双联每日4次口服疗法和铋剂四联疗法治疗幽门螺杆菌感染疗效Meta分析  

Efficacy of dual oral therapy and bismuth quadruple therapy in the treatment of Helicobacter pylori infection:a Meta-analysis

作　　者：赵书鹏 翟蕾蕾 王海昆[1] 姚萍[1] ZHAO Shupeng;ZHAI Leilei;WANG Haikun;YAO Ping(The First Department of Gastroenterology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院消化一科,新疆乌鲁木齐830000

出　　处：《胃肠病学和肝病学杂志》2023年第11期1242-1248,共7页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的比较质子泵抑制剂(proton pump inhibitor,PPI)+阿莫西林4次/d口服双联疗法和铋剂四联疗法(bismuth quadruple therapy,BQT)治疗幽门螺杆菌(Helicobacter pylori,H.pylori)的有效性及安全性。方法用计算机检索3个中文数据库(知网、维普、中国生物医学文献服务系统)和3个英文数据库(PubMed、EmBase、Cochrane library)搜索比较PPI+阿莫西林4次/d口服双联疗法与BQT疗法治疗H.pylori的研究,根据纳入及排除标准筛选文献,采用RevMan 5.4.1统计软件进行Meta分析。观察指标:意向治疗(intention-to-treat analysis,ITT)分析和符合方案(per-protocol,PP)分析的H.pylori根除率、不良反应、依从性。结果本研究共纳入6篇文献,共2550例H.pylori感染者。ITT分析显示:两种疗法的合并根除率比较,差异无统计学意义(84.5%vs 82.7%,RR=1.02,95%CI:0.99~1.06,P=0.21);PP分析显示:两种疗法的合并根除率比较,差异无统计学意义(89.4%vs 89.1%,RR=1.01,95%CI:0.98~1.04,P=0.60);PPI+阿莫西林4次/d口服双联疗法不良反应率显著低于BQT疗法(15.2%vs 31.6%,RR=0.55,95%CI:0.35~0.88,P=0.01);两组依从性差异无统计学意义(95.9%vs 94.7%,RR=1.01,95%CI:0.99~1.03,P=0.22)。结论在H.pylori的根除率方面,PPI+阿莫西林4次/d口服双联疗法治疗效果与BQT疗法相似,并且有更低的不良反应发生率及相似的依从性。Objective To compare the efficacy and safety of proton pump inhibitor(PPI)combined with Amoxicillin 4 times daily oral double regimen and bismuth quadruple therapy(BQT)in the treatment of Helicobacter pylori(H.pylori).Methods Three Chinese databases(CNKI,VIP,China Biomedical Literature Service System)and three English databases(PubMed,EmBase,Cochrane Library)were searched by computer to compare the studies on the treatment of H.pylori with PPI+Amoxicillin four times a day oral double therapy and BQT therapy.The literatures were screened according to the inclusion and exclusion criteria,and the RevMan 5.4.1 statistical software was used for Meta-analysis.Observation indicators:H.pylori eradication rate,adverse reactions and compliance by intention-to-treat(ITT)analysis and per-protocol(PP)analysis.Results Six literatures were included in this study,including 2550 H.pylori infected persons.ITT analysis showed that there was no significant difference in the combined eradication rate between the two therapies(84.5%vs 82.7%,RR=1.02,95%CI:0.99-1.06,P=0.21);PP analysis showed that there was no significant difference in the combined eradication rate between the two therapies(89.4%vs 89.1%,RR=1.01,95%CI:0.98-1.04,P=0.60).The adverse reaction rate of PPI+Amoxicillin four times daily oral double therapy was significantly lower than that of BQT therapy(15.2%vs 31.6%,RR=0.55,95%CI:0.35-0.88,P=0.01).There was no statistically significant difference in compliance between the two groups(95.9%vs 94.7%,RR=1.01,95%CI:0.99-1.03,P=0.22).Conclusion In terms of the eradication rate of H.pylori,PPI+Amoxicillin four times a day oral double therapy can achieve the same effect as BQT therapy,and has lower adverse reaction rate and similar compliance.

关 键 词：幽门螺杆菌 双重治疗 根除 安全性 依从性 

分 类 号：R378[医药卫生—病原生物学]