Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP) y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Aliment Pharmacol Ther. 2011 Dec;34(11-12):1255-68. doi: 10.1111/j.1365-2036.2011.04887.x. Epub 2011 Oct 21.
BACKGROUND A decrease in the Helicobacter pylori eradication rate after standard triple therapy has been suggested in recent years. AIM To assess the efficacy of standard triple therapy in the eradication of H. pylori through an epidemiological analysis of all published Spanish trials. A secondary aim was to review the prevalence of clarithromycin resistance in Spain. METHODS Articles on H. pylori eradication in Spain published in peer-reviewed journals were identified through MEDLINE searches. Studies that included a triple therapy consisting of any proton pump inhibitor with clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for up to 14 days were selected. Spanish studies evaluating the prevalence of clarithromycin resistance were also reviewed. Meta-analysis was performed using the generic inverse variance method. RESULTS The pooled eradication rates by year from Spanish studies evaluating the efficacy of the standard triple regimen revealed a relatively constant rate over the years. Overall, the analysis of the 32 studies (4727 patients) showed a mean H. pylori cure rate of 80% (95% CI = 77-82%) by intention-to-treat and 83% (81-86%) by per-protocol. When only peptic ulcer disease or 7-day regimens were considered, results were similar. Based on 13 studies (3293 patients), mean clarithromycin resistance rate was 8% (5-10%). CONCLUSION Although a decrease in the H. pylori eradication rate after triple therapy has been suggested in recent years, cure rates with this regimen did not change in Spain between 1997 and 2008. However, this by no means indicates that the efficacy of standard triple therapy in Spain is acceptable, as it has been calculated to be around only 80%. Therefore, it is evident that new strategies to improve first-line treatment are urgently needed.
近年来，标准三联疗法后幽门螺杆菌（Helicobacter pylori）根除率有所下降。
通过对所有已发表的西班牙试验进行流行病学分析，评估标准三联疗法根除 H. pylori 的疗效。次要目的是回顾西班牙克拉霉素耐药的流行率。
通过 MEDLINE 搜索，确定发表在同行评议期刊上的关于 H. pylori 在西班牙根除的文章。选择包括任何质子泵抑制剂加克拉霉素（500mg，每日 2 次）和阿莫西林（1g，每日 2 次）在内的三联疗法，疗程最长为 14 天的研究。还回顾了评估克拉霉素耐药流行率的西班牙研究。使用通用倒数方差法进行荟萃分析。
对评估标准三联方案疗效的西班牙研究进行年度分析，显示多年来根除率相对稳定。总体而言，32 项研究（4727 例患者）的分析显示，意向治疗的平均 H. pylori 治愈率为 80%（95%可信区间=77-82%），按方案治疗的治愈率为 83%（81-86%）。当仅考虑消化性溃疡病或 7 天疗程时，结果相似。基于 13 项研究（3293 例患者），平均克拉霉素耐药率为 8%（5-10%）。
尽管近年来有人提出三联疗法后 H. pylori 根除率下降，但 1997 年至 2008 年期间，西班牙这种方案的治愈率并未改变。然而，这绝不能表明标准三联疗法在西班牙的疗效是可以接受的，因为它的疗效估计仅为 80%左右。因此，显然需要制定新的策略来改善一线治疗。
