益生菌联合三联疗法根治儿童幽门螺杆菌感染的系统评价

Meta-analysis:combination of probiotics with triple therapy for Helicobacter pylori eradication in children

目的对益生菌制剂联合三联疗法清除儿童幽门螺杆菌(H.pylori)感染的临床疗效及其对治疗中抗生素相关的不良反应进行系统评价。方法通过检索PubMed、EMBASE、Cochrane Central Register of ControlledTrials等数据库,1982年1月至2010年4月,全面收集应用益生菌制剂联合三联疗法治疗小儿H.pylori感染的随机对照试验,并对其进行meta分析。结果纳入5个试验包括364例儿童,益生菌制剂联合三联疗法组184例患儿H.pylori根治率为72.28%,单用三联疗法组180例患儿H.pylori根治率为61.67%,合并OR值为0.58(95%CI:0.36～0.93,P=0.02);不良反应发生率分别为益生菌组23.77%,对照组28.10%,合并OR值为1.39(95%CI:0.41～4.71,P=0.60)。结论目前证据显示联合应用益生菌制剂可提高抗H.pylori感染治疗中的根治率,但并不能有效降低三联疗法治疗中不良反应的发生。

Objective To evaluate the effect of the probiotics and standard triple therapy on the eradication rate and side-effects of anti-H.pylori treatment in children.Methods All randomized trials comparing probiotics supplementation to placebo or no treatment during anti-H.pylori regimens in children were reviewed by searching the electronic databases of PubMed、 EMBASE、 Cochrane Central Register of Controlled Trials,the bibliographies of reviews,and reference lists of identified articles till April 2010.The statistical analysis was performed with Review Manager 5.0.2.Results Five eligible randomized controlled trials with 364 cases were enrolled in the analysis.One hundred and eight-four of them were in the treat group（the probiotics and standard triple therapy） and 180 were in the control group（standard triple therapy）.Based on the intention-to-treat analysis,the eradication rates were 72.28% in the treat group and 61.67% in the control group,the pooled odds ratio for eradication in the treat group versus control group was 0.58（95% CI：0.36-0.93,P=0.02） using the fixed effects model;the occurrence of total side-effects was 23.77% and 28.10% for groups with or without probiotics,the summary OR was 1.39（95% CI：0.41-4.71,P=0.60）,respectively.Conclusions The probiotics supplementation was effective in increasing the eradication rate during standard triple therapy for Helicobacter pylori infection in children.However,no significant impact was shown on reducing the occurrence of anti-H.pylori therapy related side-effects.