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大剂量双重疗法用于幽门螺杆菌补救治疗的疗效与安全性:一项系统评价和荟萃分析

Efficacy and safety of high-dose dual therapy for Helicobacter pylori rescue therapy: A systematic review and meta-analysis.

作者信息

Gao Cai Ping, Zhou Zhou, Wang Jia Zhen, Han Sheng Xi, Li Liang Ping, Lu Hong

机构信息

Department of Gastroenterology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.

Department of Internal Medicine, Santai People's Hospital, Santai, Sichuan Province, China.

出版信息

J Dig Dis. 2016 Dec;17(12):811-819. doi: 10.1111/1751-2980.12432.

Abstract

OBJECTIVE

Although some studies have reported >90% success with high-dose dual proton pump inhibitor (PPI)-amoxicillin dual therapy for Helicobacter pylori (H. pylori) eradication, the efficacy of this therapy remains controversial. We aimed to re-evaluate the efficacy and safety of high-dose dual therapy on H. pylori eradication.

METHODS

We searched PubMed, the Cochrane Library, and EMBASE for randomized clinical trials (RCTs) evaluating the efficacy of high-dose PPI-amoxicillin dual therapy as the rescue therapy on H. pylori eradication. Treatment effect was determined with a fixed-effect model using the inverse variance method and was expressed as risk ratio (RR) with 95% confidence interval (CI).

RESULTS

Because of significant statistical heterogeneity (χ  15.98, I  = 69%) among the six studies that qualified, four RCTs that included 473 patients with H. pylori infection after eradication failure were assessed. The meta-analysis showed that high-dose dual therapy and guideline-recommended rescue therapies achieved similar efficacy (81.3% vs 81.5%, RR 1.00 [95% CI 0.93-1.08], intention-to-treat analysis), compliance (95.3% vs 95.4%, RR 1.00 [95% CI 0.97-1.03]), and side effects (17.9% vs 19.7%, RR 0.88 [95% CI 0.62-1.25]).

CONCLUSIONS

High-dose PPI-amoxicillin dual therapy is comparable to recommended rescue therapies for H. pylori infection. More researches are needed to determine the efficacy of high-dose dual therapy as a first-line therapy.

摘要

目的

尽管一些研究报告称,高剂量质子泵抑制剂(PPI)-阿莫西林双重疗法根除幽门螺杆菌(H. pylori)的成功率超过90%,但该疗法的疗效仍存在争议。我们旨在重新评估高剂量双重疗法根除幽门螺杆菌的疗效和安全性。

方法

我们检索了PubMed、Cochrane图书馆和EMBASE,以查找评估高剂量PPI-阿莫西林双重疗法作为补救疗法根除幽门螺杆菌疗效的随机临床试验(RCT)。采用固定效应模型和逆方差法确定治疗效果,并以风险比(RR)及95%置信区间(CI)表示。

结果

由于纳入的6项研究存在显著的统计学异质性(χ² = 15.98,I² = 69%),因此对4项纳入473例根除失败的幽门螺杆菌感染患者的RCT进行了评估。荟萃分析表明,高剂量双重疗法与指南推荐的补救疗法在疗效(81.3%对81.5%,RR 1.00 [95% CI 0.93 - 1.08],意向性分析)、依从性(95.3%对95.4%,RR 1.00 [95% CI 0.97 - 1.03])和副作用(17.9%对19.7%,RR 0.88 [95% CI 0.62 - 1.25])方面相似。

结论

高剂量PPI-阿莫西林双重疗法与推荐的幽门螺杆菌感染补救疗法相当。需要更多研究来确定高剂量双重疗法作为一线疗法的疗效。

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