雷贝拉唑与埃索美拉唑治疗幽门螺杆菌阳性消化道溃疡的系统评价  

Systematic Evaluation of Rabeprazole and Esomeprazole in Treatment of Helicobacter Pylori Positive Peptic Ulcer

作　　者：刘文侠[1] 朱颖[1] 王伟[1] 许亚[1] 李国栋[1] LIU Wen-xia;ZHU Ying;WANG Wei;XU Ya;LI Guo-dong(Xuzhou Central Hospital,Xuzhou Jiangsu 221009,China)

机构地区：[1]徐州市中心医院,江苏徐州221009

出　　处：《抗感染药学》2023年第3期270-276,共7页Anti-infection Pharmacy

基　　金：江苏省药学会恒瑞医院药学基金科研项目(项目编号:H202042)。

摘　　要：目的:分析雷贝拉唑与埃索美拉唑治疗幽门螺杆菌(Helicobacter pylori,Hp)阳性的消化道溃疡情况,评价其根治率与安全性。方法:计算机检索PubMed、Cochrane图书馆、外文医学信息资源检索平台、中国期刊全文数据库、万方数据库、中文科技期刊全文数据库和中国生物医学文献数据库等数据库中所有关于雷贝拉唑与埃索美拉唑治疗幽门螺杆菌阳性消化道溃疡的相关文献(研究组干预措施为雷贝拉唑,对照组干预措施为埃索美拉唑),参照纳入、排除标准进行文献筛选,在文献质量评估及其特征描述之后,采用RevMan 5.2统计软件对文献统计的数据进行Meta分析。结果:纳入20篇文献,共计3473位患者;Meta分析结果显示,埃索美拉唑对于Hp阳性的消化道溃疡的Hp根除率明显优于雷贝拉唑(RR=0.90,95%CI为0.88~0.93,Z=6.19,P<0.001);雷贝拉唑与埃索美拉唑对快代谢型CYP2C19患者的Hp根除基本相当(OR=0.70,95%CI为0.48~1.03,Z=1.83,P>0.05);而对于慢代谢型患者雷贝拉唑疗效更优(OR=2.39,95%CI为0.29~0.88,Z=2.39,P<0.05);两者发生的药物不良反应一致,主要为头痛、口干(OR=1.05,95%CI为0.74~1.50,Z=0.28,P>0.05)。雷贝拉唑与埃索美拉唑治疗Hp阳性的消化道溃疡疗效的漏斗图基本对称,提示无明显发表偏倚存在。结论:以埃索美拉唑为基础的治疗方案在Hp根除上具有明显优势,而从经济性上来说雷贝拉唑更具有优势,建议在治疗方案的选择上可根据患者自身情况权衡利弊选择。对于CYP2C19基因型患者的Hp治疗,慢代谢型患者采用雷贝拉唑治疗更优,但由于纳入文献其方法学质量不高以及缺少更详细的病程和基因型,因此,需要更多大规模多中心的研究对其进行二次的系统分析。Objective:To analyze rabeprazole and esomeprazole in the treatment of Helicobacter pylori(Hp)positive peptic ulcer,and evaluate their radical rate and safety.Methods:All relevant literatures about rabeprazole and esomeprazole in the treatment of Hp positive peptic ulcer were searched in databases such as PubMed,Cochrane Library,Foreign Medical Literature Retrieval Service,CNKI,Wanfang Database,VIP database and Chinese biomedical literature database using a computer(with rabeprazole as intervening measure in the study group and esomeprazole in the control group).The literatures were screened according to the inclusion and exclusion criteria.After literature quality assessment and characteristic description,RevMan 5.2 statistical software was used for Meta analysis of literature statistics data.Results:Twenty articles were included,with a total of 3473 patients.Meta analysis results showed that the eradication rate of esomeprazole for Hp positive peptic ulcer was significantly higher than that of rabeprazole(RR=0.90,95%CI:0.88-0.93,Z=6.19,P<0.001);rabeprazole and esomeprazole had basically the same eradication rate for Hp in fast metabolizing CYP2C19 patients(OR=0.70,95%CI:0.48-1.03,Z=1.83,P>0.05);rabeprazole was more effective for patients with slow metabolism(OR=2.39,95%CI:0.29-0.88,Z=2.39,P<0.05);both had the same adverse drug reaction,mainly headache and thirst(OR=1.05,95%CI:0.74-1.50,Z=0.28,P>0.05).The funnel plots of rabeprazole and esomeprazole in the treatment of Hp positive peptic ulcer were basically symmetrical,suggesting no obvious publication bias.Conclusion:The therapeutic regimen based on esomeprazole has obvious advantages in Hp eradication,while rabeprazole has more advantages in terms of economy,so it is suggested that the therapeutic regimen should be chosen by weighing their advantages and disadvantages according to the patient's own situation.For Hp treatment of patients with CYP2C19 genotype,rabeprazole treatment is better for patients with slow metabolism.However,due to the poor methodologica

关 键 词：雷贝拉唑 埃索美拉唑 消化道溃疡 幽门螺杆菌 

分 类 号：R969.3[医药卫生—药理学]