Houben M H, van de Beek D, Hensen E F, de Craen A J, van 't Hoff B W, Tytgat G N
Dept of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Scand J Gastroenterol Suppl. 1999;230:17-22. doi: 10.1080/003655299750025499.
Helicobacter pylori cure rates vary in different geographical regions because of differences in hosts as well as in H. pylori strains.
To review systematically all available data in the literature to determine H. pylori eradication rates in The Netherlands.
A search of all published trials on H. pylori eradication therapy performed in The Netherlands was conducted via electronic database search, hand-searching of abstracts from scientific meetings and checking reference lists of pharmaceutical companies. Full papers and abstracts were included. Data on anti-H. pylori therapies were pooled based on duration and combination of drugs. Only triple and quadruple eradication regimens were studied. Dual therapies were excluded, except for ranitidine bismuth citrate-based dual therapies.
We analysed 38 study arms, involving 2197 patients. Twenty different pooled regimens were studied with a mean intention-to-treat eradication rate of 83% (range 35-96%). There were no significant differences in the percentage of patients that stopped treatment due to adverse events between the groups. In these pooled regimens only bismuth combined with tetracycline and metronidazole for 1 or 2 weeks was significantly lower in efficacy in metronidazole-resistant strains than in metronidazole-sensitive strains. The prevalence of metronidazole-resistant strains in The Netherlands showed large regional differences (7-50%).
A therapy should be tested in a defined population before becoming standard. Several eradication regimens studied in The Netherlands yield acceptable cure rates of 80% or more on an intention-to-treat basis. We advise taking the local prevalence of metronidazole resistance into account when choosing a first-line eradication regimen.
由于宿主以及幽门螺杆菌菌株的差异，幽门螺杆菌的治愈率在不同地理区域有所不同。
系统回顾文献中所有可用数据，以确定荷兰的幽门螺杆菌根除率。
通过电子数据库搜索、手工检索科学会议摘要以及查阅制药公司的参考文献列表，对荷兰进行的所有已发表的幽门螺杆菌根除治疗试验进行检索。纳入全文和摘要。根据药物的持续时间和组合对抗幽门螺杆菌治疗的数据进行汇总。仅研究三联和四联根除方案。排除双联疗法，但基于枸橼酸铋雷尼替丁的双联疗法除外。
我们分析了38个研究组，涉及2197例患者。研究了20种不同的汇总方案，意向性治疗根除率平均为83%（范围35%-96%）。各组之间因不良事件停止治疗的患者百分比无显著差异。在这些汇总方案中，仅铋剂联合四环素和甲硝唑治疗1或2周时，对甲硝唑耐药菌株的疗效显著低于对甲硝唑敏感的菌株。荷兰甲硝唑耐药菌株的流行率存在较大的地区差异（7%-50%）。
一种治疗方法在成为标准治疗方法之前应在特定人群中进行测试。在荷兰研究的几种根除方案在意向性治疗基础上产生了80%或更高的可接受治愈率。我们建议在选择一线根除方案时考虑当地甲硝唑耐药的流行情况。
