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Chlamydia pneumoniae infection and cerebrovascular disease: a systematic review and meta-analysis.

Chen J, Zhu M, Ma G, Zhao Z, Sun Z - BMC Neurol (2013)

Bottom Line: Random effect model was used as pooling method and publication bias was estimated for the results.No significant association was found in serum anti-C.pneumonae IgM seropositivity or in-situ-detection of C.pneumoniae in arterial biopsies with CV disease.Subgroup analysis by available studies suggested that C.pneumoniae may paly a role in atherosclerotic stroke, but be less significant in stroke of cardioembolism or other etiologies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, Shandong province 250014, China. zhumeijia1818@gmail.com.

ABSTRACT

Background: A wealth of published studies have been published on association between Chlamydia pneumoniae (C.pneumoniae) infection and cerebrovascular (CV) disease, but the results were inconsistent. This meta-analysis provides a systematic review of the available evidence from all serological and pathological studies of CV disease and C.pneumoniae.

Methods: A comprehensive research was conducted of MEDLINE, EMBASE, CNKI, WanFang technological periodical database and reference lists of articles to identify eligible case-control and cohort studies. Odds radio (OR) was calculated for each study outcome. Random effect model was used as pooling method and publication bias was estimated for the results.

Results: Fifty-two published studies that met criteria were selected. In case control studies, an association between C.pneumoniae infection and CV disease was revealed by serum specific IgG (OR, 1.61; 95% CI: 1.34 to 1.94), serum IgA (OR, 2.33; 95% CI: 1.76 to 3.08) and PCR technique of C.pneumoniae in peripheral blood cells (OR, 1.90; 95% CI: 1.17 to 3.07). No significant association was found in serum anti-C.pneumonae IgM seropositivity or in-situ-detection of C.pneumoniae in arterial biopsies with CV disease. Subgroup analysis by available studies suggested that C.pneumoniae may paly a role in atherosclerotic stroke, but be less significant in stroke of cardioembolism or other etiologies.

Conclusion: Association between C.pneumoniae infection and CV disease depends on the analytical method adopted, which seems stronger with stroke due to large artery atherosclerosis. Establishing a causal relationship between C.peumoniae infection and CV disease will require more prospective studies with combination of techniques and stratified by etiological subtypes.

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Related in: MedlinePlus

Funnel plots for publication bias detection.
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Figure 3: Funnel plots for publication bias detection.

Mentions: Forty-two studies – thirty-six cross-sectional, five nested case control studies and one cohort study -- compared the association of CV disease group versus control groups with serum anti-C.pneumoniae IgG titers. The number of CV cases in the case–control studies ranged from 18 to 483, with a total of 4240; while the number of subjects in control groups ranged from 15 to 483, with a total of 7493. The overall estimated OR of case–control studies based on random effect was 1.61 (95% CI, 1.34 to 1.94; p = 0.00) and the cross-sectional studies demonstrated a more significant positive association with OR = 1.74 (95% CI, 1.43 to 2.10; p = 0.00). The Q statistic suggested an excessive heterogeneity between case–control studies (p, 0.00), with I2 = 65.9%. Furthermore, sensitivity analysis showed that the results were not affected by sequential exclusion of any particular study. No available methods favored the presence of publication bias. The Begger’s test yielded a P-value of 0.83 (zc = 1.58) and the Egger’s fixed effects regression suggested a marginally significant evidence for publication bias (t = 2.12; p = 0.04). Forest plot was shown in Figure 2. Funnel plot was shown in Figure 3. Considering the result yielded by Egger’s test, we had to conclude that the hypothesis of publication bias could not be further considered as valid. Applying“trim and fill” method to evaluate publication bias obtained a corrected OR = 1.62 (95% CI :1.34 to 1.95; p = 0.00), which suggested correction for potential publication bias did not materially alter the combined risk estimate. The one and only cohort study by Katie AC et al., with sample size of 1612 cases, which was not enrolled in this pooled analysis, reported an RR = 0.88 (95% CI: 0.52 to 1.47).


Chlamydia pneumoniae infection and cerebrovascular disease: a systematic review and meta-analysis.

