目的比较"含黄连素四联方案"与"传统三联方案"(2种抗生素+质子泵抑制剂)治疗幽门螺杆菌(Helicobacter pylori, H. pylori)相关性消化性溃疡的效度和安全性.方法分别在Medline(1988-05/2018-05)、EMBASE(1988-05/201...目的比较"含黄连素四联方案"与"传统三联方案"(2种抗生素+质子泵抑制剂)治疗幽门螺杆菌(Helicobacter pylori, H. pylori)相关性消化性溃疡的效度和安全性.方法分别在Medline(1988-05/2018-05)、EMBASE(1988-05/2018-05)、Web of Science(1988-05/2018-05)、中国生物医学文献数据(1988-05/2018-05)、中国知网(1988-05/2018-05)、万方网络数据检索文献(1988-05/2018-05)等数据库检索文献.同时通过参考文献查找相关文献补充检索.通过绘制漏斗图评估有无发表偏倚,依据同质性检验评估纳入文献同质性情况,若异质性较低(P>0.1且I2<50%)采用固定效应模型分析,反之则采用随机效应模型进行合并分析.结果本研究共纳入7项随机对照试验,包含患者948例.合并分析显示,试验组根除成功率(86.78%vs 70.04%)、溃疡愈合率(50.73%vs 40.30%)和溃疡治疗总有效率(94.57%vs 81.66%)均显著优于对照组,差异有统计学意义.试验组不良反应发生率显著低于对照组(26.54%vs40.44%).结论相较于"传统三联方案","含黄连素四联方案"根除H. pylori治疗可能获得更优的根除率,可能更加促进消化道溃疡的愈合,并可能降低药物不良反应发生率,但上述结果还有待更大样本、更加严格的随机对照试验进一步验证.展开更多
BACKGROUND Allicin(2-propene-1-sulfinothioic acid S-2-propenyl ester,diallyl thiosulfinate)extracted from garlic,has proven activity against Helicobacter pylori(H.Pylori)infection.In recent years,clinical trials have ...BACKGROUND Allicin(2-propene-1-sulfinothioic acid S-2-propenyl ester,diallyl thiosulfinate)extracted from garlic,has proven activity against Helicobacter pylori(H.Pylori)infection.In recent years,clinical trials have explored its utility as an add-on therapy with variable outcomes reported.AIM To perform a systemic review of allicin as an add-on treatment for H.Pylori infection and assess its efficacy in randomized controlled trials(RCTs).METHODS Electronic databases including MEDLINE,EMBASE,the Web of Science,the Cochrane Database,the China National Knowledge Infrastructure Database,Chinese VIP Information Databases,Chinese Medical Databases,and the Wan-Fang Database were searched for keywords including“allicin”,“Helicobacter pylori”,“randomized clinical trials”,and their synonyms.A meta-analysis was performed using the fixed-effects model for low heterogeneity and the randomeffects model for high heterogeneity with sensitivity analysis.Bias was evaluated using Egger’s tests.Trial sequential analysis(TSA)was used to evaluate information size and treatment benefits.The Grading of Recommendations Assessment,Development and Evaluation(GRADE)was used to assess the level of quality,and studies were classed as“high quality”,“moderate quality”,“low quality”,and“very low quality”.RESULTS A total of eight RCTs consisting of 867 participants(435 from the allicin group and 432 from the control group)were included.Eradication rate in the allicin group(93.33%,406/435)was significantly higher than that of the control group(83.56%,361/432)[I2=0%,odds ratio(OR)=2.75,95%confidence interval(CI):1.74-4.35,P<0.001].The healing rate of ulcers following H.pylori therapy in the allicin group(86.17%,349/405)was significantly higher than that of the control group(75.87%,305/402)[I2=0%,OR=2.05,95%CI:1.39-3.03,P<0.001].The total remission rate of peptic ulcers across all allicin groups was 95.99%,which was significantly higher than that of controls[95.99%(359/374)vs 89.25%(332/372),I2=0,heterogeneity P=0.84,OR=3.13,95%CI:1.51-6.51,P=0.002].No significant differences in side effects were observed.TSA suggested that the trials were of sufficient standard to draw reliable conclusions.The quality of outcomes including eradication rates and side effects was graded as“very low”due to downgrades for“risk of bias”and“indirectness”.Other outcomes such as ulcer healing rates and total ulcer remission rates were graded as"low"due to downgrades for“risk of bias”.CONCLUSION Allicin as an add-on therapy improves H.pylori eradication,healing of ulcers,and remission of symptoms.These results are suggested to be treated with caution due to limited quality.展开更多
