乳杆菌治疗幽门螺杆菌感染疗效的Meta分析

The effect of Lactobacilliin eradication of Helicobacter pylori:A Meta analysis

目的系统评价乳杆菌治疗幽门螺杆菌(H.pylori)感染的有效性。方法计算机检索PubMed、Cochrane Central Register of Controlled Trials、Clinicatrials.gov、中国临床试验注册中心(http://www.chictr.org.cn/)、中国知网(CNKI)、万方数据库。检索时间从建库至2016年6月30日。此外追索已纳入文献和综述的参考文献。经两位研究者独立筛选文献、提取资料和评价质量,交叉核对后,采用Stata 12.0进行Meta分析。结果最终纳入17个RCT,共1 758例患者。Meta分析结果:乳杆菌联合常规三联疗法能提高H.pylori根除率[OR=2.762,95%CI(2.163,3.526),P<0.001],降低不良反应发生率[OR=0.334,95%CI(0.242,0.461),P<0.001],但乳杆菌单独应用对H.pylori根除率结果与对照组比较差异无统计学意义。根据乳杆菌给药疗程的亚组分析结果,0~14(含14)d乳杆菌联合给药方案显著提高了H.pylori根除率[OR=2.893,95%CI(2.187,3.827),P<0.05],14~28(含28)d给药疗程也显著提高了H.pylori根除率[OR=2.619,95%CI(1.652,4.153),P<0.05]。乳杆菌联合三联疗法在欧洲人群及亚洲人群的亚组分析中,均提高了H.pylori根除率。结论乳杆菌联合三联疗法有利于提高H.pylori根除率,并能降低总不良反应的发生,在H.pylori感染相关疾病的治疗中具有一定意义。

Objective To evaluate the efficacy of Lactobacilli in eradication of Helicobacter pylori. Methods Eli- gible articles and randomized clinical trials （RCTs） published prior to June 30, 2016 and the related refer- ences were retrieved from PubMed, Cochrane Central Register of Controlled Trials, Clinicatrials. gov, Chi- nese Clinical Trial Registry （http： //www. chictr, org. cn/）, and China National Knowledge Infrastructure （CNKI） . Statistical analysis was performed with Stata version 12.0 software. Results Seventeen RCTs involving 1,758 patients were included in the analysis. Lactobacilli combined with conventional triple thera- py significantly increased the eradication rate compared with the control group EOR = 2. 762, 95% CI （2. 163, 3. 526）, P〈0.001] and decreased the rate of adverse events [OR：0.334, 95%CI （0.242, 0. 461）, P〈0. 001], while Lactobacilli alone did not change the eradication rate obviously. In the subgroup analysis, both the short （0 - 14 days） and long （14 - 28 days） course of treatment of Lactobacillus combined thera- py increased the eradication rate of Helicobacterpylori. Also, Lactobacilli combined with conventional triple thera- py significantly increased the eradication rate not only in Europeans, but also in Asians. Conclusion Lactobacilli combined with conventional triple therapy can increase the eradication rate of Helicobacter pylori while de- crease the adverse effect, which has clinical significance in the treatment of Helicobacter pylori infection dis- eases.