高剂量二联疗法对比铋剂四联疗法治疗幽门螺杆菌感染疗效的meta分析

Efficacy of high-dose dual therapy versus bismuth quadruple therapy in the treatment of Helicobacter pylori infection:a meta-analysis

目的探讨高剂量二联疗法(HDDT)对比含铋剂四联疗法(BQT)在根除幽门螺杆菌(Hp)的有效性及安全性。方法从PubMed、Embase、Cochrane Library、维普、中国知网、中国生物医学文献服务系统和万方数据库中检索比较HDDT与BQT治疗Hp感染的随机对照试验(RCT)研究,检索时间限定为2000年1月至2021年1月。根据纳入与排除标准筛选文献,评估文献质量并提取数据,采用Revman5.4软件进行meta分析。结果共纳入7项RCT研究,共2017例确诊Hp感染患者。Meta分析结果显示:意向性分析(ITT)中HDDT组根除率与BQT组无明显差异[86.3%vs.84.9%,RR=1.02,95%CI(0.98,1.06),P=0.27];符合方案分析(PP)中HDDT组根除率与BQT组亦无明显差异[89.7%vs.89.8%,RR=1.01,95%CI(0.98,1.04),P=0.70]。HDDT组不良反应发生率明显低于BQT组[15.2%vs.37.1%,RR=0.38,95%CI(0.24,0.59),P<0.01],且依从性更好[96.4%vs.93.9%,RR=1.02,95%CI(1.00,1.05),P=0.01]。结论BQT与HDDT具有相似的Hp根除疗效,但HDDT的不良反应发生率更低且依从性更好。

Objective To explore the efficacy and safety of high-dose dual therapy(HDDT)versus bismuth quadruple therapy(BQT)in the treatment of Helicobacter pylori(Hp)infection.Methods Randomized controlled trials(RCTs)comparing HDDT and BQT in the treatment of Hp infection were searched from PubMed,Embase,Cochrane Library,VIP,CNKI,SinoMed,and Wanfang Database from January 2000 to January 2021.The literatures were screened according to the inclusion and exclusion criteria,the quality was assessed,and effective data of these RCTs were extracted.Revman5.4 software was used to carry out the meta-analysis.Results A total of seven RCTs were assessed,involving 2017 patients diagnosed with Hp infection.The results of meta-analysis showed that there was no significant difference in the eradication rate between the HDDT group and the BQT group in intention-to-treat(ITT)analysis[86.3%vs.84.9%,RR=1.02,95%CI(0.98,1.06),P=0.27].There was no significant difference in the eradication rate between the HDDT group and the BQT group in per-protocol(PP)analysis[89.7%vs.89.8%,RR=1.01,95%CI(0.98,1.04),P=0.70].The incidence of adverse reactions in the HDDT group was significantly lower than that in the BQT group[15.2%vs.37.1%,RR=0.38,95%CI(0.24,0.59),P<0.01],and adherence was better[96.4%vs.93.9%,RR=1.02,95%CI(1.00,1.05),P=0.01].Conclusion HDDT and BQT have similar efficacy in the eradication of Hp.However,HDDT has a lower incidence of adverse reactions and better adherence.