益生菌联合三联疗法根除幽门螺杆菌的Meta分析

Effection of probiotics combined with triple therapy for eradication of Helicobacter pylori

目的：系统评价益生菌联合三联疗法在根除幽门螺杆菌（Hp）及降低胃肠道不良反应中的疗效。方法从常用电子数据库中检索益生菌联合三联疗法与单独三联疗法根除Hp的随机临床试验，分析各项研究的根除率与不良反应发生率的合并RR值，行敏感性分析，用漏斗图检查发表偏移。结果共12项随机临床试验（2480例）符合纳入标准，益生菌联合三联疗法与单独三联疗法按意向治疗分析（ITT）Hp根除率分别为：79.8%（95%CI：0.65～0.91）和67.3%（95%CI：0.50～0.81），合并RR值为1.14（95%CI：1.09～1.19），P＜0.05。两种疗法的不良反应发生率分别为：13.2%（95%CI：0.03～0.41）和25.5%（95%CI：0.04～0.58），合并RR值为0.50（95%CI：0.31～0.81），P＜0.05。结论益生菌可以提高三联疗法对Hp的根除率，同时降低胃肠道不良反应的发生率。

Obejective To systematically evaluate the effect of supplement of probiotics to standard triple therapy on the eradication rate and side-effects of anti-Helicobacter Pylori （Hp） treatment. Methods Publications of ramdamized clinical trails on the triple therapy or probiotics combined with triple therapy to eradicate Hp were searched using electronic databases. The relative risk （RR） of HP eradication rate and rate of side effects were analysed. Sensitivity analysis was also performed. The publication bias were tested by funnel plot. Results Total of 12 randomized clinical trials including 2 480 cases were identified. According to intention-to-treat （ITT） analysis, for patients with or without probiofics, Hp eradication rate was 79.8% （95%CI： 0.65-0.91） and 67.3% （95%CI： 0.50-0.81）, respectively; RR was 1.14 （95%CI： 1.09- 1.19）, P 〈 0.05. For groups with or without probiotics, the occurrence of total side effects were 13.2% （95%CI： 0.03-0.41） and 25.5 （95%CI： 0.04-0.58）, respectively; the summary RR was 0.50 （95%CI： 0.31- 0.81）, P 〈 0.05. Conclusions Probiotics supplementation is effective in increasing the eradication rate during standard triple therapy for Hp eradication. Furthermore, probiotics show a positive impact on Hp therapy-related side effects.