Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Gastroenterology, Laboratory Department of Baiyun Branch, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Helicobacter. 2023 Dec;28(6):e13015. doi: 10.1111/hel.13015. Epub 2023 Aug 27.
The prevalence of antibiotic resistance for Helicobacter pylori (H. pylori) has been increasing over the year, making it more difficult for traditional empirical therapy to successfully eradicate H. pylori. Thus, tailored therapy (TT) guided by molecular-based antibiotic susceptibility testing (AST) has been frequently recommended. We conducted a single-arm meta-analysis to determine the efficacy of tailored therapy guided by molecular-based AST.
A systematic literature review was performed on multiple databases, and studies on molecular-based TT were included. The eradication rates of TT by intention-to-treat (ITT) and per-protocol (PP) analyses were pooled respectively.
A total of 35 studies from 31 literature (4626 patients) were included in the single-arm meta-analysis. Overall, the pooled eradication rate of TT was 86.9% (95% CI:84.7%-89.1%) by the ITT analysis, and 91.5% (95% CI:89.8%-93.2%) by PP analysis. The pooled eradication rates of first-line TT and rescue TT were 86.6% and 85.1% by ITT analysis and 92.0% and 87.9% by PP analysis, respectively. When tailored rescue therapy was based on the genotypic resistance to at least four antibiotics, the pooled eradication rates reached 89.4% by ITT analysis and 92.1% by PP analysis. For genotype-susceptive strains, the pooled eradication rate of TT with targeted antibiotics was 93.1% (95% CI:91.3%-94.9%), among which the pooled eradication rate of tailored bismuth quadruple therapy was the highest (94.3%). Besides, the eradication rate of 7-day TT or tailored triple therapy without bismuth for genotype-susceptive strains could both reach more than 93.0%.
Tailored therapy guided by molecular-based AST can achieve somewhat ideal therapeutic outcomes. TT with a 7-day duration or without bismuth for genotype-susceptible strains can achieve good eradication efficacy. The effectiveness of TT can be improved to some extent by expanding the coverage of AST or by adding bismuth.
幽门螺杆菌（H. pylori）对抗生素的耐药率逐年上升，传统经验性治疗成功根除 H. pylori 的难度越来越大。因此，经常推荐基于分子的抗生素药敏试验（AST）指导的靶向治疗（TT）。我们进行了一项单臂荟萃分析，以确定基于分子的 AST 指导的靶向治疗的疗效。
对多个数据库进行系统文献回顾，并纳入基于分子的 TT 研究。分别汇总意向治疗（ITT）和按方案（PP）分析的 TT 根除率。
单臂荟萃分析共纳入 31 篇文献中的 35 项研究（4626 例患者）。总体而言，ITT 分析中 TT 的总体根除率为 86.9%（95%CI：84.7%-89.1%），PP 分析中为 91.5%（95%CI：89.8%-93.2%）。ITT 分析中一线 TT 和挽救 TT 的根除率分别为 86.6%和 85.1%，PP 分析中分别为 92.0%和 87.9%。当基于对至少四种抗生素的基因型耐药进行靶向挽救治疗时，ITT 分析的根除率达到 89.4%，PP 分析中达到 92.1%。对于基因型敏感菌株，靶向抗生素 TT 的总体根除率为 93.1%（95%CI：91.3%-94.9%），其中靶向铋四联疗法的根除率最高（94.3%）。此外，对于基因型敏感菌株，7 天 TT 或无铋的靶向三联疗法的根除率均可达到 93.0%以上。
基于分子的 AST 指导的靶向治疗可以获得较为理想的治疗效果。对于基因型敏感菌株，7 天疗程或不含铋的靶向三联疗法可达到良好的根除效果。通过扩大 AST 的覆盖范围或添加铋，可在一定程度上提高 TT 的疗效。
