抗幽门螺杆菌感染的中药治疗价值探索

[目的]筛选具有抗幽门螺杆菌(helicobacter pylori,HP)感染治疗价值的中药成分.[方法]摸索各中药成分的最低抑菌浓度,制备含有低于最低抑菌浓度中药提取液的HP的培养上清作用于Hela细胞,观察中药提取液对细胞空泡化的影响.[结果]各中药成分的最低抑菌浓度以黄连(0.39mg/ml)、厚朴(6.25mg/ml)、元胡(6.25mg/ml)最低,槟榔(25.00mg/ml)、黄柏(25.00mg/ml)、白芍(25.00mg/ml)等次之;药液作用后的细胞产生空泡的细胞的百分率以槟榔(8.o％)最低,厚朴(18.0％)次之.[结论]筛选到具有显著抑制细胞空泡化的中药成分为槟榔、厚朴,为临床治疗幽门螺杆菌感染提供了一种全新的思路.     

中药联合“三联疗法”治疗幽门螺杆菌感染

本文简述了幽门螺杆菌(Hp)根除治疗方法和中医药有关研究现状。重点介绍了中药联合"三联疗法"可显著提高Hp根除率,是一个值得探索的治疗新模式。     

幽门螺杆菌感染与冠状动脉疾病关系的Meta分析

为了全面地,系统地了解幽门螺杆菌感染与冠状动脉疾病关系的研究现状,以Helicobacter Pylori,COronary Heart Disease,Myocadial Infarction和Atherosclerosis作为关键词查光盘并辅以文献追溯的方法收集文献,选择1990年1月至2000年10月以英文全文发表的专业论文为分析对象,对冠心病与幽门螺杆菌感染的关系进行Meta分析,共收集论文20篇,累积样本量为9737人,病例4283人,研究对象平均年龄在65岁以下的研究18个,其中12个一般的病例对照研究综合OR为1．96,OR95％的可信区间（confidence interval,CI)为1．76－2．18,6个巢式病例对照研究综合OR为1．21,OR95％CI为1．07－1．35,2个研究对象平均年龄在70岁以上的研究未发现冠心病与幽门螺杆菌感染有关,收集到冠心病与幽门螺杆菌毒力株感染关系的研究论文4篇,Meta分析结果表明冠心病与幽门螺杆菌毒力株感染有关,综合OR为1．52,OR95％CI为1．26－1．84,此文结果提示,65岁前发生的冠心病与HP感染有关,但这种关联是否为因果联系,尚待设计严谨的队列研究及对冠心病人抗HP感染治疗的随机对照实验来确定。     

乳糜泻与幽门螺杆菌感染相关性的Meta分析

目的 探讨乳糜泻与幽门螺杆菌(Helicobacter pylori,H.pylori)感染的相关性。方法 收集已发表的乳糜泻患者感染H.pylori的文献,记录发表年份、地区、第一作者、研究人群及检测方法等,建立Meta回归模型并同时进行亚组分析及异质性检测。结果 共检索316篇文献,最终8篇符合入选标准。入选文献共纳入2 635例患者,H.pylori总感染率为36.02%。Meta分析结果显示,乳糜泻患者与健康对照组比较,H.pylori感染率差异无统计学意义,乳糜泻与H.pylori感染呈负相关。亚组分析提示,南美洲人群中乳糜泻患者的H.pylori感染率高于对照组,乳糜泻与H.pylori呈正相关,而欧洲、亚洲人群中乳糜泻患者的H.pylori感染率低于对照组;2010年及之后的乳糜泻患者中H.pylori感染率低于对照组,2010年之前的乳糜泻患者中H.pylori感染率与对照组比较差异无统计学意义(P>0.05);采用H+RUT检测H.pylori感染时乳糜泻组H.pylori感染率低于对照组,差异有统计学意义(P<0.05),采用H与RUT,H+ELISA、...     

幽门螺杆菌耐药性机制及中药治疗进展

幽门螺杆菌(Hp)是一种革兰阴性微需氧菌,已被认为是一种重要的人类病原体,感染全球约50%的人口,并导致上消化道疾病的发展,包括慢性胃炎、消化性溃疡疾病、胃癌和黏膜相关淋巴组织(MALT)淋巴瘤,其被世界卫生组织和国际癌症研究机构定义为Ⅰ类致癌物[1-4]。因此,根除Hp可以减少慢性萎缩性胃炎和肠化生的发生,有助于胃癌及相关胃病的预防和治疗[5]。     

