胃复春联合HP根除术治疗幽门螺杆菌相关慢性萎缩性胃炎有效性和安全性的Meta分析

Meta-analysis on the Efficacy and Safety of Weifuchun Combined with HP Eradication in the Treatment of Helicobacter Pylori Associated Chronic Atrophic Gastritis

目的大量的研究证明幽门螺杆菌(Helicobacter pylori,HP)与慢性萎缩性胃炎(chronic atrophic gastritis,CAG)关系密切,临床上常将根除HP作为慢性萎缩性胃炎治疗的关键环节。但是随着近年来HP根除疗法耐药率的升高,中药的杀菌、抑菌作用被重点突出。近年来,有关于中药与西药联合运用以提高HP根除率的文献报道不断增加。为此,本文系统地评价胃复春联合HP根除术对于HP相关慢性萎缩性胃炎的治疗有效性、安全性。方法检索万方数据库、CNKI、维普、Cochrane Library、PubMed及Embase等数据库中有关胃复春联合HP根除疗法治疗CAG的随机对照试验,日期为2001年1月至2020年8月。对于纳入的文献进行资料提取以及质量评价,共纳入的9篇文献采用改进Jadad量表做系统质量评价。采用RevMan5.3软件对纳入文献的HP根除率、不良反应发生率、总体疗效率行Meta系统评价。结果①共纳入9篇随机对照试验,有3项高质量文献,剩余均为低质量文献。②Meta结果,联合组在HP根除率上[MD=3.41,95%CI(2.23,5.19),Z=5.70,P<0.00001];不良反应发生率上[MD=0.37,95%CI(0.18,0.79),Z=2.57,P=0.01];总体疗效率[MD=3.88,95%CI(2.68,5.62),Z=7.16,P<0.00001]方面都是优于不联合组。结论胃复春联合HP根除术组在HP根除率、不良反应发生率以及总体疗效率方面均有显著性意义。说明对于CAG的治疗,在HP根除治疗的基础上联合胃复春可以进一步提高HP根除率、总体疗效率,并减少不良反应发生率。但因纳入的文献整体数量不多、文章的质量不高,需更多大样本、多中心的随机对照试验来进一步提供有效数据。

Objective A large number of studies have demonstrated that Helicobacter Pylori(HP)is closely related to chronic atrophic gastritis(CAG),and the eradication of HP is often regarded as a key link in the clinical treatment of chronic atrophic gastritis.However,with the increase of drug resistance rate of HP eradication therapy in recent years,the bactericidal and bacteriostatic effects of traditional Chinese medicine have been highlighted.In recent years,there have been increasing reports on the combination of traditional Chinese medicine and western medicine to improve the eradication rate of HP.To this end,this paper systematically evaluated the efficacy and safety of Weifuchun combined with HP eradication in the treatment of HP-related chronic atrophic gastritis.Methods Randomized controlled trials of gastroenterol combined with HP eradication therapy for CAG from January 2001 to August 2020 were searched using computer systems from Wanfang Database,CNKI,Viper,Cochrane Library,PubMed and Embase databases.Data extraction and quality evaluation were carried out for the included literatures.A total of 9 included literatures were systematically evaluated by using the improved Jadad scale.The HP eradication rate,adverse reaction rate and overall efficacy rate in the included literature were Meta systematic evaluation using RevMan 5.3 software.Results①A total of 9 randomized controlled trials were included,of which 3 were of high quality and the rest were of low quality.②Meta results:the eradication rate of HP in the combined group[MD=3.41,95%CI(2.23,5.19),Z=5.70,P<0.00001].The incidence of adverse reactions was[MD=0.37,95%CI(0.18,0.79),Z=2.57,P=0.01].The overall efficacy rate[MD=3.88,95%CI(2.68,5.62),Z=7.16,P<0.00001]was superior to the non-combined group.Conclusion HP eradication rate,adverse reaction rate and overall efficacy rate were significant in the group of gastroenterology combined with HP eradication.It indicates that for the treatment of CAG,the combination of HP eradication and gastroenterology on the basis of HP eradication treatment can further improve the eradication rate and overall efficacy rate of HP,and reduce the incidence of adverse reactions.However,due to the small number of included literatures and the low quality of the articles,more large sample and multi-center randomized controlled trials are needed to provide further effective data.