累积Meta分析在三联疗法根除幽门螺杆菌效果评价中的应用

CUMULATIVE META-ANALYSIS ON THE EFFECT OF TRIPLE THERAPY IN THE TREATMENT OF HELICOBACTER PYLORI INFECTION

目的采用累积Meta分析,对以雷贝拉唑(Rab)和奥美拉唑(Ome)为基础的三联疗法根除幽门螺杆菌(Hp)的效果进行系统评价。方法检索1993年1月—2013年1月公开发表的关于比较雷贝拉唑或奥美拉唑三联疗法治疗Hp阳性相关消化系统疾病的随机对照试验,根据标准筛选出31篇中英文文献,运用Revman5.0软件对文献试验数据进行Meta分析,绘制森林图,同时绘制漏斗图检查发表偏倚。并应用stata12.0软件进行累积Meta分析,并与传统Meta分析结果进行比较。结果雷贝拉唑组对Hp的根除率及溃疡愈合率显著优于奥美拉唑组,合并效应量OR值及其95%CI分别为1.64(1.27,2.11)和2.16(1.51,3.09),P<0.001。雷贝拉唑组与奥美拉唑组不良反应发生率差异无统计学意义,合并效应量OR值及其95%CI为0.81(0.61,1.08)(P>0.05)。累积Meta分析显示,按年代先后顺序累积后,三种结局指标OR值及95%可信区间趋于稳定且有较好的变化趋势。可确定根除率和愈合率疗效最初被证实具有统计学意义的时间。结论与奥美拉唑相比,雷贝拉唑三联疗法具有Hp根除率、溃疡愈合率高优点,用其根除Hp感染是有效的和安全的。按年代先后顺序累积后,根除率、愈合率、不良反应发生率的OR值趋于稳定,OR95%CI范围变窄,根除率、愈合率疗效最初被证实具有统计学意义的时间为2008年。

Objective To evaluate the efficacy and safety of Rabeprazole-based triple therapy for Helicobacter pylori with Omeprazole-based triple therapy by performing a Meta-analysis.Methods A database search was performed.Randomized controlled trials of the comparison between Rabeprazole and Omeprazol based triple therapy in the treatment of Hp positive related disease published on periodicals from January 1993 to January 2013 were retrieved.And 31 documents were selected according to the inclusion and exclusion criterion.RevMan5.0software was used for the Meta-analysis of the document data.The forest plot was drawn,meanwhile the funnel plot was drawn to check the literature publication bias.Stata 12.0software was used for the cumulative Meta-analysis.Results Rabeprazole based triple therapy achieved higher eradication rate and healing rate than Omeprazole.（eradication rate：OR=1.64,95%CI（1.27,2.11）,healing rate：OR=2.16,95%CI（1.51,3.09））.There was no significant difference in adverse effect rate between Rabeprazole group and Omeprazole group（OR=0.81,95%CI（0.61,1.08）,P 〉0.05）.The time when the significant effectiveness of eradicating and healing treatment appear first could be confirmed.The confidence intervals of treatment effectiveness of total population turn narrowed by accumulation in chronological order.Conclusions Compared with Omeprazole based triple therapy,Rabeprazole based triple therapy has advantages such as higher eradication rate,higher healing rate.It is as safe as Omeprazole.So it is the better choice for the treatment of Hp-positive related gastrointestinal diseases.The time that eradication rate and healing rate effect is initially confirmed to have statistically significance by the year 2008.