Meta-analysis Of The Effect Of Hp Eradication On NAFLD Patients With Hp Infection

Objective:NAFLD as a chronic liver disease affects approximately10%-50% of the global population.Because it affects a large number of people and may cause serious complications,it has brought a huge medical and economic burden to the public.The pathogenesis of NAFLD is complicated.Studies have shown that Hp infection is closely related to NAFLD.However,the therapeutic effect of eradication of Hp on patients with NAFLD combined with Hp infection is controversial.This study aims to evaluate the impact of Hp eradication on NAFLD patients with Hp infection.Methods: Search Chinese and English subject terms and free words according to the research content,and search in Pub Med,Embase,Cochrane Library,Web of Science,CNKI,Wanfang,Weipu,Sino Med and other Chinese and English databases from the construction of the library to December 2020,there was a clinical randomized controlled trial on eradication of Hp in the treatment of NAFLD combined with Hp infection.Two researchers independently screened,evaluated,and extracted relevant data for the included literature,and finally used Rev Man 5.3 software to draw a forest map and analyze the results.Results: A total of 11 randomized controlled trials were included in this study,including 1684 patients,of which 824 patients underwent Hp eradication therapy.Meta analysis results:(1)Eradication of Hp can improve liver function and reduce transaminase:(1)ALT: Hp eradication versus lifestyle intervention or conventional medication: MD=-10.37;95%CI:-19.34,-1.40,p=0.02;eradication of Hp on the basis of conventional drug treatment versus conventional drug treatment: MD=-24.58;95%CI:-29.61,-19.55,P<0.00001;(2)AST: Hp eradication versus lifestyle intervention or conventional medication:MD=-6.51;95%CI:-11.02,-1.99,P=0.005;eradication of Hp on the basis of conventional drug treatment versus conventional drug treatment: MD=-15.95;95% CI:-17.46,-14.45,P<0.00001;(2)Eradication of Hp can reduce TC,TG,LDL and increase HDL:(1)TC: Hp eradication versus lifestyle intervention or conventional medication: MD=-0.52;95%CI:-1.14,0.09,P=0.09;eradication of Hp on the basis of conventional drug treatment versus conventional drug treatment: MD=-1.34;95%CI:-1.62,-1.06,P<0.00001;combined analysis:MD combined=-1.08;95%CI:-1.31,-0.84,P < 0.00001;(2)TG: Hp eradication versus lifestyle intervention or conventional medication: MD=-1.11;95%CI:-1.45,-0.77,P < 0.00001;eradication of Hp on the basis of conventional drug treatment versus conventional drug treatment: MD=-1.30;95%CI:-1.36,-1.24;(3)LDL: Hp eradication versus lifestyle intervention or conventional medication: MD=-0.28;95%CI:-0.87,0.30,P=0.35;eradication of Hp on the basis of conventional drug treatment versus conventional drug treatment: MD=-1.04;95%CI:-1.17,-0.91,P<0.00001;combined analysis:MD combined=-0.87;95%CI:-1.03,-0.71,P < 0.00001;(4)HDL:Hp eradication versus lifestyle intervention or conventional medication: MD=0.18;95%CI:-0.18,0.55,P=0.33;eradication of Hp on the basis of conventional drug treatment versus conventional drug treatment: MD=0.58;95%CI: 0.50,0.67,P<0.00001;combined analysis: MD combined = 0.35;95% CI: 0.15,0.55,P=0.0005;(3)Hp eradication cannot reduce FPG: MD=-0.11;95%CI:-0.22,0.00,P=0.05;(4)Hp eradication can reduce HOMA-IR: Hp eradication versus lifestyle intervention or conventional medication: MD =-0.22;95%CI:-1.10,0.65,P=0.61;eradication of Hp on the basis of conventional drug treatment versus conventional drug treatment: MD=-0.95;95%CI:-1.46,-0.45,P=0.0002;combined analysis: MD combined=-0.78;95% CI:-0.95,-0.61,P<0.00001;(5)Eradication of Hp can reduce liver fiber indicators:(1)HA: MD=-63.69;95%CI:-85.31,-42.06,P<0.00001;(2)LN: MD=-35.57;95%CI:-61.73,-9.40,P=0.008;(3)PCⅢ: MD=-42.80;95%CI:-61.42,-24.18,P=0.05;(4)Ⅳ-C:MD=-29.84;95%CI:-51.40,-8.28,P=0.007);(6)Hp eradication can not reduce BMI: MD=0.56;95%CI:-0.37,1.50,P=0.24;(7)Hp eradication can reduce TNF-α: MD=-16.02;95%CI:-17.31,-14.73,P<0.00001;(8)Eradication of Hp can improve the clinical symptoms of patients:(1)Bloating: OR=3.41;95%CI:1.78,6.55,P=0.0002;(2)Asthenia: OR=4.94;95%CI: 2.39,10.22,P<0.0001;(3)Didual pain in liver area: OR=3.75;95%CI: 1.95,7.22,P<0.0001.Conclusion:1.Eradication of Hp can improve liver function indexes,blood lipid metabolism indexes,insulin resistance indexes,liver fibrosis indexes,inflammatory cytokines,etc.in patients with NAFLD combined with Hp infection,which is beneficial to delay the progression of the disease.2.For patients with NAFLD and Hp infection,the eradication of Hp on the basis of conventional drug therapy can significantly improve the therapeutic effect.3.Eradication of Hp can reduce the level of insulin resistance in patients with NAFLD combined with Hp infection,and can provide new treatment ideas for patients with complications such as T2 DM.4.Eradication of Hp can reduce TC,TG,LDL and increase HDL in patients with NAFLD combined with Hp infection,which is beneficial to prevent cardiovascular and cerebrovascular complications.