左氧氟沙星为基础的三联疗法根除幽门螺杆菌的meta分析

Levofloxacin based triple therapy for eradication of Helicobacter pylori:a meta-analysis

目的系统评价左氧氟沙星为基础的三联疗法（与标准三联疗法相比较）根除幽门螺杆菌（H.pylori）的有效性及安全性。方法在Medline、Embase、Pubmed、Cochrane library、Sinomed检索平台和万方数据库、中国期刊全文数据库中检索2014年之前发表的关于左氧氟沙星为基础的三联疗法根除幽门螺杆菌的随机对照临床研究。应用改良版Jadad评分量表对纳入的研究进行质量评价。利用Sata 12.0软件进行数据分析,根据异质性检验的结果选择效应量合并模型进行meta分析。采用Harbord方法及剪-补法进行发表偏倚的检验。结果按入选标准,共纳入40个随机对照临床研究,共7 388例H.pylori感染者纳入该meta分析。分析表明以左氧氟沙星为基础的三联疗法与标准三联疗法相比,其H.pylori根除率高,相对危险度（RR值）为1.10（95%CI为1.07~1.13）;消化性溃疡治愈率高,RR值为1.06（95%CI为1.02~1.09）;不良反应低,RR值为0.81（95%CI为0.69~0.94）。结论左氧氟沙星为基础的三联疗法能有效根除H.pylori及治疗消化性溃疡,且不良反应低,是一线根除方案的又一选择。

Objective To systematically evaluate the efficacy and safety of eradicating Helicobacter pylori（H.pylori） by levofloxacin based triple therapy compared to standard triple therapy.Methods Correlated randomized controlled clinical trials（RCTs） evaluating the efficacy and safety of eradicating H.pylori by levofloxacin based triple therapy from papers published before 2014 were retrieved from Medline,Embase,Pubmed,Cochrane library,Sinomed retrieval platform,Wanfang Database,and CNKI.The quality of trials was assessed by the improved Jadad standard.Stata 12.0 software was used to analyze data.The combination model of effect size was selected according to the results of heterogeneity tests and the meta analysis was conducted.The Harbord and Trim and Filled method were utilized to evaluate the publication bias.Results Forty RCTs with 7 388 cases infected by H.pylori were selected for meta analysis according to the enrollment criteria.The results of analysis showed that compared to standard triple therapy,the eradication rate of H.pylori of levofloxacin based triple therapy was higher and the relative risk（RR） was 1.10（95%CI =1.07-1.13）;the healing rate of peptic ulcer was higher and RR was 1.06（95%CI = 1.02-1.09）;and the side effect rate was lower and RR was 0.81（95%CI = 0.69-0.94）.Conclusion Levofloxacin based triple therapy is effective for eradicating H.pylori and treating digestive ulcers with low side effect rate.It is an alternative choice of first-line treatments for eradicating H.pylori.