幽门螺杆菌感染和T辅助细胞

幽门螺杆菌（HP）感染是慢性胃窦炎和消化性溃疡的重要致病因素。HP抗原诱导胃窦粘膜产生以CD4^ Th1为主的特异性细胞免疫反应,但是Th1介导的细胞免疫对HP感染不仅无保护作用,而且与疾病的严重程度有关,与此同时CD4^ Th2细胞受到抑制,从而导致B细胞分泌的IgA减少,不能有效地清除HP,因此HP感染持续存在。现在开发的疫苗是通过诱导胃窦部粘膜产生以Th2为主的免疫反应,促进粘膜局部的B细胞分泌足够的IgA来清除HP,从而有效地预防HP感染,甚至清除慢性HP感染病人粘膜中的HP。     

中国人群幽门螺杆菌感染相关因素的Meta分析

目的: 评价H pylori感染的相关因素, 为预防决策提供依据.方法: 以幽门螺杆菌、感染、相关因素和流行病学等为检索词,检索CNKI中国期刊全文数据库及CBM光盘数据库,并辅以文献追溯、手工检索等方法收集1990-01/2008-05国内正式刊物上公开发表的有关H pylori感染相关因素的研究文献. 对这些研究中涉及的某些相关因素采用Meta分析方法选择危险比值比OR值作为效应指标进行综合定量分析, 估计其合并OR值及其95%CI.根据异质性检验结果选择固定效应模型或随机效应模型进行合并, 并从原始文献统计方法采用单因素分析还是多因素分析及变换模型2个角度进行敏感性分析, 评价Meta分析结论的稳定性, 同时计算失效安全系数来估计发表偏倚的大小.结果: 纳入本次Meta分析的文献共21篇, 涉及包括来自宿主的因素( 性别、本人胃病史)、行为习惯(吸烟、饮酒、饮用水源、饮水习惯、养狗、近期服用抗生素)、饮食习惯( 进食生蔬菜、豆类、大蒜、腌制食物、熏制食物)、家人或照顾者胃病史及年幼时是否接受口嚼食物, 可能与H pylori感染相关的因素OR值及其95%CI分别为: 本人胃病史2.09(1.40, 3.12)、看护人胃病史2.43(1.74, 3.40)、饮用不洁水源2.01(1.35,3.00)、饮水习惯3.08(1.02, 9.26)、养狗1.75(1.02, 3.00)、接受过口嚼食物2.66(1.41,5.02)、吸烟1.47(1.09, 1.97)、经常食用大蒜0.67(0.56, 0.80)、豆类0.37(0.17, 0.79)、熏制1.94(1.25, 3.02)及腌制食物1.87(1.43,2.44), 性别、近期服用抗生素、饮酒、经常食用生蔬菜与H pylori感染无关.结论: 在选择的15个因素中, 影响我国人群H pylori感染的主要因素为本人胃病史、看护人胃病史、饮用不洁水源、喝生水、养狗、接受过口嚼食物、吸烟、经常食用大蒜、熏制及腌制食物等.     

幽门螺杆菌感染的治疗

幽门螺杆菌感染的治疗陈洁平徐采朴解放军第三军医大学第一附属医院消化科四川省重庆市６３００３８ＳｕｂｊｅｃｔｈｅａｄｉｎｇｓＨｅｌｉｃｏｂａｃｔｅｒｉｎｆｅｃｔｉｏｎｓ／ｔｈｅｒａｐｙＨｅｌｉｃｏｂａｃｔｅｒｐｙｌｏｒｉ主题词螺杆菌感染／治疗螺杆...     

幽门螺杆菌感染与1型糖尿病的相关性Meta分析

目的:通过Meta分析探讨幽门螺杆菌(Helicobacter pylori,H.pylori)感染与1型糖尿病(type 1 diabetes mellitus).是否具有相关性.方法:从PubMed、Embase、Cochrane Library、万方、维普资讯和中国知网等在线数据库检索自建库至2015-11发表的有关H.pylori感染与1型糖尿病关系的文献.由2名研究人员独立提取资料并评价纳入文献的质量,采用Revman5.3软件进行Meta分析,计算合并OR值及其95%CI.结果:纳入11篇参考文献,总样本量2982人,其中病例组1085例,对照组1897例,数据表现为异质性.与对照组比较,H.pylori感染增加1型糖尿病的发生风险(OR=1.68,95%CI:1.09-2.59).回归分析显示检测方法和地区分布与研究结论无关.发表偏倚和敏感性分析证实上述Meta分析结果是稳定和可靠的.结论:H.pylori感染与1型糖尿病的发生存在相关性.     

