He Lei, Deng Tao, Luo Hesheng
Department of Gastroenterology, Renmin Hospital of Wuhan University, China.
Intern Med. 2015;54(7):703-10. doi: 10.2169/internalmedicine.54.3442. Epub 2015 Apr 1.
To compare the efficacy of sequential therapy, concomitant therapy and hybrid therapy for the treatment of Helicobacter pylori (H. pylori) infection.
PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and CNKI were searched up to the end of May 10, 2014 in order to identify all randomized controlled trials (RCTs) reporting the effects of sequential therapy, concomitant therapy and hybrid therapy on H. pylori eradication. The relative risk (RR) of eradicating H. pylori infection after sequential therapy compared with concomitant therapy or hybrid therapy was pooled. The eradication rates were considered both on an intention-to-treat (ITT) and per-protocol (PP) basis.
A total of 10 RCTs involving 3,501 patients were included. The pooled data suggested that the differences between the three groups were not statistically significant (ITT analysis: sequential therapy vs. concomitant therapy: RR=1.01, 95%confidence interval (CI): 0.97-1.04, sequential therapy vs. hybrid therapy: RR=1.02, 95%CI: 0.85-1.22, concomitant therapy vs. hybrid therapy: RR=1.03, 95%CI: 0.97-1.08; PP analysis: sequential therapy vs. concomitant therapy: RR=1.00, 95%CI: 0.96-1.03, sequential therapy vs. hybrid therapy: RR=0.97, 95%CI: 0.86-1.09, concomitant therapy vs. hybrid therapy: RR=1.01, 95%CI: 0.93-1.10). In the ITT and PP analyses, the overall eradication rates were 84.3% (95%CI: 79.1-89.4) and 86.4% (95%CI: 81.7-91.0) for the sequential therapy group, 86.7% (95%CI: 81.0-92.3) and 89.8% (95%CI: 85.1-94.5) for the concomitant therapy group and 86.6% (95%CI: 82.3-91.0) and 92.7% (95%CI: 90.5-94.9) for the hybrid therapy group, respectively. There were no significant differences among these therapies in terms of the rate of side effects.
The pooled evidence suggests that sequential therapy, concomitant therapy and hybrid therapy are similar with respect to the treatment of H. pylori infection.
比较序贯疗法、联合疗法和混合疗法治疗幽门螺杆菌（H. pylori）感染的疗效。
检索截至2014年5月10日的PubMed、Web of Science、Medline、Embase、Cochrane对照试验中央注册库和中国知网，以识别所有报告序贯疗法、联合疗法和混合疗法对幽门螺杆菌根除效果的随机对照试验（RCT）。汇总序贯疗法与联合疗法或混合疗法相比根除幽门螺杆菌感染的相对风险（RR）。在意向性治疗（ITT）和符合方案（PP）基础上考虑根除率。
共纳入10项RCT，涉及3501例患者。汇总数据表明，三组之间的差异无统计学意义（ITT分析：序贯疗法与联合疗法：RR = 1.01，95%置信区间（CI）：0.97 - 1.04；序贯疗法与混合疗法：RR = 1.02，95%CI：0.85 - 1.22；联合疗法与混合疗法：RR = 1.03，95%CI：0.97 - 1.08；PP分析：序贯疗法与联合疗法：RR = 1.00，95%CI：0.96 - 1.03；序贯疗法与混合疗法：RR = 0.97，95%CI：0.86 - 1.09；联合疗法与混合疗法：RR = 1.01，95%CI：0.93 - 1.10）。在ITT和PP分析中，序贯疗法组的总体根除率分别为84.3%（95%CI：79.1 - 89.4）和86.4%（95%CI：81.7 - 91.0），联合疗法组为86.7%（95%CI：81.0 - 92.3）和89.8%（95%CI：85.1 - 94.5），混合疗法组为86.6%（95%CI：82.3 - 91.0）和92.7%（95%CI：90.5 - 94.9）。这些疗法在副作用发生率方面无显著差异。
汇总证据表明，序贯疗法、联合疗法和混合疗法在治疗幽门螺杆菌感染方面相似。
