-medical.com/neuropathy/43524
Objective Chronic infection of Helicobacter pylori (Hp) has been linked with extradigestive diseases such as coronary atherosclerotic heart disease. However, the relationship of Helicobacter pylori and as well as its subtypes is uncertain up to now. This study aimed to investigate the association of Hp and ischemic stroke as well as its subtypes. Methods In case group,93 ischemic stroke patients were enrolled based on WHO criteria and subclassified etiologically according to modified TOAST criteria (69 AT,10 CE,11 SAD).On the other hand,101 matched subjects without infections, history of stroke and relevant vascular diseases were included in control group. Risk factors for ischemic stroke were collected and serologic Hp antibody was assessed by ELISA in all subjects. Conditional logistic regression multiplicity? was conducted to understand the effects of Hp infection on ischemic stroke. Results Although the seroprevalence of Hp antibody was a little higher in case group than in control group, there was no statistical significance between two group (69.9% vs 66.3%, OR= 1.178,95%CI 0.643-2.158,P=0.645). Even though after adjusting for potential risk factors for Hp infection and known risk factors for ischemic stroke, there was no statistical significance between two group (OR=1.010,95%CI 0.499-2.043, P=0.979). Meanwhile, there was no statistical significance in all TOAST subtypes (univariate analysis:for AT, OR=1.243,95%CI 0.640-2.415, P=0.615; for CE, OR=0.761,95%CI 0.201-2.880, P=0.733; for SAD, OR=1.353, 95%CI 0.337-5.431, P=0.988. multivariate analysis:for AT, OR=1.291,95%CI 0.588-2.836, P=0.524; for CE, OR=0.468,95%CI 0.096-2.284, P=0.348; for SAD, OR=1.349,95%CI 0.282-6.446, P=0.708). Conclusion Hp chronic infection seems not to be a risk factor for ischemic stroke, also is not closely linked with any TOAST subtypes. Objective Chronic infection by Helicobacter pylori (Hp) has been regarded as a possible etiological factor for vascular diseases. There is controversial evidence on the relevance of Hp chronic infection as a risk factor for ischemia stroke, the present study was done to systematically review the relationship between Hp and ischemia stroke as well as its subtypes. Methods We searched MEDLINE, EMbase and Cochrance Collaboration database with the time limit of 1995 to 2010. Meta-analyses were performed for the included case-control studies using RevMan 5.0 software after strict screening, estimating ORs and 95%Cls for the association between H. pylori infection and ischemic stroke subtypes. We also performed heterogeneity test, sensitivity analysis and publication bias assessment. Results Fourteen studies (with 1942 case patients and 1928 control subjects) on H.pylori and ischemic stroke were collected and the pooled OR was 1.68,95%CI:1.32-2.13, P=0.0007; Nine studies on H.pylori and stroke subtypes were also collected(with 551 case patients and 1137 control subjects), Patients with large vessel stroke had higher odds for H. pylori infection than controls(OR 1.99,95%CI:1.58-2.51, P=0.07). There were some heterogeneity in the outcome between Hp and ischemic stroke as well as its subtypes, random effects model was adopted to analyze the one which with apparent heterogeneity, but the result was still stable after sensitivity analysis, funnel polt showed evidence of publication bias and lack of negative results. Conclusions Association between H. pylori infection and stroke is significant and seems higher with stroke due to large vessel disease. Deep approachs need to be confirmed by future large sample, prospective investigation.

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