雷贝拉唑和奥美拉唑联合抗生素治疗Hp相关消化性溃疡的疗效及安全性荟萃分析

Meta-analysis on the Clinical Efficacy and Safety of Rabeprazole Versus Omeprazole Combined with Antibiotics in the Treatment for the Eradication of Helicobacter Pylori-related Peptic Ulcer Infection

目的系统评价雷贝拉唑、奥美拉唑联合抗生素治疗幽门螺杆菌(Hp)相关消化性溃疡的疗效和安全性,为其临床运用提供参考和借鉴。方法系统检索PubMed、Embase、Cochrane Library、中国知网(CNKI)、中文科技期刊数据库(VIP)、万方数字化期刊库。检索时限为建库至2022年01月23日。试验组采用雷贝拉唑联合抗生素进行治疗,对照组采用奥美拉唑联合抗生素治疗。按Cochrane系统评价的相关要求,对纳入的研究进行资料提取和质量评价,采用RevMan 5.3软件进行数据处理与分析,对数据不能合并者,进行描述性的定性分析。结果本研究共纳入11篇RCT研究文献,共包含1603例患者,其中试验组800例,对照组803例。Meta分析结果显示,试验组Hp相关消化性溃疡愈合率[OR=3.23,95%CI(2.30~4.52),P<0.05]高于对照组;试验组Hp根除率[OR=3.30,95%CI(2.43~4.49),P<0.05]高于对照组,治疗后复发率[OR=0.26,95%CI(0.12~0.58),P<0.05]低于对照组;在腹痛改善[OR=3.54,95%CI(2.30~5.43),P<0.05]、腹胀改善[OR=2.64,95%CI(1.46~4.76),P<0.05]方面试验组优于对照组;两组在消化系统[RR=0.93,95%CI(0.63~1.38),P=0.72]、神经系统[RR=1.81,95%CI(0.89~3.67),P=0.10]及免疫系统[RR=0.48,95%CI(0.15~1.48),P=0.20]、不良反应发生率比较,差异无统计学意义(P>0.05);试验组IL-2[MD=2.82,95%CI(2.50~3.15),P<0.05],IL-6[MD=-26.59,95%CI(-28.39~-24.79),P<0.05],CRP[MD=-26.59,95%CI(-28.39~-24.79),P<0.05]水平高于对照组。结论雷贝拉唑联合抗生素治疗Hp相关消化性溃疡具有较好的疗效和安全性。

Objective To compare the clinical efficacy and safety of rabeprazole and omeprazole combined with antibiotics in the treatment for the eradication of Helicobacter pylori-related peptic ulcer to provide reference for its clinical application.Methods Literature databases such as PubMed, Embase, Cochrane Library, CNKI,China Science and Technology Journal Database, Wanfang Date were searched by computer from the establishment of the database to January 23,2021.The experimental group was treated with rabeprazole combined with antibiotics, and the control group was treated with omeprazole combined with antibiotics.The data and quality of the included studies was evaluated according to the Cochrane systematic evaluation method.RevMan 5.3 software was used for data processing and analysis.If the data could not be combined, descriptive qualitative analysis was performed.Results A total of 1 603 patients with 11 RCTs were included, with 800 patients in the treatment group and 803 patients in the control group.Meta-analysis results showed that the healing rate of the experimental group on Hp-related peptic ulcer [OR=3.23,95% CI(2.30~4.52),P<0.05] was higher than that of the conthol group;the eradication rate of the experimental group on Hp [OR=3.30,95% CI(2.43~4.49),P<0.05] was higher than the control group;the recurrence rate after treatment of the experimental group [OR=0.26,95% CI(0.12~0.58),P<0.05] was lower than the control group;the number of the clinical symptoms improved after treatment of the experimental group in abdominal pain [OR=3.54,95% CI(2.30~5.43),P<0.05] and abdominal distension [OR=2.64,95% CI(1.46~4.76),P<0.05] was better than the control group;there was no statistically significant difference between the two groups in the incidence of adverse reactions in digestive system [RR=0.93,95% CI(0.63~1.38),P=0.72],nervous system [RR=1.81,95% CI(0.89~3.67),P=0.10] and immune system [RR=0.48,95% CI(0.15~1.48),P=0.20];the indicator changes of the level of inflammatory factors after treatment of the experimental group in IL-2[MD=2.82,95% CI(2.50~3.15),P<0.05],IL-6[MD=-26.59,95% CI(-28.39~-24.79),P<0.05] and CRP [MD=-26.59,95% CI(-28.39~-24.79),P<0.05] were better than the control group.Conclusion Rabeprazole combined with antibiotics has a good efficacy and safety in the treatment of Hp-related peptic ulcer.