布拉氏酵母菌联合标准三联疗法根治幽门螺杆菌感染的meta分析

Meta analysis of Saccharomyces boulardii supplementation for Helicobacter pylori eradication in standard triple therapy

目的系统评价布拉氏酵母菌联合标准三联疗法根治幽门螺杆菌感染的疗效与安全性。方法通过检索PubMed、EMBASE、Cochrane Central Register of Controlled Trials、MEDLINE等数据库1982年1月至2011年12月相关文献,全面收集应用布拉氏酵母菌联合标准三联疗法治疗Hp感染的随机对照试验,并用RevMan 5.0.2软件进行meta分析。结果纳入5个试验包括1 307例患者。其中4项试验的数据显示,与对照组相比,布拉氏酵母菌联合标准三联疗法能显著提高Hp根除率(n=915,OR=1.66,95%CI:1.22～1.26,P=0.001);有效降低三联疗法相关性不良反应(n=1 305,OR=0.32,95%CI:0.17～0.63,P=0.008),特别是腹泻的发生率(4项试验,n=1 215,OR=0.42,95%CI:0.27～0.64,P<0.000 1);但2组间的其他不良反应发生率无显著性差异。结论布拉氏酵母菌联合标准三联疗法可显著性提高Hp感染的根治率,降低三联疗法总体相关性不良反应,特别是腹泻发生率。

Objective To evaluate the effectiveness and security of Saccharomyces boulardii（S.boulardii） supplementation for Helicobacter pylori（H.pyloir,Hp） eradication in standard triple therapy.Methods The PubMed,EMBASE,Cochrane Central Register of Controlled Trials and MEDLINE databases were searched in Nov 2011,with no language restrictions,for randomized controlled trials（RCTs）.Additional references were obtained from reviewed articles.The data were analyzed by the Cochrane Collaboration RevMan 5.0.2 software.Results Five RCTs involving a total of 1 307 participants met the inclusion criteria.Compared with placebo or no intervention,S.boulardii given along with standard triple therapy significantly increased the eradication rate（4 RCTs,n=915,OR=1.66,95%CI：1.22-1.26,P=0.001） and reduced the risk of overall Hp therapy-related adverse effects（5 RCTs,n=1 305,OR=0.32,95%CI：0.17-0.63,P=0.008）,particularly diarrhoea（4 RCTs,OR=0.42,95%CI：0.27-0.64,P〈0.000 1）.There were no significant differences between groups in the risk of other adverse effects.Conclusion In patients with Hp infection,there is evidence to recommend the use of S.boulardii along with standard triple therapy as an option to increase the eradication rate and decrease overall therapy-related side effects,particularly diarrhoea.