伏诺拉生联合阿莫西林双联方案根除幽门螺杆菌疗效及安全性的Meta分析

Efficacy and safety of vonoprazan⁃amoxicillin dual therapy for Helicobacter pylori eradication:A meta⁃analysis

目的:比较伏诺拉生(vonoprazan,VPZ)联合阿莫西林方案(VA)与基于质子泵抑制剂(proton pump inhibitor,PPI)的含铋剂四联疗法根除幽门螺杆菌的有效性和安全性。方法:检索截至2023年9月14日的PubMed、Embase、Cochrane、中国知网、万方数据库公开发表的比较伏诺拉生联合阿莫西林方案与标准铋剂四联疗法治疗幽门螺杆菌感染的临床研究,利用RevMan 5.4软件进行Meta分析。结果:根据纳入及排除标准,最终共纳入11篇文献,共3033例患者;通过意向性治疗(intention⁃to⁃treat,ITT)分析和按方案治疗(per⁃protocol,PP)分析评估根除效果,伏诺拉生联合阿莫西林方案与标准铋剂四联疗法根除率相当(P>0.05),但伏诺拉生联合阿莫西林方案不良反应发生率更低(合并发生率:11.5%vs.25.3%,RR=0.46,95%CI:0.39~0.54,P<0.001),亚组分析显示伏诺拉生联合高剂量阿莫西林14 d疗程方案比铋剂四联方案根除率更高(ITT总体根除率:91.8%vs.82.6%;RR=1.09,95%CI:1.03~1.17,P<0.05;PP总体根除率:95.6%vs.86.7%;RR=1.08,95%CI:1.02~1.14,P<0.05)。结论:伏诺拉生联合阿莫西林双联方案可被推荐用于根除幽门螺杆菌治疗。

Objective:To compare the efcacy and safety of Vonoprazan⁃Amoxicillin(VA)dual therapy versus proton pump in⁃hibitor(PPI)⁃based bismuth⁃containing quadruple therapy(BCQ)in the eradication of Helicobacter(H.)pylori.Methods:We per⁃formed a systematic search in PubMed,Embase,Cochrane Library,CNKI,and Wanfang databases for relevant clinic trials up to September 2019.The related literatures were analyzed by RevMan 5.4 software.Results:Eleven studies with 3033 patients were evaluated in this meta⁃analysis.The H.pylori radication rate of VA dual Therapy was compared with PPI⁃based quadruple therapy(P>0.05)by intention⁃to⁃treat(ITT)analysis and per⁃protocol(PP)analysis.The incidence of adverse events in VA dual thera⁃py was lower than that in PPI⁃based quadruple therapy[pooled incidence,11.5%vs.25.3%,RR:0.46,95%CI:0.39~0.54,P<0.001].Subgroup analysis showed that vonoprazan and high⁃dose amoxicillin(VHA)dual therapy had a higher eradication rate than BCQ(ITT pooledincidence,91.8%vs.82.6%,RR=1.09,95%CI:1.03~1.17,P<0.05;PP pooled incidence,95.6%vs.86.7%,RR=1.08,95%CI:1.02~1.14,P<0.05).Conclusions:VA dual therapy can be recommended for H.pylori eradication therapy.