Houben M H, van de Beek D, Hensen E F, de Craen A J, Rauws E A, Tytgat G N
Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Aliment Pharmacol Ther. 1999 Aug;13(8):1047-55. doi: 10.1046/j.1365-2036.1999.00555.x.
We systematically reviewed all available data in the literature to determine the overall eradication rates of currently advised Helicobacter pylori eradication regimens and to resolve conflicting evidence on the impact of antimicrobial resistance on the eradication rates.
A comprehensive search of all published trials on H. pylori eradication therapy was carried out via an electronic database search, hand-searching and checking reference lists of pharmaceutical companies and other reviews. Full papers and abstracts in the English language which study currently advised eradication regimes were included.
770 study-arms were analysed. Mean eradication rates for bismuth based triple, proton pump inhibitor triple, quadruple and ranitidine bismuth citrate combination therapies vary from 65 to 92%. In case of nitroimidazole resistance, a drop in efficacy of up to 50% was found for bismuth-based triple and proton pump inhibitor-based triple therapies. For quadruple therapy, a significant difference in efficacy was found in the equal-effects analysis; however, this could not be confirmed in the random-effects analysis. In case of clarithromycin resistance, a mean drop in efficacy of 56% was found for one- and two-week clarithromycin containing proton pump inhibitor-triple therapies and of 58% for two-week ranitidine bismuth citrate combined with clarithromycin therapies. For ranitidine bismuth citrate combined with clarithromycin and nitroimidazole, no difference in efficacy was found in case of nitroimidazole or clarithromycin resistance, but data are still scarce.
The cure rate with most regimens dropped significantly, in case of nitroimidazole-resistant strains, compared to nitroimidazole-susceptible strains. In case of clarithromycin resistance, the efficacy of most regimens is also decreased; however, data are still scarce. These data should allow physicians to make a better choice of an appropriate therapy for their patients.
我们系统回顾了文献中所有可得数据，以确定当前推荐的幽门螺杆菌根除方案的总体根除率，并解决关于抗菌药物耐药性对根除率影响的相互矛盾的证据。
通过电子数据库检索、手工检索以及查阅制药公司的参考文献列表和其他综述，对所有已发表的幽门螺杆菌根除治疗试验进行全面搜索。纳入研究当前推荐根除方案的英文全文论文和摘要。
分析了770个研究组。基于铋剂的三联疗法、质子泵抑制剂三联疗法、四联疗法以及雷尼替丁枸橼酸铋联合疗法的平均根除率在65%至92%之间。对于硝基咪唑耐药的情况，基于铋剂的三联疗法和基于质子泵抑制剂的三联疗法的疗效下降高达50%。对于四联疗法，等效性分析发现疗效存在显著差异；然而，随机效应分析未能证实这一点。对于克拉霉素耐药的情况，含克拉霉素的一周和两周质子泵抑制剂三联疗法的平均疗效下降56%，两周雷尼替丁枸橼酸铋联合克拉霉素疗法的平均疗效下降58%。对于雷尼替丁枸橼酸铋联合克拉霉素和硝基咪唑，在硝基咪唑或克拉霉素耐药的情况下未发现疗效差异，但数据仍然稀少。
与硝基咪唑敏感菌株相比，对于硝基咪唑耐药菌株，大多数方案的治愈率显著下降。对于克拉霉素耐药的情况，大多数方案的疗效也会降低；然而，数据仍然稀少。这些数据应有助于医生为患者更好地选择合适的治疗方法。
