Li Bo, Lan Xiaoqian, Wang Li, Zhao Jiani, Ding Jingli, Ding Hao, Lei Jun, Wei Yiping, Zhang Wenxiong
Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China; Jiangxi Medical College, Nanchang University, 330006, Nanchang, China.
Jiangxi Medical College, Nanchang University, 330006, Nanchang, China; Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, China.
Microb Pathog. 2020 Feb 16;142:104075. doi: 10.1016/j.micpath.2020.104075.
Helicobacter pylori (H. pylori) infection is one of the important risk factors of gastric related diseases and antibiotic therapy has become an effective treatment. At present, proton-pump inhibitor and amoxicillin-based triple therapy, including clarithromycin (PAC) and metronidazole (PAM), are two commonly used first-line therapies for H. pylori infection, which has a high incidence and possibly poor prognosis worldwide.
A systematic literature review was performed using the databases PubMed, the Cochrane Library, Ovid Medline, Science Direct, Embase, Scopus and Web of Science. Only randomized clinical trials with full texts published were included.
Eighteen studies involving 3264 patients were included. The pooled risk ratios (RR) between the PAC and PAM groups were comparable in the intention-to-treat (ITT) eradication rates (71.0% versus 75.2%, RR = 0.96, p = 0.38) and per-protocol (PP) eradication rates (79.6% versus 80.1%, RR = 1.02, p = 0.65). PAM is highly effective in clarithromycin-resistant cases (70.4% versus 48.2%, RR = 0.65, p = 0.002) and that PAC showed significant efficacy in metronidazole-resistant cases (87.3% versus 58.6%, RR = 1.43, p = 0.0006). In subgroup analysis, when using low-dose PPI, the PAM group showed greater efficacy than the PAC group. Furthermore, we found that PAM showed higher effectiveness in the studies published in recent years, especially for people over 60 years old (RR = 0.80, 95% CI: 0.71-0.89, p < 0.001).
In general, both PAC and PAM regimens were effective and comparable in eradicating H. pylori. However, the PAM regimen showed greater efficacy than the PAC regimen in recent years, especially for people over 60 years old.
幽门螺杆菌（H. pylori）感染是胃部相关疾病的重要危险因素之一，抗生素治疗已成为一种有效的治疗方法。目前，以质子泵抑制剂和阿莫西林为基础的三联疗法，包括克拉霉素（PAC）和甲硝唑（PAM），是两种常用的幽门螺杆菌感染一线治疗方案，在全球范围内发病率高且预后可能较差。
使用PubMed、Cochrane图书馆、Ovid Medline、Science Direct、Embase、Scopus和Web of Science数据库进行系统的文献综述。仅纳入发表了全文的随机临床试验。
纳入了18项研究，涉及3264名患者。PAC组和PAM组在意向性治疗（ITT）根除率（71.0%对75.2%，RR = 0.96，p = 0.38）和符合方案（PP）根除率（79.6%对80.1%，RR = 1.02，p = 0.65）方面的合并风险比（RR）相当。PAM在克拉霉素耐药病例中疗效显著（70.4%对48.2%，RR = 0.65，p = 0.002），而PAC在甲硝唑耐药病例中显示出显著疗效（87.3%对58.6%，RR = 1.43，p = 0.0006）。在亚组分析中，使用低剂量质子泵抑制剂时，PAM组比PAC组疗效更佳。此外，我们发现PAM在近年来发表的研究中显示出更高的有效性，尤其是对于60岁以上的人群（RR = 0.80，95%CI：0.71 - 0.89，p < 0.001）。
总体而言，PAC和PAM方案在根除幽门螺杆菌方面均有效且相当。然而，近年来PAM方案比PAC方案疗效更佳，尤其是对于60岁以上的人群。