文摘目的比较"含黄连素四联方案"与"传统三联方案"(2种抗生素+质子泵抑制剂)治疗幽门螺杆菌(Helicobacter pylori, H. pylori)相关性消化性溃疡的效度和安全性.方法分别在Medline(1988-05/2018-05)、EMBASE(1988-05/2018-05)、Web of Science(1988-05/2018-05)、中国生物医学文献数据(1988-05/2018-05)、中国知网(1988-05/2018-05)、万方网络数据检索文献(1988-05/2018-05)等数据库检索文献.同时通过参考文献查找相关文献补充检索.通过绘制漏斗图评估有无发表偏倚,依据同质性检验评估纳入文献同质性情况,若异质性较低(P>0.1且I2<50%)采用固定效应模型分析,反之则采用随机效应模型进行合并分析.结果本研究共纳入7项随机对照试验,包含患者948例.合并分析显示,试验组根除成功率(86.78%vs 70.04%)、溃疡愈合率(50.73%vs 40.30%)和溃疡治疗总有效率(94.57%vs 81.66%)均显著优于对照组,差异有统计学意义.试验组不良反应发生率显著低于对照组(26.54%vs40.44%).结论相较于"传统三联方案","含黄连素四联方案"根除H. pylori治疗可能获得更优的根除率,可能更加促进消化道溃疡的愈合,并可能降低药物不良反应发生率,但上述结果还有待更大样本、更加严格的随机对照试验进一步验证.
基金Supported by BeiJingJiShuiTan Hospital Foundation for Young Scholars,No.QN-201906
文摘BACKGROUND Allicin(2-propene-1-sulfinothioic acid S-2-propenyl ester,diallyl thiosulfinate)extracted from garlic,has proven activity against Helicobacter pylori(H.Pylori)infection.In recent years,clinical trials have explored its utility as an add-on therapy with variable outcomes reported.AIM To perform a systemic review of allicin as an add-on treatment for H.Pylori infection and assess its efficacy in randomized controlled trials(RCTs).METHODS Electronic databases including MEDLINE,EMBASE,the Web of Science,the Cochrane Database,the China National Knowledge Infrastructure Database,Chinese VIP Information Databases,Chinese Medical Databases,and the Wan-Fang Database were searched for keywords including“allicin”,“Helicobacter pylori”,“randomized clinical trials”,and their synonyms.A meta-analysis was performed using the fixed-effects model for low heterogeneity and the randomeffects model for high heterogeneity with sensitivity analysis.Bias was evaluated using Egger’s tests.Trial sequential analysis(TSA)was used to evaluate information size and treatment benefits.The Grading of Recommendations Assessment,Development and Evaluation(GRADE)was used to assess the level of quality,and studies were classed as“high quality”,“moderate quality”,“low quality”,and“very low quality”.RESULTS A total of eight RCTs consisting of 867 participants(435 from the allicin group and 432 from the control group)were included.Eradication rate in the allicin group(93.33%,406/435)was significantly higher than that of the control group(83.56%,361/432)[I2=0%,odds ratio(OR)=2.75,95%confidence interval(CI):1.74-4.35,P<0.001].The healing rate of ulcers following H.pylori therapy in the allicin group(86.17%,349/405)was significantly higher than that of the control group(75.87%,305/402)[I2=0%,OR=2.05,95%CI:1.39-3.03,P<0.001].The total remission rate of peptic ulcers across all allicin groups was 95.99%,which was significantly higher than that of controls[95.99%(359/374)vs 89.25%(332/372),I2=0,heterogeneity P=0.84,OR=3.13,95%CI:1.51-6.51,P=0.002].No significant differences in side effects were observed.TSA suggested that the trials were of sufficient standard to draw reliable conclusions.The quality of outcomes including eradication rates and side effects was graded as“very low”due to downgrades for“risk of bias”and“indirectness”.Other outcomes such as ulcer healing rates and total ulcer remission rates were graded as"low"due to downgrades for“risk of bias”.CONCLUSION Allicin as an add-on therapy improves H.pylori eradication,healing of ulcers,and remission of symptoms.These results are suggested to be treated with caution due to limited quality.
