Feng Li, Wen Mao-Yao, Zhu Yong-Jun, Men Ruo-Ting, Yang Li
1Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; and 2Department of Gastroenterology, The Second People's Hospital of Chengdu, Sichuan, China.
Am J Ther. 2016 May-Jun;23(3):e880-93. doi: 10.1097/MJT.0000000000000191.
The effectiveness of standard triple therapy (STT) for the eradication of Helicobacter pylori has decreased recently. Sequential therapy (SQT) is a new regimen proposed to address this problem. The aim of this study was to compare the efficacy of SQT versus STT for H. pylori eradication. We searched The Cochrane Library, MEDLINE, Web of Science, and EMBASE databases up to July 2014. The risk ratios (RRs) of eradication rate were pooled, with a 95% confidence interval (CI). Thirty-six randomized clinical trials including a total of 10,316 patients met the inclusion criteria. The RR for eradication of H. pylori with SQT compared with STT was 1.14 (95% CI: 1.09-1.17), the eradication rates were 84.1% and 75.1%, respectively. There was significant heterogeneity between trial results (I = 73%; P < 0.00001). Subgroup analyses showed that SQT was superior to both 7- and 10-day STT, but not significantly better than 14-day STT. This superiority existed when patients were treated with either metronidazole or tinidazole. Patients with single clarithromycin-resistant strain showed a greater benefit of SQT over STT (eradication rates 80.9% vs. 40.7%), RR = 1.98 (95% CI: 1.33-2.94). There was no significant difference between groups in terms of the risk of adverse effects. In conclusion, SQT is more efficacious than STT (7 days and 10 days) in the eradication of HP, but the pooled rate seemed suboptimal. Further research is needed to develop more effective therapeutic approaches. Surveillance of resistance rates should be performed to guide treatment.
标准三联疗法（STT）根除幽门螺杆菌的有效性近来有所下降。序贯疗法（SQT）是为解决这一问题而提出的一种新方案。本研究的目的是比较SQT与STT根除幽门螺杆菌的疗效。我们检索了截至2014年7月的Cochrane图书馆、MEDLINE、科学网和EMBASE数据库。汇总根除率的风险比（RRs）及95%置信区间（CI）。36项随机临床试验共纳入10316例患者，符合纳入标准。与STT相比，SQT根除幽门螺杆菌的RR为1.14（95%CI：1.09 - 1.17），根除率分别为84.1%和75.1%。试验结果间存在显著异质性（I² = 73%；P < 0.00001）。亚组分析显示，SQT优于7天和10天的STT，但并不显著优于14天的STT。当患者使用甲硝唑或替硝唑治疗时，这种优势均存在。对克拉霉素单耐药菌株患者，SQT比STT的获益更大（根除率80.9%对40.7%），RR = 1.98（95%CI：1.33 - 2.94）。两组间不良反应风险无显著差异。总之，SQT在根除幽门螺杆菌方面比7天和10天的STT更有效，但汇总率似乎并不理想。需要进一步研究以开发更有效的治疗方法。应进行耐药率监测以指导治疗。
