Song Zhi-Qiang, Liu Jian, Zhou Li-Ya
Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China.
Chin Med J (Engl). 2016 Apr 20;129(8):992-9. doi: 10.4103/0366-6999.179803.
Helicobacter pylori (H. pylori) eradication remains a challenge with increasing antibiotic resistance. Hybrid therapy has attracted widespread attention because of initial report with good efficacy and safety. However, many issues on hybrid therapy are still unclear such as the eradication efficacy, safety, compliance, influencing factors, correlation with antibiotic resistance, and comparison with other regimens. Therefore, a comprehensive review on the evidence of hybrid therapy for H. pylori infection was conducted.
The data used in this review were mainly from PubMed articles published in English up to September 30, 2015, searching by the terms of "Helicobacter pylori" or "H. pylori", and "hybrid".
Clinical research articles were selected mainly according to their level of relevance to this topic.
Totally, 1871 patients of 12 studies received hybrid therapy. The eradication rates were 77.6-97.4% in intention-to-treat and 82.6-99.1% in per-protocol analyses. Compliance was 93.3-100.0%, overall adverse effects rate was 14.5-67.5%, and discontinued medication rate due to adverse effects was 0-6.7%. H. pylori culture and sensitivity test were performed only in 13.3% patients. Pooled analysis showed that the eradication rates with dual clarithromycin and metronidazole susceptible, isolated metronidazole or clarithromycin resistance, and dual clarithromycin and metronidazole resistance were 98.5%, 97.6%, 92.9%, and 80.0%, respectively. Overall, the efficacy, compliance, and safety of hybrid therapy were similar with sequential or concomitant therapy. However, hybrid therapy might be superior to sequential therapy in Asians.
Hybrid therapy showed wide differences in the efficacy but consistently good compliance and safety across different regions. Dual clarithromycin and metronidazole resistance were the key factor to efficacy. Hybrid therapy was similar to sequential or concomitant therapy in the efficacy, safety, and compliance.
随着抗生素耐药性的增加，幽门螺杆菌（H. pylori）根除仍然是一项挑战。混合疗法因其初步报道的良好疗效和安全性而受到广泛关注。然而，混合疗法的许多问题仍不明确，如根除疗效、安全性、依从性、影响因素、与抗生素耐药性的相关性以及与其他方案的比较。因此，对H. pylori感染混合疗法的证据进行了全面综述。
本综述中使用的数据主要来自截至2015年9月30日以英文发表在PubMed上的文章，通过搜索“幽门螺杆菌”或“H. pylori”以及“混合”等术语获取。
主要根据临床研究文章与本主题的相关程度进行选择。
共有12项研究的1871例患者接受了混合疗法。意向性分析中的根除率为77.6% - 97.4%，符合方案分析中的根除率为82.6% - 99.1%。依从性为93.3% - 100.0%，总体不良反应率为14.5% - 67.5%，因不良反应停药率为0 - 6.7%。仅13.3%的患者进行了H. pylori培养和药敏试验。汇总分析显示，克拉霉素和甲硝唑双重敏感、单独甲硝唑或克拉霉素耐药以及克拉霉素和甲硝唑双重耐药时的根除率分别为98.5%、97.6%、92.9%和80.0%。总体而言，混合疗法的疗效、依从性和安全性与序贯或伴随疗法相似。然而，在亚洲人中，混合疗法可能优于序贯疗法。
混合疗法在不同地区的疗效差异很大，但依从性和安全性始终良好。克拉霉素和甲硝唑双重耐药是影响疗效的关键因素。混合疗法在疗效、安全性和依从性方面与序贯或伴随疗法相似。