四联疗法联合中医药对幽门螺杆菌的补救治疗

目的 对进行过根除幽门螺杆菌(H.pylori)治疗而失败的患者,应用含铋剂、质子泵抑制剂的四联疗法和中医药联合补救治疗并观察根除疗效.方法 120例H.pylori阳性患者随机分成两组,每组60例;对照组应用埃索美拉唑镁肠溶片20 mg,枸橼酸铋钾胶囊(商品名丽珠得乐)0.6g(相当于铋0.22 g),阿莫西林(珠海联邦制药股份有限公司)1000 mg,呋喃唑酮(商品名痢特灵,上海利生制药厂生产)100 mg,2次/d,共7d;而治疗组除应用对照组药物外,同时服用中药14 d,观察上腹痛、反酸、饱胀感、嗳气等症状缓解情况,并在补救治疗结束1个月后复查胃黏膜快速尿素酶试验和组织学染色或查14C-尿素呼气试验,观察其根除率.结果治疗组58例完成治疗,其中53例H.pylori转阴,根除率按意图治疗(ITT)和试验方案(PP)分析分别为88.33％ (53/60)和91.38％(53/58),对照组55例完成治疗,其中48例转阴,根除率按意图治疗(ITT)和试验方案(PP)分析分别为80.00％(48/60)和87.27％(48/55),两组间比较有显著性差异(P＜0.05).治疗后两组症状缓解率分别为94.83％(治疗组)和83.64％(对照组),两组间比较有显著性差异(P＜0.05).结论 对H.pylori根除治疗失败的患者,应用四联疗法和中医药联合补救疗法不仅能获得较高的H.pylori根除率,对临床症状的改善也有良好作用,且副反应较小,值得临床推广.     

Use of traditional Chinese medicine as an adjunctive treatment for COVID-19: A systematic review and meta-analysis

Background:This review aims to evaluate the supportive effects of frequently used traditional Chinese medicine (TCM) for the treatment of coronavirus disease 2019 (COVID-19).Methods:Five databases were searched through July 7, 2020. Randomized controlled trials investigating the efficacy of TCM for use in the treatment of COVID-19 were included. Newcastle–Ottawa Scale (NOS) and modified Jadad score were used for the evaluation of the methodological quality of the included studies. Weighted mean difference, odds ratio (OR), and 95% confidence interval (95% CI) were calculated for pooling out results. Data were extracted for conducting a meta-analysis using STATA version 12.0.Results:Eight studies with a total of 750 patients were included in this meta-analysis. All included trial groups involved treatment with TCM and Western medicine, while the control groups were treated only with Western medicine. The intervention therapy significantly improved the overall effective rate (n = 346, OR = 2.5, 95% CIs = 1.46–4.29), fever symptom disappearance rate (n = 436; OR = 3.6; 95% CIs = 2.13–6.08), fatigue symptom disappearance rate (n = 436; OR = 3.04; 95% CIs = 1.76–5.26), cough symptom disappearance rate (n = 436; OR = 2.91; 95% CIs = 1.36–6.19), and sputum production reduction (n = 436; OR = 5.51; 95% CIs = 1.94–15.64). Based on the Newcastle–Ottawa Scale assessment, 6 studies received a score of 4, and 1 study achieved a score of 5. One study was assessed using the modified Jadad score, achieving a score of 6.Conclusions:The integration of TCM with Western medicine has significantly improved the treatment for COVID-19 patients compared to Western medicine treatment alone. Combined therapy using TCM and Western medicine revealed the potential adjunctive role of TCM in treating COVID-19. However, high-quality clinical studies are still required to further evaluate the efficacy and safety of TCM in the treatment of COVID-19.     

中药联合熊去氧胆酸治疗原发性胆汁性胆管炎临床疗效Meta分析

目的:通过Meta分析评价中药联合熊去氧胆酸治疗原发性胆汁性胆管炎(PBC)的临床疗效。方法:应用计算机从Cochrane Library、Pub Med、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、万方医药期刊全文及学位论文数据库中,搜索中药联合熊去氧胆酸(UDCA)和单用UDCA治疗PBC的随机对照试验(RCT)文献,截止日期到2017年12月,对纳入文献进行资料提取和文献偏倚风险评估并采用RevMan5.3进行分析。结果:结果:共纳入6项RCT试验,共401例患者,其中治疗组201例,对照组200例。Meta分析显示中药联合UDCA治疗PBC患者24周后,在提高临床症状改善率[OR=5.99,95%CI(3.71,9.68),P<0.05]、降低肝功能指标ALP[MD=-27.10,95%CI(-31.99,-22.21),P<0.05]、GGT[MD=-17.69,95%CI(-23.67,-11.71),P<0.05]、ALT[MD=-16.85,95%CI(-21.18,-12.52),P<0.05]、AST[MD=-8.67,95%CI(-11.19,-6.16),P<0.05]、降低总胆红素TBil[MD=-10.43,95%CI(-14.34,-6.52),P<0.05]、降低总胆汁酸TBil[MD=-12.24,95%CI(-20.83,-3.65),P<0.05],均优于对照组,复发率两组无差异统计学意义[OR=0.56,95%CI(0.14,2.23),P=0.41]。结论:中药联合UDCA治疗PBC在24周内对改善临床症状以及肝功能指标优于单独使用熊去氧胆酸治疗,但受纳入的RCT研究样本量和质量的限制且存在不明确和高风险偏倚,上述结论需更高质量的研究再验证。     

