老年人根除幽门螺杆菌疗效和安全性的倾向性评分匹配分析

Efficacy and Safety of Helicobacter pylori Eradication in the Elderly:A Propensity Score Matching Analysis

背景:老年人根除幽门螺杆菌(Hp)需权衡获益与风险。目的:探讨老年人接受Hp根除治疗的有效性、安全性和耐药情况。方法:从重庆大坪医院4项Hp根除治疗随机对照试验的研究队列中选择研究对象,采集基本资料和诊疗相关信息,采用倾向性评分匹配法匹配老年组(≥60岁)与非老年组(<60岁),分析两组患者的Hp根除率、依从性、不良反应、耐药率和根除率影响因素。结果:994例接受Hp根除治疗的患者初步入选,通过倾向性评分匹配,共244例患者纳入研究,每组122例。老年组与非老年组Hp根除率均在90%以上,两组间依从性、药物相关不良反应发生率和抗菌药物耐药率差异均无统计学意义(P均>0.05)。老年组Hp根除率分别按性别、吸烟史、饮酒史、合并疾病(高血压、糖尿病、手术史、炎症)、依从性等因素进行分层分析,差异均无统计学意义(P均>0.05)。老年复治患者克拉霉素耐药率显著高于初治患者(P<0.05)。多因素Logistic回归分析显示吸烟和依从性差是影响Hp根除率的独立危险因素。结论:老年人接受Hp根除治疗具有与非老年人同等的有效性和安全性。复治老年患者应避免选择含克拉霉素经验性根除治疗方案。

Background:The benefits and risks of eradicating Helicobacter pylori(Hp)should be balanced in aged people.Aims:To investigate the efficacy,safety and antibiotic resistance status of Hp eradication treatment in the elderly.Methods:Four cohorts of subjects who received Hp eradication treatment in randomized controlled trials conducted in Chongqing Daping Hospital were reviewed;the demographic and clinical data were extracted and recorded.Propensity score matching was performed to select comparable elderly group(≥60 years old)and non⁃elderly group(<60 years old).The eradication rate,compliance,adverse events,antibiotic resistance,and the influencing factors of eradication were analyzed in these two groups.Results:A total of 994 subjects receiving Hp eradication treatment were enrolled initially,among them,224 were categorized as elderly group and non⁃elderly group by propensity score matching,with 122 subjects in each group.The Hp eradication rates were higher than 90%in both elderly and non⁃elderly groups,and no significant differences were observed in compliance,drug⁃related adverse events,and antibiotic resistance rates between these two groups(all P>0.05).Furthermore,there were no significant differences in the Hp eradication rates in terms of gender,cigarette smoking,alcohol consumption,comorbidities(hypertension,diabetes,surgical history,and inflammation),compliance,etc.in the elderly group(all P>0.05).But in retreated elderly subjects,the resistance rate of clarithromycin was higher than that in naïve elderly subjects(P<0.05).Smoking and poor compliance were identified as independent risk factors for Hp eradication by multivariate Logistic regression analysis.Conclusions:Hp eradication in the elderly demonstrates comparable efficacy and safety with non⁃elderly subjects.Clarithromycin⁃containing regimens are not recommended for empirical retreatment in aged people.