摘要
幽门螺杆菌(Helicobacter pylori,Hp)是一种常见的与胃肠疾病有关的感染性细菌。目前,对于儿童Hp根除治疗,首推三联疗法或四联疗法,但该疗法成功率低至50%,而最新研究显示运用疗程为10 d序贯疗法清除率可达95%。计算机检索Pub Med、EMbase、The Cochrane Library(2016年第11期)、CBM、CNKI、VIP和Google Scholar数据库,搜集有关抗生素治疗儿童幽门螺杆菌的随机对照试验或平行对照试验,检索时限均为从建库至2016年11月。由两名研究者独立按纳入排除标准进行文献筛选、资料提取和方法学质量评价,然后采用Stata 12.0软件进行Meta分析。最终纳入14个RCT,共计1290名儿童,其中557名儿童接受序贯疗法,733名儿童接受标准疗法。本研究结果证实:应用序贯疗法可增加Hp清除率达15.0%[RR=1.15,95%CI(1.09,1.22),P<0.001];基于标准疗法的亚组分析结果显示:序贯疗法较疗程为7 d标准疗法[RR=1.15,95%CI(1.08,1.22),P<0.001]与疗程为10 d标准疗法[RR=1.21,95%CI(1.11,1.32),P<0.001]均有效提高Hp清除率,而疗程为14 d标准疗法[RR=0.98,95%CI(0.84,1.14),P=0.762]则无明显差异。在不良反应结局方面,两种疗法差异均无统计学意义(P>0.05)。亚组漏斗图未显示存在显著发表偏倚。本研究推荐在儿童时期应及早采用序贯疗法来控制Hp感染。
Helicobacter pylori is a common infection associated with many gastrointestinal diseases. Triple or quadruple therapy are the current recommendation for Hp eradication in children but is associated with success rates as low as 50%.Recent studies have demonstrated that a lO-day sequential therapy regimen achieved eradication rates of nearly 95%.The databases of PubMed, EMbase, Cochrane Library （Issue 11, 2016 ）, CBM, CNKI, VIP and Google Scholar were retrieved with computer for collecting the randomized controlled trials （ RCT ） about the treatment of antibiotic therapy improves Helicobacter pylori （ Hp ） from database establishment time to Nov 2016.The literature was screened and data was extracted and given methodological quality evaluation by 2 researchers independently according to inclusion and exclusion criteria.The data was given a Meta-analysis by using Stata 12.0 software.There were totally 14 RCT included involved 1290 patients, a total of 557 children received sequential therapy, and 733 children received standard simultaneous therapy.This Meta-analysis found that sequential therapy increased eradication rates by 15.0%[RR=1.15, 95%CI （ 1.09, 1.22 ）, P〈0.001].The results based on the standard simultaneous therapy showed that compared with 7-day standard therapy[RR= 1.15, 95%CI （ 1.08, 1.22）, P〈0.001] and 10-day standard therapy[RR=1.21r 95%CI （ 1.11, 1.32）, P〈0.001 ）, the sequential therapy significantly increased the eradication of Hp, but the sequential therapy had no significant difference compared to 14-day standard therapy[RR=0.98, 95%CI （0.84, 1.14 ）, P=0.762].In the aspects of adverse effect, there was no statistically difference between these two therapies.Subgroups funnel figure showed no significant publication bias.This study recommended in childhood should adopt sequential therapy as early as possible to control the Hp infection.
出处
《中国医学创新》
CAS
2017年第17期49-55,共7页
Medical Innovation of China
基金
广东省中医药局科研课题(20130601)
关键词
幽门螺杆菌
序贯疗法
三联疗法
清除率
META分析
Helicobacter pylori
Sequential therapy
Standard triple therapy
Eradication
Meta analysis
作者简介
通信作者：刘国华
