铝碳酸镁治疗幽门螺杆菌相关性胃溃疡及ESD术后人造溃疡有效性的Meta分析

Hydrotalcite in the treatment of Helicobacter pylori associated gastric ulcers and artificial ulcers after ESD: a Meta-analysis

目的系统评价铝碳酸镁联合幽门螺杆菌(H. pylori)根除治疗H. pylori相关性胃溃疡及铝碳酸镁联合质子泵抑制剂(PPI)治疗内镜黏膜下剥离术(ESD)后人造溃疡的有效性。方法计算机检索CBM、CNKI、Wanfang Data、VIP、Pub Med、Embase、Web of Science、Scopus及The Cochrane Library数据库,纳入联用铝碳酸镁治疗H. pylori相关性胃溃疡及联用铝碳酸镁治疗ESD术后人造溃疡的随机对照试验(RCTs),筛选文献、提取数据并评价偏倚风险后,采用Rev Man 5. 3统计软件进行Meta分析。结果①H. pylori相关性胃溃疡:与单独应用H. pylori根除相比,铝碳酸镁联合H. pylori根除治疗能降低溃疡的1年后复发率(ITT分析:RR=0. 48,95%CI:0. 36～0. 65,P <0. 001)。②ESD术后人造溃疡:与单独应用PPI相比,铝碳酸镁联合PPI治疗能提高术后4周的溃疡愈合率(ITT分析,WMD=12. 92,95%CI:10. 15～15. 69,P <0. 001)。结论目前证据表明,在H. pylori根除治疗的基础上联用铝碳酸镁有助于降低H. pylori相关性胃溃疡的1年后复发率;在PPI基础上联用铝碳酸镁有助于加快ESD术后人造溃疡的愈合。

Objective To systematically evaluate the efficacy of Hydrotalcite in the treatment of Helicobacter pylori ( H.pylori ) associated gastric ulcers and artificial ulcers after ESD. Methods CBM, CNKI, Wanfang Data, VIP, PubMed, Embase, Web of Science, Scopus and The Cochrane Library were retrieved to identify randomized clinical trials about Hydrotalcite plus H.pylori eradication or Hydrotalcite plus PPI for the treatment of H.pylori associated gastric ulcers or artificial ulcers after ESD. Risk of bias of included studies were evaluated according to Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Meta-analysis was performed with RevMan 5.3 software . Results ① H.pylori associated gastric ulcers: compared with H.pylori eradication alone, concomitant use of Hydrotalcite decreased one-year recurrence rate (ITT analysis: RR=0.48, 95% CI: 0.36-0.65, P <0.001).② Artificial ulcers after ESD: compared with PPI alone, concomitant use of Hydrotalcite increased ulcer healing rate 4 weeks after ESD (ITT analysis: WMD=12.92, 95% CI: 10.15-15.69, P <0.001). Conclusion Concomitant use of Hydrotalcite is superior to H.pylori eradication alone in decreasing one-year recurrence rate of H.pylori associated gastric ulcers;concomitant use of Hydrotalcite with PPI is superior to PPI alone in promoting healing of artificial ulcers after ESD.