高剂量二联疗法首次根除幽门螺杆菌疗效和安全性Meta分析  

Meta-analysis of the Efficacy and Safety of High-dose Dual Therapy for the First-line Helicobacter pylori Infection

作　　者：霍鲁月 吴胜男 庄帅帅 孙为豪[1] HUO Luyue;WU Shengnan;ZHUANG Shuaishuai(Department of Geriatric Gastroenterology,The First Affiliated Hospital of Nanjing Medical University,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院老年消化科,210029

出　　处：《医学研究杂志》2024年第2期74-80,共7页Journal of Medical Research

基　　金：国家自然科学基金资助项目(81072030)。

摘　　要：目的系统评价高剂量二联疗法(high-dose dual therapy,HDDT)与四联疗法(quadruple therapy,QT)对比治疗首次幽门螺杆菌(helicobacter pylori,Hp)感染的疗效和安全性。方法检索中国知网、万方数据知识服务平台、维普网、CBM、PubMed、Embase、Cochrane Library等数据库,收集关于HDDT对比QT治疗Hp感染的随机对照试验(randomized controlled trial,RCT),检索时间从建库至2022年7月3日。采用RevMan 5.4和Stata 17.0软件进行Meta分析。结果共纳入11篇文献,4015例患者。Meta分析结果显示,在意向性治疗分析中,HDDT根除率优于QT,且差异有统计学意义(RR=1.04,95%CI:1.01~1.06,Ρ<0.01);在符合方案分析中,两组根除率比较差异无统计学意义(RR=1.02,95%CI:1.00~1.04,Ρ=0.08)。从不良反应发生率来看,HDDT较QT显著降低,且差异有统计学意义(RR=0.47,95%CI:0.36~0.61,Ρ<0.01)。从依从性上比较,两组均具有良好的依从性,差异无统计学意义(RR=1.01,95%CI:1.00~1.02,Ρ=0.06)。结论HDDT首次根除Hp感染的疗效优于QT,且安全性更好,可作为一线治疗方案应用于临床。Objective To systematically evaluate the efficacy and safety of high-dose dual therapy(HDDT)versus quadruple therapy(QT)for the first-line helicobacter pylori(Hp)infection.Methods The randomized controlled trial(RCT)about HDDT versus QT for the first-line treatment of Hp infection were searched from CNKI,VIP,Wanfang,CBM,PubMed,Embase,Cochrane Library and other databases from the establishment of databases to 3July 2022.RevMan 5.4 and Stata 17.0software were used for Meta-analysis.Results A total of 11studies with 4015 patients were included.The results of Meta-analysis showed that:the eradication rate of HDDT was statistically superior to that of QT(RR=1.04,95%CI:1.01-1.06,P<0.01)in the intention-to-treat analysis;the eradication rate of the two groups was not statistically significant(RR=1.02,95%CI:1.00-1.04,P=0.08)in the coincidence protocol analysis.HDDT had a significantly lower rate of adverse reactions than QT(RR=0.47,95%CI:0.36-0.61,P<0.01);but HDDT and QT both had achieved a similar eradication rate(RR=1.01,95%CI:1.00-1.02,P=0.06)in the per-protocol analysis.Conclusion The efficacy of HDDT in eradicating Hp infection for the first time is better than that of QT,and the safety is better,so it can be used as a first-line treatment in clinic.

关 键 词：幽门螺杆菌 高剂量二联疗法 四联 首次 

分 类 号：R573[医药卫生—消化系统]