清热利湿法联合四联疗法治疗幽门螺旋杆菌感染慢性胃炎的Meta分析  

A Meta-analysis of treating helicobacter pylori infection chronic gastritis by the heat clearing and dampness removing method plus quadruple therapy

作　　者：喜小梅 李德奎[1] 张毅[1] 吕雅莉 吴建军[1] 魏兴民[1] XI Xiaomei

机构地区：[1]甘肃中医药大学,甘肃兰州730000

出　　处：《中医临床研究》2024年第19期102-108,共7页Clinical Journal Of Chinese Medicine

基　　金：甘肃省高校科技创新科研项目(2022B-122)。

摘　　要：目的:基于Meta分析研究清热利湿法联合四联疗法治疗幽门螺旋杆菌相关性慢性胃炎的有效性,为临床治疗和用药提供理论依据。方法:在中国知网、万方、维普、中华医学期刊、中国生物医学文献服务系统、PubMed、Web of Science等数据库检索与主题相关的随机对照研究,检索时限均为建库至2022年11月,采取主题词与自由词结合的方式。由两名评审员根据纳入和排除标准阅读和筛选文献,并在交叉核对后提取资料。参照Cochrane协作网偏倚风险评估工具对纳入的文献进行评估,用RevMan5.4和R4.2.2软件对数据进行Meta分析。结果:共纳入13篇文献,1 252例患者,Meta分析结果显示,试验组幽门螺旋杆菌清除率[相对危险度(RR=1.19,95%置信区间(CI):1.13~1.26,P<0.000 1]、临床疗效(RR=1.21,95%CI:1.15~1.28,P <0.000 1)和黏膜病变分级疗效(RR=1.47,95%CI:1.19~1.80,P <0.000 3)等明显优于对照组,中医证候积分[均数差(MD=-3.64,95%CI:-5.25~-2.03,P <0.01]、肿瘤坏死因子-α(MD=-7.17 95%,CI:-8.96~-5.38,P <0.000 1)、白细胞介素-6(MD=-7.80,95%CI:-15.02~-0.58,P=0.034 2)、白细胞介素-8(MD=-8.49,95%CI:-8.77~-8.21,P <0.000 1)和幽门螺旋杆菌复发率(RR=0.24,95%CI:0.08~0.70,P=0.009)等指标均明显低于对照组。结论:清热利湿法联合四联疗法在有效性、安全性方面优于单用四联疗法,在改善幽门螺旋杆菌清除率、临床疗效、黏膜病变分级等方面效果显著,可明显改善患者胃脘疼痛、痞胀、口苦、大便黏滞、反酸、脘腹灼热、恶心、呕吐、纳呆等症状,降低肿瘤坏死因子-α、白细胞介素-6、白细胞介素-8水平及幽门螺旋杆菌复发率。Objective:To study the feasibility of the clearing heat and removing dampness method plus quadruple therapy in the treatment of chronic gastritis with Hp infection based on Meta-analysis.Methods:Randomized controlled studies related to the topic were searched in CNKI,Wanfang,VIP,Chinese Medical Journal,China Biomedical Literature Service System(SinoMed),PubMed,Web of Science and other databases,and the search period was rom bception to November 2022.Two reviewers read and screened the literature according to the inclusion criteria and extracted the data after cross-checking.Meta-analysis was performed by RevMan 5.4 and R4.2.2 software.Results:A total of 13 articles with 1252 patients were included,and the results of Meta-analysis showed that the effective rate in the experimental group was significantly better than that of quadruple therapy alone in terms of Hp clearance(RR=1.19,95%CI:1.13~1.26,P<0.0001),clinical efficacy(RR=1.21,95%CI:1.15~1.28,P<0.0001),mucosal lesions grades(RR=1.47,95%CI:1.19~1.80,P<0.0003),TCM syndrome score(MD=-3.64,95%CI:-5.25~-2.03,P<0.01),TNF-α(MD=-7.17,95%CI:-8.96~-5.38,P<0.0001),IL-6(MD=-7.80,95%CI:-15.02~-0.58,P=0.0342),IL-8(MD=-8.49,95%CI:-8.77~-8.21,P<0.0001),and recurrence rate of Hp(RR=0.24,95%CI:0.08~0.70,P=0.009).Conclusion:The clinical efficacy of the combination therapy is superior to that of quadruple therapy alone,which can significantly clear Hp and improve the symptoms such as epigastric pain,epigastric fullness,bitter taste,acid reflux,poor stool viscosity,heartburn,nausea and vomiting,poor appetite.

关 键 词：幽门螺杆菌感染慢性胃炎 四联疗法 清热利湿法 META分析 疗效 

分 类 号：R573.3[医药卫生—消化系统]