Gastroenterology and Endoscopy Unit, Versilia Hospital, Lido di Camaiore, Italy.
BMJ. 2013 Aug 7;347:f4587. doi: 10.1136/bmj.f4587.
To do a systematic review and meta-analysis of studies comparing sequential therapy for eradication of Helicobacter pylori with pre-existing and new therapies, thus providing a glimpse of eradication success worldwide.
Systematic review and meta-analysis.
Medline, Embase, and Cochrane Central Register of Controlled Trials up to May 2013; abstract books of major European, American, and Asian gastroenterological meetings.
Randomised controlled trials in previously untreated adults, in which sequential therapy was compared with a pre-existing or new therapy.
46 randomised controlled trials were reviewed and analysed. 5666 patients were randomised to sequential therapy and 7866 to other (established and new) treatments. The overall eradication rate of sequential therapy was 84.3% (95% confidence interval 82.1% to 86.4%). Sequential therapy was superior to seven day triple therapy (relative risk 1.21, 95% confidence interval 1.17 to 1.25; I(2)=29.3%; number needed to treat 6, 95% confidence interval 5% to 7%), marginally superior to 10 day triple therapy (1.11, 1.04 to 1.19; I(2)= 67.2%; NNT 10, 7 to 15), but not superior to 14 day triple therapy (1.00, 0.94 to 1.06; I(2)=54.3%), bismuth based therapy (1.01, 0.95 to 1.06; I(2)=21.1%), and non-bismuth based therapy (0.99, 0.94 to 1.05; I(2)=52.3%). Data on eradication according to pre-treatment antimicrobial susceptibility testing were available in eight studies, and sequential therapy was able to eradicate 72.8% (61.6% to 82.8%) of the strains resistant to clarithromycin.
Eradication rates with pre-existing and new therapies for H pylori are suboptimal. Regional monitoring of resistance rates should help to guide treatment, and new agents for treatment need to be developed.
对比较幽门螺杆菌根除的序贯疗法与既往和新疗法的研究进行系统评价和荟萃分析，从而了解全球的根除成功率。
系统评价和荟萃分析。
截至 2013 年 5 月，检索 Medline、Embase 和 Cochrane 对照试验中心注册库；主要欧洲、美国和亚洲胃肠病学会议的摘要集。
对既往未治疗的成年人进行的随机对照试验，其中序贯疗法与既往或新疗法进行比较。
共评价和分析了 46 项随机对照试验。5666 例患者被随机分配至序贯治疗组，7866 例患者被随机分配至其他（已确立和新）治疗组。序贯疗法的总体根除率为 84.3%（95%置信区间 82.1%至 86.4%）。序贯疗法优于 7 天三联疗法（相对危险度 1.21，95%置信区间 1.17 至 1.25；I²=29.3%；需要治疗数 6，95%置信区间 5%至 7），略优于 10 天三联疗法（1.11，1.04 至 1.19；I²=67.2%；NNT10，7 至 15），但不优于 14 天三联疗法（1.00，0.94 至 1.06；I²=54.3%）、铋剂疗法（1.01，0.95 至 1.06；I²=21.1%）和非铋剂疗法（0.99，0.94 至 1.05；I²=52.3%）。有 8 项研究提供了根据治疗前抗菌药物敏感性检测结果进行的根除率数据，对克拉霉素耐药菌株，序贯疗法能够根除 72.8%（61.6%至 82.8%）。
目前用于治疗幽门螺杆菌的既往和新疗法的根除率不理想。区域耐药率监测有助于指导治疗，需要开发新的治疗药物。
