酪酸梭菌辅助治疗幽门螺杆菌相关性胃炎及消化性溃疡的系统评价与Meta分析  

Systematic evaluation and Meta-analysis of the adjuvant treatment of Helicobacter pylori associated gastritis and peptic ulcer with Clostridium butyricum

作　　者：吕游 丁岩冰[2] LYU You;DING Yanbing(Department of Gastroenterology,Yangzhou Dongfang Hospital,Yangzhou 225000;Department of Gastroenterology,Affiliated Hospital of Yangzhou University,China)

机构地区：[1]扬州东方医院消化内科,江苏扬州225000 [2]扬州大学附属医院消化内科

出　　处：《胃肠病学和肝病学杂志》2025年第3期339-349,共11页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金项目(82273084);扬州市“十三五”科教强卫专项(YXZX20184)。

摘　　要：目的系统评价酪酸梭菌辅助三联疗法(triple therapy,TR)/铋剂四联(bismuth quadruple therapy,BQT)治疗幽门螺杆菌(Helicobacter pylori,H.pylori)感染的有效性及安全性。方法计算机检索知网、万方、维普、CBM、PubMed、EmBase和Cochrane Library数据库,搜集酪酸梭菌联合TR/BQT治疗H.pylori感染的随机对照试验(randomized controlled trial,RCT),检索时间均从建库至2023年9月30日,根据纳入及排除标准选择2名研究人员进行文献筛选和资料提取,同时对纳入研究进行偏倚风险评价,采用RevMan 5.3软件进行Meta分析。结果共纳入29个RCT、3375例患者,Meta分析结果显示:与TR/BQT方案相比,酪酸梭菌联合TR/BQT在H.pylori根除率(RR=1.17,95%CI:1.13~1.22,P<0.0001)、临床总有效率(RR=1.21,95%CI:1.05~1.21,P<0.00001)、消化道症状缓解率(RR=1.13,95%CI:1.05~1.21,P=0.0005)方面均优于TR/BQT方案组,差异均有统计学意义;酪酸梭菌组不良反应发生率显著低于对照组,且差异有统计学意义(RR=0.46,95%CI:0.39~0.54,P<0.0001)。结论与TR/BQT方案相比,在H.pylori根除率和临床总有效率方面酪酸梭菌联合TR/BQT效果更加显著,同时还可以缓解消化道症状,对于不良反应的发生率也有显著降低。Objective To systematically evaluate the effectiveness and safety of Clostridium butyricum assisted triple therapy(TR)/bismuth quadruple therapy(BQT)in the treatment of Helicobacter pylori(H.pylori)infection.Methods Computer search was conducted on CNKI,Wanfang,VIP,CBM,PubMed,EmBase and Cochrane Library databases to collect randomized controlled trials(RCTs)of Clostridium butyricum combined with TR/BQT in the treatment of H.pylori infection.The search time was from the establishment of the database to Sep.30,2023.Two researchers were selected based on inclusion and exclusion criteria for literature screening and data extraction,and bias risk assessment was conducted on the included studies,Meta-analysis was conducted using RevMan 5.3 software.Results A total of 29 RCTs and 3375 patients were included.The Meta-analysis results showed that compared with TR/BQT regimen,the combination of Clostridium butyricum and TR/BQT was superior to the TR/BQT regimen in terms of H.pylori eradication rate(RR=1.17,95%CI:1.13-1.22,P<0.0001),clinical total effective rate(RR=1.21,95%CI:1.05-1.21,P<0.0001)and gastrointestinal symptom relief rate(RR=1.13,95%CI:1.05-1.21,P=0.0005)with statistically significant differences.The incidence of adverse reactions in the Clostridium butyricum group was significantly lower than the control group,and the difference was statistically significant(RR=0.46,95%CI:0.39-0.54,P<0.0001).Conclusion Compared with traditional triple or bismuth quadruple regimens,the combination of Clostridium butyricum and TR/BQT has a more significant effect on H.pylori eradication rate and total clinical response rate.It can also alleviate gastrointestinal symptoms and significantly reduce the incidence of adverse reactions.

关 键 词：酪酸梭菌 幽门螺杆菌 传统三联 铋剂四联 慢性胃炎 消化性溃疡 META分析 

分 类 号：R573[医药卫生—消化系统]