Chen J, Zhu M, Ma G, Zhao Z, Sun Z - BMC Neurol (2013)

Funnel plots for publication bias detection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222774&req=5

Figure 3: Funnel plots for publication bias detection.
Mentions: Forty-two studies – thirty-six cross-sectional, five nested case control studies and one cohort study -- compared the association of CV disease group versus control groups with serum anti-C.pneumoniae IgG titers. The number of CV cases in the case–control studies ranged from 18 to 483, with a total of 4240; while the number of subjects in control groups ranged from 15 to 483, with a total of 7493. The overall estimated OR of case–control studies based on random effect was 1.61 (95% CI, 1.34 to 1.94; p = 0.00) and the cross-sectional studies demonstrated a more significant positive association with OR = 1.74 (95% CI, 1.43 to 2.10; p = 0.00). The Q statistic suggested an excessive heterogeneity between case–control studies (p, 0.00), with I2 = 65.9%. Furthermore, sensitivity analysis showed that the results were not affected by sequential exclusion of any particular study. No available methods favored the presence of publication bias. The Begger’s test yielded a P-value of 0.83 (zc = 1.58) and the Egger’s fixed effects regression suggested a marginally significant evidence for publication bias (t = 2.12; p = 0.04). Forest plot was shown in Figure 2. Funnel plot was shown in Figure 3. Considering the result yielded by Egger’s test, we had to conclude that the hypothesis of publication bias could not be further considered as valid. Applying“trim and fill” method to evaluate publication bias obtained a corrected OR = 1.62 (95% CI :1.34 to 1.95; p = 0.00), which suggested correction for potential publication bias did not materially alter the combined risk estimate. The one and only cohort study by Katie AC et al., with sample size of 1612 cases, which was not enrolled in this pooled analysis, reported an RR = 0.88 (95% CI: 0.52 to 1.47).

Bottom Line: Random effect model was used as pooling method and publication bias was estimated for the results.No significant association was found in serum anti-C.pneumonae IgM seropositivity or in-situ-detection of C.pneumoniae in arterial biopsies with CV disease.Subgroup analysis by available studies suggested that C.pneumoniae may paly a role in atherosclerotic stroke, but be less significant in stroke of cardioembolism or other etiologies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, Affiliated Qianfoshan Hospital of Shandong University, 66 Jingshi Road, Jinan, Shandong province 250014, China. zhumeijia1818@gmail.com.

ABSTRACT

Background: A wealth of published studies have been published on association between Chlamydia pneumoniae (C.pneumoniae) infection and cerebrovascular (CV) disease, but the results were inconsistent. This meta-analysis provides a systematic review of the available evidence from all serological and pathological studies of CV disease and C.pneumoniae.

Methods: A comprehensive research was conducted of MEDLINE, EMBASE, CNKI, WanFang technological periodical database and reference lists of articles to identify eligible case-control and cohort studies. Odds radio (OR) was calculated for each study outcome. Random effect model was used as pooling method and publication bias was estimated for the results.

Results: Fifty-two published studies that met criteria were selected. In case control studies, an association between C.pneumoniae infection and CV disease was revealed by serum specific IgG (OR, 1.61; 95% CI: 1.34 to 1.94), serum IgA (OR, 2.33; 95% CI: 1.76 to 3.08) and PCR technique of C.pneumoniae in peripheral blood cells (OR, 1.90; 95% CI: 1.17 to 3.07). No significant association was found in serum anti-C.pneumonae IgM seropositivity or in-situ-detection of C.pneumoniae in arterial biopsies with CV disease. Subgroup analysis by available studies suggested that C.pneumoniae may paly a role in atherosclerotic stroke, but be less significant in stroke of cardioembolism or other etiologies.

Conclusion: Association between C.pneumoniae infection and CV disease depends on the analytical method adopted, which seems stronger with stroke due to large artery atherosclerosis. Establishing a causal relationship between C.peumoniae infection and CV disease will require more prospective studies with combination of techniques and stratified by etiological subtypes.

Show MeSH
Related in: MedlinePlus