益生菌联合标准三联疗法根除幽门螺杆菌的荟萃分析

Effect of Probiotics Supplementation on Standard Triple Therapy for Helicobacter pylori Eradication:A Systematic Review

背景:标准三联疗法根除幽门螺杆菌(H.pylori)的根除率常低于80%,且胃肠道不良反应较明显。目的:系统性评价益生菌联合标准三联疗法能否提高H.pylori根除率,减少根除过程中的不良反应。方法:从常用电子数据库检索标准三联疗法联合与未联合益生菌根除H.pylori的随机临床试验,荟萃分析各项研究的根除率和不良反应发生率的合并OR值;行亚组分析和敏感性分析;以漏斗图检测发表偏倚。结果:共11项随机临床试验(1335例)符合纳入标准。三联疗法联合与未联合益生菌按意向治疗(ITT)分析的H.pylori根除率分别为81.8%(95%CI:80.9%～87.5%)和72.4%(95%CI:71.1%～79.3%),合并OR值为1.82(95%CI:1.31～2.51);总不良反应发生率分别为24.6%(95%CI:20.4%～29.2%)和38.7%(95%CI:32.4%～43.8%),合并OR值为0.44(95%CI:0.30～0.66)。结论:联合益生菌可有效提高标准三联疗法的H.pylori根除率,降低根除过程中的不良反应发生率。

It has become clear that the success rate of standard triple therapy for Helicobacter pylori （H. pylori） eradication are now frequently below 80%, furthermore, gastrointestinal side-effects are among the major pitfalls in such regimens. Aims： To systematically evaluate the effect of supplement with probiotics to standard triple therapy on the eradication rate and side-effects of anti-H, pylori treatment. Methods： Standardized searches of frequently used electronic databases for publications relevant to the topic areas were performed. According to the inclusion criteria, all randomized clinical trials comparing probiotics supplementation to placebo or without such treatment during anti-H, pylori regimens were included. The outcome measure examined was the summary odds ratio （OR） of improving H. pylori eradication rate and reducing side-effects. Sub-analysis and sensitivity analysis were also performed. The publication bias was tested by funnel plot. Results： Eleven randomized clinical trials including 1335 cases were identified. Pooled H. pylori eradication rate was 81.8% （95% CI： 80.9%-87.5%） and 72.4% （95% CI：71.1%-79.3%） for patients with or without probiotics, respectively, at intention-to-treat （ITT） analysis, the summary OR was 1.82 （95% CI： 1.31-2.51）; the occurrence of total side-effects was 24.6% （95% CI： 20.4%-29.2%） and 38.7% （95% CI： 32.4%-43.8%） for groups with or without probiotics, respectively, the summary OR was 0.44 （95% CI： 0.30-0.66）. Conclusions： Probiotics supplementation is effective in increasing the eradication rate during standard triple therapy for H. pylori eradication. Furthermore, probiotics show a positive impact on H. pylori therapy-related side-effects.