系统评价与荟萃分析：幽门螺杆菌感染一线治疗中，联合治疗与三联治疗的比较。
Systematic Review with Meta-Analysis: Concomitant Therapy vs. Triple Therapy for the First-Line Treatment of Helicobacter pylori Infection.
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan. Institute of Occupational Medicine and Industry Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan. Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan. Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, National Taiwan University College of Medicine, Yun-Lin, Taiwan. Department of Internal Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
出版信息
Am J Gastroenterol. 2018 Oct;113(10):1444-1457. doi: 10.1038/s41395-018-0217-2. Epub 2018 Aug 31.
BACKGROUND
Whether concomitant therapy is superior to triple therapy of various treatment lengths for the first-line treatment of H. pylori remains controversial. The objective of this study is to compare the efficacy of concomitant therapy and triple therapy given for 5-14 days.
METHODS
Randomized control trials (RCTs) comparing the efficacy of concomitant therapy for 5-14 days and proton pump inhibitor-amoxicillin-clarithromycin (PAC)-based triple therapy for 5-14 days in the first-line treatment of adult patients with H. pylori infection published from 1990 to January 2018 were searched from the PubMed, Cochrane Library, and Embase. Abstracts from international annual conferences were also searched. The primary and secondary outcomes were the eradication rate according to the intention-to-treat analysis and the adverse effects, respectively. Subgroup analyses were also performed according to treatment length. This study is registered with PROSPERO, number CRD42017081328.
RESULTS
Of the 639 articles identified, 23 RCTs including 3305 patients in the concomitant therapy group and 3327 patients in the triple therapy group were eligible. Overall, concomitant therapy was superior to triple therapy [risk ratio (RR): 1.15; 95% confidence interval (CI): 1.09-1.21; p < 0.001]. However, there were significant heterogeneity (I = 74.0%, p < 0.001). In the subgroup analysis, 5-day concomitant therapy was superior to 5-day triple therapy (RR: 1.30; 95% CI: 1.04-1.62; p = 0.02), 5- or 7-day concomitant therapy was superior to 7-day triple therapy (RR: 1.16; 95% CI: 1.12-1.21; p < 0.001), and 5- or 7-, or 10- or 14-day concomitant therapy was superior to 10-day triple therapy (RR: 1.15; 95% CI: 1.08-1.23; p < 0.001). However, 5- or 10-day concomitant therapy was not superior to 14-day triple therapy (RR: 1.02; 95% CI: 0.89-1.16; p = 0.796). The frequency of adverse effects was significantly higher in concomitant therapy than triple therapy (RR: 1.19; 95% CI: 1.06-1.34; P = 0.004).
CONCLUSIONS
Concomitant therapy given for 5 or 10 days was superior to 5- or 7-, or 10-day PAC-based triple therapy, but was not superior to 14-day triple therapy.
背景
对于幽门螺杆菌的一线治疗，联合治疗是否优于各种治疗时长的三联疗法仍存在争议。本研究旨在比较 5-14 天的联合治疗与质子泵抑制剂-阿莫西林-克拉霉素（PAC）为基础的三联疗法 5-14 天的疗效。
方法
从 1990 年至 2018 年 1 月，从 PubMed、Cochrane 图书馆和 Embase 中检索比较 5-14 天的联合治疗与 PAC 为基础的三联疗法（5-14 天）治疗成人幽门螺杆菌感染的随机对照试验（RCT）。还检索了国际年度会议的摘要。主要和次要结局分别为根据意向治疗分析的根除率和不良反应。还根据治疗时间进行了亚组分析。本研究已在 PROSPERO 注册，编号 CRD42017081328。
结果
从 639 篇文章中，有 23 项 RCT 符合条件，共有 3305 例患者接受联合治疗，3327 例患者接受三联治疗。总体而言，联合治疗优于三联治疗[风险比（RR）：1.15；95%置信区间（CI）：1.09-1.21；p<0.001]。然而，存在显著的异质性（I=74.0%，p<0.001）。在亚组分析中，5 天的联合治疗优于 5 天的三联治疗（RR：1.30；95%CI：1.04-1.62；p=0.02），5 天或 7 天的联合治疗优于 7 天的三联治疗（RR：1.16；95%CI：1.12-1.21；p<0.001），5 天、7 天、10 天或 14 天的联合治疗优于 10 天的三联治疗（RR：1.15；95%CI：1.08-1.23；p<0.001）。然而，5 天或 10 天的联合治疗并不优于 14 天的三联治疗（RR：1.02；95%CI：0.89-1.16；p=0.796）。联合治疗的不良反应发生率明显高于三联治疗（RR：1.19；95%CI：1.06-1.34；p=0.004）。
结论
5 天或 10 天的联合治疗优于 5-7 天或 10 天的 PAC 为基础的三联治疗，但并不优于 14 天的三联治疗。
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