Lin Jiang, Huang Wei-Wen
Department of Gastroenterology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China.
World J Gastroenterol. 2009 Oct 7;15(37):4715-9. doi: 10.3748/wjg.15.4715.
To evaluate the efficacy and safety of Traditional Chinese Medicine (TCM) in the treatment of Helicobacter pylori (H. pylori) infection.
We electronically and manually searched electronic databases, references lists and conferences compilations, and included all randomized clinical trials comparing the treatment of H. pylori using TCM with proton pump inhibitor or colloidal bismuth subcitrate-based triple therapy as controls. The Jadad score was used to assess trial quality, H. pylori eradication rate and the incidence of side effects were taken as outcome measurements, and heterogeneity analysis, meta-analysis and funnel plot analysis were conducted.
Sixteen trials were included. The Jadad scores of all the trials were not more than 2. Clinical heterogeneity and substantial statistical heterogeneity existed among the trials (P = 0.001, I(2) = 59%) and meta-analysis was not conducted. The average eradication rates following TCM and triple therapy were 72% and 78% and the incidence of side effects were 2% and 29%, respectively. The funnel plot was obviously asymmetric.
Available evidence is not convincing enough to show that TCM has the same efficacy as triple therapy in H. pylori treatment. TCM may be safer than triple therapy. TCM should not be recommended as monotherapy in H. pylori infection.
评估中药治疗幽门螺杆菌(H. pylori)感染的疗效和安全性。
我们通过电子和手动方式检索电子数据库、参考文献列表及会议汇编,纳入所有比较使用中药治疗H. pylori与以质子泵抑制剂或枸橼酸铋钾为基础的三联疗法作为对照的随机临床试验。采用Jadad评分评估试验质量,以H. pylori根除率和副作用发生率作为结局指标进行测量,并进行异质性分析、荟萃分析和漏斗图分析。
纳入16项试验。所有试验的Jadad评分均不超过2分。各试验间存在临床异质性和显著的统计学异质性(P = 0.001,I² = 59%),未进行荟萃分析。中药治疗组和三联疗法组的平均根除率分别为72%和78%,副作用发生率分别为2%和29%。漏斗图明显不对称。
现有证据不足以令人信服地表明中药在治疗H. pylori感染方面与三联疗法具有相同疗效。中药可能比三联疗法更安全。不建议将中药作为H. pylori感染的单一疗法。