不同含米诺环素四联方案在幽门螺杆菌感染初治患者中的疗效及卫生经济学评价

Efficacy and health economics evaluation of different minocycline-containing quadruple regimens in newly treated patients with Helicobacter pylori infection

目的评价不同含米诺环素四联方案在幽门螺杆菌(Hp)感染初治患者中的疗效及卫生经济学。方法回顾性分析2022年1月1日至2023年7月31日于首都医科大学附属北京积水潭医院接受含米诺环素四联方案根除治疗的554例Hp感染初治患者的临床资料。根据根除治疗方案的不同分为MAPB组(166例)、MMPB组(81例)和MLPB组(307例)。MAPB组为米诺环素-阿莫西林-质子泵抑制剂(PPI)-铋剂方案;MMPB组为米诺环素-甲硝唑-PPI-铋剂方案;MLPB组为米诺环素-左氧氟沙星-PPI-铋剂方案;3组疗程均为14 d。结局指标包括Hp根除率和不良反应发生率。以上述研究结果作为参数,分别采用多方案比较法和净效益法对所有治疗方案进行评估并筛选优势方案。通过敏感性分析评价所得结果的稳定性。结果MAPB组、MMPB组和MLPB组患者Hp根除率分别为92.8%(154/166)、84.0%(68/81)和94.1%(289/307),3组间比较差异有统计学意义(χ^(2)=9.382,P=0.009)。554例患者中185例(33.4%)在根除治疗期间报告了药物不良反应。其中,MMPB组患者不良反应发生率最高(46.9%),组间差异有统计学意义(χ^(2)=38.545,P<0.001)。多方案比较法结果显示,上述3种方案均非绝对劣势方案。多方案比较法和净效益法结果均显示,米诺环素-左氧氟沙星-PPI-铋剂方案为优势方案。敏感性分析结果显示,米诺环素-阿莫西林-PPI-铋剂方案的根除率对结果影响较大。结论含米诺环素四联方案用于Hp感染初治患者的根除治疗显示出较好的效果。其中,米诺环素-左氧氟沙星-PPI-铋剂方案可能具有最优的卫生经济学价值。

Objective To evaluate the efficacy and health economics of different minocycline-containing quadruple regimens in newly treated patients with Helicobacter pylori(Hp)infection.Methods From January 1,2022 to July 31,2023,the clinical data of 554 Hp infection patients who received eradication treatment with a quadruple regimen containing minocycline in Beijing Jishuitan Hospital,Capital Medical University were retrospectively analyzed.According to different eradication treatment plans,they were divided into MAPB group(166 cases),MMPB group(81 cases),and MLPB group(307 cases).The MAPB group received minocycline-amoxicillin-proton pump inhibitor(PPI)-bismuth regimen,the MMPB group received minocycline-metronidazole-PPI-bismuth regimen,and the MLPB group received minocycline-levofloxacin-PPI-bismuth regimen.All three groups were treated for 14 d.Outcome measures included Hp eradication rate and incidence of adverse reactions.Using the results of the above studies as parameters,multi-strategy comparison and net benefit method were used to evaluate all treatment strategies and screen the superior one,respectively.Sensitivity analysis was performed to evaluate the stability of the results.Results The Hp eradication rates of patients in the MAPB group,MMPB group,and MLPB group were 92.8%(154/166),84.0%(68/81),and 94.1%(289/307)(χ^(2)=9.382,P=0.009).Adverse drug reactions were reported in 185 of 554 patients(33.4%)during eradication therapy.The incidence of adverse events(46.9%)was highest in MMPB group(χ^(2)=38.545,P<0.001).The results of multi-scheme comparison showed that none of the above three schemes was absolutely inferior.The multi-scheme comparison method and the net benefit method results showed that minocycline-levofloxacin-PPI-bismuth regimen might be advantage intervention.Sensitive analysis showed that eradication rate of minocycline-amoxicillin-PPI-bismuth regimen had significant impact on stability of such result.Conclusions Minocycline-containing quadruple therapies showed satisfactory efficacy in the eradication treatment of newly treated patients with Hp infection.Minocycline-levofloxacin-PPI-bismuth regimen might stand optimal health economic value.