基于 Vonoprazan 的幽门螺杆菌感染治疗的疗效和安全性：系统评价和网络荟萃分析。

OBJECTIVE: The aim of this study was to evaluate the effectiveness and safety of the nine most widely studied Vonoprazan (VPZ)-based treatment regimens along with traditional Proton pump inhibitor (PPI)-based treatment regimens in eradicating Helicobacter pylori (H. pylori) infection. DESIGN: Through searching PubMed, Embase, Cochrane Library, Web of Science, we exclusively included randomized controlled trials (RCTs) to investigate the efficacy of VPZ-based and PPI-based therapies for H. pylori infection. The included studies were evaluated for methodological quality using the Cochrane bias risk assessment tool, and the data analysis software was used to analyze the data accordingly. RESULTS: The RCTs were collected from the earliest available date up to August 2023. Twenty-one RCTs were included, with a total sample size of 5481. The results of the network meta-analysis showed that the eradication rate of the VPZ-based quadruple 14-day (VPZ-Q14) treatment regimen in Intention-to-treat (ITT) analysis was the highest (SUCRA: 0.874); The eradication rate of the VPZ-based quadruple 10-day (VPZ-Q10) treatment plan in Per-protocol (PP) analysis was the highest (SUCRA: 0.849). All regimens were well tolerated without significant differences. According to the probability ranking of safety, high-dose VPZ-based dual 14-day therapy (H-VPZ-D14) ranked first in SUCRA, reaching 0.952. This indicates that H-VPZ-D14 treatment is the safest with a relatively low incidence of adverse effect. Therefore, VPZ-based therapies not only have a higher eradication rate, but also possess satisfactory safety. CONCLUSION: Compared with traditional PPI-based therapies, VPZ-based therapies have shown superior eradication effects. Based on the Ranking Plot of the Network, the VPZ-Q14 or VPZ-Q10 treatment regimen for H. pylori has a higher eradication rate and acceptable differences compared to other treatment regimens. In addition, for regions with high antibiotic resistance rates, we recommend a 14-day quadruple therapy with bismuth based on VPZ.

目的：本研究旨在评估九种研究最多的基于 Vonoprazan（VPZ）的治疗方案与传统质子泵抑制剂（PPI）为基础的治疗方案在根除幽门螺杆菌（H. pylori）感染方面的有效性和安全性。

设计：通过检索 PubMed、Embase、Cochrane 图书馆、Web of Science，我们专门纳入了随机对照试验（RCTs），以调查基于 VPZ 和 PPI 的治疗方案对 H. pylori 感染的疗效。使用 Cochrane 偏倚风险评估工具对纳入的研究进行方法学质量评估，并使用数据分析软件进行相应的数据分析。

结果：从最早可获得的日期到 2023 年 8 月，共收集了 21 项 RCT。共有 5481 名患者纳入研究。网络荟萃分析结果显示，基于意向治疗（ITT）分析，VPZ 四联 14 天（VPZ-Q14）治疗方案的根除率最高（SUCRA：0.874）；基于方案（PP）分析，VPZ 四联 10 天（VPZ-Q10）治疗方案的根除率最高（SUCRA：0.849）。所有方案均具有良好的耐受性，无显著差异。根据安全性概率排名，高剂量 VPZ 双联 14 天治疗（H-VPZ-D14）在 SUCRA 中排名第一，达到 0.952。这表明 H-VPZ-D14 治疗安全性最高，不良反应发生率相对较低。因此，VPZ 为基础的治疗方案不仅具有更高的根除率，而且具有令人满意的安全性。

结论：与传统 PPI 为基础的治疗方案相比，VPZ 为基础的治疗方案具有更优越的根除效果。基于网络的排名图，VPZ-Q14 或 VPZ-Q10 治疗方案在根除率方面优于其他治疗方案，差异可接受。此外，对于抗生素耐药率较高的地区，我们建议使用基于 VPZ 的铋四联 14 天疗法。