多西环素根除幽门螺杆菌感染有效性和安全性的meta分析  

Efficacy and Safety of Doxycycline in Eradicating Helicobacter pylori Infection:A Meta⁃analysis

作　　者：杨成海 伍乐乐 陈烨 YANG Chenghai;WU Lele;CHEN Ye(ntegrative Microecology Clinical Center,Shenzhen Hospital,Southern Medical University,Shenzhen,Guangdong Province,518101)

机构地区：[1]南方医科大学深圳医院整合微生态诊疗中心,518101

出　　处：《胃肠病学》2024年第2期95-103,共9页Chinese Journal of Gastroenterology

基　　金：国家自然科学基金(82270581);深圳市科技计划项目(JCYJ20220530154012028);深圳市宝安区医疗卫生科研项目(2023JD240)。

摘　　要：背景:多西环素可用于根除幽门螺杆菌(Hp)感染,但尚缺乏大样本研究证实其有效性和安全性。目的:探讨多西环素根除Hp感染的有效性和安全性。方法:检索中国知网、万方、维普和PubMed、Embase、Web of Science、Cochrane Library等数据库,收集比较多西环素和其他抗菌药物根除Hp感染的相关文献,检索时间均为建库至2023年10月。采用RevMan 5.3软件行meta分析。结果:最终纳入19篇文献、共3686例Hp感染患者。含多西环素方案的意向性治疗(ITT)根除率(82.51%对73.65%;OR=1.72,95%CI:1.42~2.07,P<0.00001)和按方案治疗(PP)根除率(88.96%对78.06%;OR=1.63,95%CI:1.28~2.06,P<0.0001)均显著高于非多西环素方案。含多西环素方案的不良反应发生率显著低于非多西环素方案(8.35%对15.01%;OR=0.55,95%CI:0.42~0.71,P<0.00001)。亚组分析显示含多西环素方案的Hp根除率与含阿莫西林方案(OR=1.09,95%CI:0.78~1.52,P=0.61)、含四环素方案(OR=0.87,95%CI:0.33~2.26,P=0.77)相比无明显差异,但显著高于含克拉霉素方案(OR=2.67,95%CI:1.84~3.88,P<0.00001)和含左氧氟沙星方案(OR=2.20,95%CI:1.50~3.22,P<0.0001)。结论:含多西环素方案的Hp根除率显著高于非多西环素方案,且不良反应发生率低,值得临床推广应用。Background:Doxycycline can be used in the eradication of Helicobacter pylori(Hp)infection,but there is a lack of large sample study to confirm its efficacy and safety.Aims:To explore the efficacy and safety of doxycycline in the eradication of Hp infection.Methods:Literatures on doxycycline and other antibiotics in the eradication of Hp infection were retrieved from CNKI,Wanfang data,VIP,PubMed,Embase,Web of Science,and Cochrane Library from the date of database establishment to October 2023.Meta⁃analysis was conducted by RevMan 5.3 software.Results:Nineteen literatures including 3686 patients with Hp infection were enrolled.Both intention⁃to⁃treat(ITT)eradication rate(82.51%vs.73.65%;OR=1.72,95%CI:1.42⁃2.07,P<0.00001)and per⁃protocol(PP)eradication rate(88.96%vs.78.06%;OR=1.63,95%CI:1.28⁃2.06,P<0.0001)of doxycycline⁃based regimen were significantly higher than those of non⁃doxycycline regimens.The adverse reaction rate of doxycycline⁃based regimen was significantly lower than that of non⁃doxycycline regimens(8.35%vs.15.01%;OR=0.55,95%CI:0.42⁃0.71,P<0.00001).Subgroup analysis showed that Hp eradication rate of doxycycline⁃based regimen was significantly higher than that of clarithromycin⁃based regimen(OR=2.67,95%CI:1.84⁃3.88,P<0.00001)and levofloxacin⁃based regimen(OR=2.20,95%CI:1.50⁃3.22,P<0.0001),however,no significant difference in Hp eradication rate was found between doxycycline⁃based regimen and amoxicillin⁃based regimen(OR=1.09,95%CI:0.78⁃1.52,P=0.61)and tetracycline⁃based regimen(OR=0.87,95%CI:0.33⁃2.26,P=0.77).Conclusions:The eradication rate of doxycycline⁃based regimen in the eradication of Hp is significantly higher than that of non⁃doxycycline regimens,and the adverse reaction rate is low,which is worthy of clinical application.

关 键 词：多西环素 幽门螺杆菌 治疗 安全性 META分析 

分 类 号：R573[医药卫生—消化系统]