Zhang M, Chen C Y, Wang X T, Lyu B
Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, China.
Zhonghua Nei Ke Za Zhi. 2017 May 1;56(5):368-374. doi: 10.3760/cma.j.issn.0578-1426.2017.05.013.
To evaluate the efficacy of levofloxacin-based triple therapy and bismuth-based quadruple therapy in the treatment of (Hp) infection as rescue regimens. Related randomized controlled trials assessing the efficacy and safety of levofloxacin-based triple therapy eradicating Hp as salvage treatment were retrieved from Pubmed, Cochrane Library, SPRINGER, VIP database, WanFang database and CKNI database. The literature quality was evaluated by the improved Jadad criterion. RevMan5.3 sofeware was applied to data analysis. The mergment model was chosen on the basis of the outcome of the heterogeneity tests and original data was pooled for meta-analysis. Publication bias assessed with funnel plots. Ultimately seventeen literatures were included for meta-analysis, the analysis showed that the eradication rate of levofloxacin-based triple therapy was higher comparing to the bismuth-based quadruple therapy but the difference was not statistically significant(77.0% vs 68.7%, =1.52, 95% 0.96-2.42, =0.34). In European countries, levofloxacin-based triple therapy was more effective than quadruple therapy(80.6% vs 68.5%, =2.18, 95% 1.25-3.81, <0.05), while eradication rates of two groups in Asian countries were similar. The 7-day levofloxacin-based triple therapy and quadruple therapy showed comparable efficacy, whereas the 10-day levofloxacin-based triple therapy was significantly more effective than quadruple therapy(87.7% vs 61.3%, =4.92, 95% 3.09-7.82, <0.05). The efficacy was not influenced by the dose of levofloxacin. The adverse effects were significantly lesser(19.1% vs 29.5%, =0.47, 95% 0.26-0.82, <0.05), whereas the compliance rate was significantly higher in levofloxacin group (96.0% vs 89.9%, =2.27, 95% 1.33-3.87, <0.05). Comparing with bismuth-based quadruple therapy, levofloxacin-based triple therapy has higher eradication rate, compliance rate and lesser side effects, so we recommend it as a second-line rescue therapy after front-line Hp eradication failure. The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.
评估以左氧氟沙星为基础的三联疗法和以铋剂为基础的四联疗法作为补救方案治疗幽门螺杆菌（Hp）感染的疗效。从PubMed、Cochrane图书馆、施普林格、维普数据库、万方数据库和中国知网数据库中检索评估以左氧氟沙星为基础的三联疗法根除Hp作为挽救治疗的疗效和安全性的相关随机对照试验。采用改良的Jadad标准评估文献质量。应用RevMan5.3软件进行数据分析。根据异质性检验结果选择合并模型，并对原始数据进行汇总以进行荟萃分析。用漏斗图评估发表偏倚。最终纳入17篇文献进行荟萃分析，分析显示，与以铋剂为基础的四联疗法相比，以左氧氟沙星为基础的三联疗法的根除率更高，但差异无统计学意义（77.0%对68.7%，Z = 1.52，95%CI 0.96 - 2.42，P = 0.34）。在欧洲国家，以左氧氟沙星为基础的三联疗法比四联疗法更有效（80.6%对68.5%，Z = 2.18，95%CI 1.25 - 3.81，P < 0.05），而在亚洲国家两组的根除率相似。7天的以左氧氟沙星为基础的三联疗法和四联疗法疗效相当，而10天的以左氧氟沙星为基础的三联疗法比四联疗法显著更有效（87.7%对61.3%，Z = 4.92，95%CI 3.09 - 7.82，P < 0.05）。疗效不受左氧氟沙星剂量的影响。不良反应显著较少（19.1%对29.5%，Z = 0.47，95%CI 0.26 - 0.82，P < 0.05），而左氧氟沙星组的依从率显著更高（96.0%对89.9%，Z = 2.27，95%CI 1.33 - 3.87，P < 0.05）。与以铋剂为基础的四联疗法相比，以左氧氟沙星为基础的三联疗法有更高的根除率、依从率和更少的副作用，因此我们推荐在一线根除Hp失败后将其作为二线补救疗法。根据喹诺酮类耐药情况，最佳二线替代方案在不同国家可能有所不同。
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