益生菌四联对比铋剂四联疗法补救根除幽门螺杆菌感染的Meta分析

Probiotics-containing Quadruple Therapy Versus Bismuth Quadruple Therapy as a Rescue Regimen for the Eradication of Helicobacter Pylori Infection: A Meta-analysis

目的系统评价益生菌四联疗法(PQT)对比铋剂四联疗法(BQT)补救根除幽门螺杆菌(Helicobacter pylori,Hp)感染的疗效和安全性。方法检索关于PQT对比BQT补救根除Hp感染的临床试验,检索时限均为建库至2016年10月。由2名评价员,根据纳入与排除标准筛选文献、提取资料,依据改良Jadad量表评价纳入研究的方法学质量,采用Rev Man5.3软件进行meta分析。结果最终纳入9个临床试验,共875例患者,结果显示:补救治疗中PQT的Hp根除率高于BQT,但差异无统计学意义(RR=1.03,95%CI:0.97~1.10,P=0.36);按PP分析,PQT与BQT的Hp根除率相当,但差异无统计学意义(RR=1.00,95%CI:0.94~1.07,P=0.90)。PQT的不良反应发生率明显低于BQT,且差异有统计学意义(RR=0.31,95%CI:0.23~0.41,P<0.000 01)。结论与BQT相比,补救治疗中PQT的不良反应发生率更低,但Hp的根除率无差异,该结论有待大样本高质量的研究验证。

OBJECTIVE To systematically review the efficacy and safety ofprobiotics containing quadruple therapy（PQT） as a rescue regimen for the eradication of Helicobacter pylori （lip） infection. METHODS To search clinical trials about PQT versus bismuth quadruple therapy（BQT） as a rescue regimen for the eradication of Hp infection from inception to October 2016. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies by revised Jadad scale. The meta-analysis was performed by RevMan5.3 software. RESULTS A total of 9 clinical trials containing 875 patients were finally included. The results of meta-analysis showed that： according to ITT analysis, the Hp eradication rate of PQT as a rescue regimen was higher than that of BQT, but the difference was not statistically significant （RR=1.03, 95%CI： 0.97-1.10,P=0.36）; according to PP analysis, the Hp eradication rate of PQT versus BQT was considerable, but the difference was not statistically significant （RR=I.00, 95%CI： 0.94-1.07, P=0.90）. The incidence of adverse reactions of PQT was significantly lower than that of the control group, and the difference was statistically significant （RR=0.31, 95%CI： 0.23-0.41, P〈0.000 01）. CONCLUSION Compared with BQT, the incidence of adverse reactions of PQT is lower, but there is no significant difference in Hp eradication rate between the two therapies. More large-scale and high-quality studies are needed to confirm the above conclusions.