益生菌增效治疗儿童幽门螺杆菌感染有效性及安全性的系统评价

Efficacy and safety of probiotics as adjunctive therapy for Helicobacter pylori infection in children:a systematic review

目的：评价益生菌作为增效剂治疗儿童幽门螺杆菌（Helicobacter pylori,H.pylori）感染的临床疗效及其治疗中抗生素相关不良反应发生的改善情况。方法：系统检索Pub Med、Embase、Cochrane Controlled Trials Register（CCTR）、Web of Science、中国知网（CNKI）、中文科技期刊数（VIP）、万方数据库,检索从建库至2013年10月,查找关于益生菌增效抗H.pylori根治疗法治疗儿童H.pylori感染的临床随机对照试验（randomized controlled trials,RCTs）,对纳入的RCTs进行质量评价,采用Rev Man 5.2进行Meta分析。结果：本研究共纳入11项RCTs,共769例儿童患者,益生菌增效抗H.pylori根治疗法治疗儿童H.pylori感染的根治率（RR=1.20,95%CI=1.10~1.30,P=0.000）和总不良反应发生率（RR=0.44,95%CI=0.26~0.73,P=0.001）,与单用抗H.pylori根治疗法有统计学差异,根治率与总不良反应的改善情况均优于单用抗H.pylori根治疗法。益生菌增效治疗组的腹泻发生率明显低于单用H.pylori根治疗法组（RR=0.27,95%CI=0.14~0.52,P=0.000）,恶心、呕吐的发生率也低于单用H.pylori根治疗法组（RR=0.47,95%CI=0.24~0.93,P=0.030）。结论：益生菌增效H.pylori根治疗法治疗儿童H.pylori感染能提高H.pylori的根治率,同时也能改善抗生素相关的不良反应。

Objective：To evaluate the effect of the probiotics as adjunctive therapy on the eradication rate and side effects of anti-Helicobacter pylori（H.pylori）eradication treatment in children. Methods：All randomized controlled trials（RCTs）comparing probiotics supplementation with placebo or no extra intervention during anti-H.pylori regimens in children were systematically searched from the databases of Pub Med,Embase,Cochrane Controlled Trials Register（CCTR）,Web of Science,CNKI,VIP and Wangfang（from their inception to October 2013）. The qualities of included RCTs were evaluated and the Meta analysis was conducted by means of Rev Man5.2. Results：Eleven randomized controlled trials with 769 cases were enrolled in the analysis. The eradication rates（RR=1.20,95%CI=1.10 to 1.30,P=0.000）and the total occurrence of side effects（RR=0.44,95%CI=0.26 to 0.73,P=0.001）were significantly better in the treatment group（using probiotics combinded with anti-H.pylori eradication therapy） than in control group（using anti-H.pylori eradication therapy alone）. Moreover,the incidences of diarrhea,nausea and vomiting were significantly lower in treatment group than in control group（RR=0.27,95%CI=0.14 to 0.52,P=0.000;RR=0.47,95%CI=0.24 to 0.93,P=0.030）. Conclusion：The probiotics supplementation is effective not only in increasing the eradication rate of anti-H.pylori eradication treatment in children but also in alleviating anti-H.pylori therapy related side effects.