“含黄连素四联方案”治疗幽门螺杆菌感染及其相关消化性溃疡的Meta分析

Berberine-based quadruple therapy for patients with Helicobacter pylori associated peptic ulcer: A meta-analysis

目的比较"含黄连素四联方案"与"传统三联方案"(2种抗生素+质子泵抑制剂)治疗幽门螺杆菌(Helicobacter pylori, H. pylori)相关性消化性溃疡的效度和安全性.方法分别在Medline(1988-05/2018-05)、EMBASE(1988-05/2018-05)、Web of Science(1988-05/2018-05)、中国生物医学文献数据(1988-05/2018-05)、中国知网(1988-05/2018-05)、万方网络数据检索文献(1988-05/2018-05)等数据库检索文献.同时通过参考文献查找相关文献补充检索.通过绘制漏斗图评估有无发表偏倚,依据同质性检验评估纳入文献同质性情况,若异质性较低(P>0.1且I2<50%)采用固定效应模型分析,反之则采用随机效应模型进行合并分析.结果本研究共纳入7项随机对照试验,包含患者948例.合并分析显示,试验组根除成功率(86.78%vs 70.04%)、溃疡愈合率(50.73%vs 40.30%)和溃疡治疗总有效率(94.57%vs 81.66%)均显著优于对照组,差异有统计学意义.试验组不良反应发生率显著低于对照组(26.54%vs40.44%).结论相较于"传统三联方案","含黄连素四联方案"根除H. pylori治疗可能获得更优的根除率,可能更加促进消化道溃疡的愈合,并可能降低药物不良反应发生率,但上述结果还有待更大样本、更加严格的随机对照试验进一步验证.

AIM To compare the efficacy and safety of berberine-based quadruple therapy and classical triple therapy(a proton pump inhibitor with two antibiotics)in patients with Helicobacter pylori(H.pylori)associated peptic ulcer.METHODS Electronic databases including Medline,Embase,Web of Science,Cochrane Central Register of Controlled Trial,Wanfang Database,and VIP Database were searched with the search terms of“berberine AND H.pylori AND eradication”.A funnel plot was adopted to evaluate publication bias.The meta-analysis was performed using a fixed effects model in case of low heterogeneity and a randomized effects model in case of high heterogeneity.RESULTS A total of seven randomized controlled trials(RCTs)with 948 subjects were included.The eradication rate(86.78%vs 70.04%),healing rate of ulcer(50.73%vs 40.30%),and total effective rate(94.57%vs 81.66%)in the berberine group were significantly higher than those in the control group.In addition,the total incidence of side effects in the berberine group was significantly lower than that of the control group(26.54%vs 40.44%).CONCLUSION Compared with proton pump inhibitor-based triple therapy,berberine-based quadruple therapy might improve eradication rate and promote the healing of gastric ulcer in patients with H.pylori associated peptic ulcer.In addition,berberine-based quadruple therapy might reduce the side effects throughout the therapy.More RCTs with high quality are expected to confirm our finding.