Efficacy and safety of integrated traditional Chinese and Western medicine for the treatment of infant bronchiolitis: A systematic review,meta-analysis and GRADE evaluation

Background:Infant bronchiolitis has a high death rate in severe cases. In China, traditional Chinese medicine (TCM) is commonly used to treat infant bronchiolitis. However, it has not received enough international attention.Objective:We aimed to assess the efficacy and safety of integrated TCM and Western medicine for treating infant bronchiolitis.Methods:We conducted a systematic review through 7 databases that included randomized controlled trials on integrated TCM and Western medicine for treating bronchiolitis, published in English or Chinese before February 4, 2021. To assess the risk of bias, the Cochrane Collaboration tool was employed to determine the quality of the included studies. We investigated clinical efficacy endpoints, hospitalization time, rates of recurrence, and adverse reactions and meta-analyzed the odds ratio (OR), mean difference (MD), and relative risk (RR), respectively. We assessed the overall certainty of the effect estimates using the GRADE approach. This study is registered with PROSPERO (CRD42021245294). Ethical approval is not required.Results:Forty-six studies (6427 children) were available for inclusion. We used 41 (5490 participants), 11 (1350 participants), 5 (1083 participants), and 11 (1295 participants) studies to analyze clinical efficacy endpoints (OR: 3.31; 95% confidence interval [CI]: 2.93, 3.74; P < .5), hospitalization time (MD: –2.10; 95% CI: –2.87, –1.34; P < .5), recurrence rate (RR: 0·41; 95% CI: 0.30, 0.56; P < .01), and adverse reaction rate (RR: 0.87; 95% CI: 0.55, 1.39; P = .57), respectively.Conclusions:Integrated TCM and Western medicine is superior to Western medicine alone for treating bronchiolitis in terms of clinical efficacy, hospitalization time, and recurrence rate, with no increase in the adverse reaction rate. TCM is useful as an alternative therapy for viral bronchiolitis. Although further studies are needed to establish specific protocols for the use of TCM in clinical practice, these results may strengthen guideline recommendations regarding the use of TCM.     

含莫西沙星的三联疗法作为根除幽门螺杆菌一线方案的Meta分析

目的 综合分析含莫西沙星的三联方案作为根除幽门螺杆菌（Hp）一线方案的疗效.方法 检索比较含莫西沙星的三联方案和标准三联方案根除幽门螺杆菌治疗的随机对照临床试验,进行荟萃分析.结果 共有7项随机对照试验符合人选标准,共纳入899例患者.基于意向治疗分析的结果显示含莫西沙星组Hp根除率为85.7%,标准治疗组为74.7%,差异有显著性（P〈0.0001）.基于按符合方案集分析的结果显示含莫西沙星组Hp根除率为86.5%,标准治疗组为76.1%,差异有显著性（P〈0.0001）.进一步行敏感性分析显示,纳入高质量研究、中文研究、疗程7天的研究和不同疾病谱的研究时结果均未出现变化.结论 含莫西沙星的三联治疗方案有较高的Hp根除率,且优于目前的标准治疗方案,可以作为根除Hp的一线治疗方案.     

中医药治疗肝硬化腹水研究进展

目前现代医学治疗肝硬化腹水的措施较为单一且疗效一般,但是中医中药在治疗该病时显示出了独特的优势,本文对中医中药领域治疗肝硬化腹水的病因病机、辨证分型及中医治疗方法等进行了阐述,以展现中医药疗法治疗肝硬化腹水的特色。     

含莫西沙星的三联方案补救根除幽门螺杆菌的系统评价

目的系统评价含莫西沙星的三联方案补救根除幽门螺杆菌（Hp）的疗效。方法检索比较含莫西沙星的三联方案和含铋剂的四联方案根除幽门螺杆菌补救治疗的随机对照临床试验,并进行荟萃分析。结果共有6项随机对照试验符合人选标准,共纳入725例患者。基于意向治疗（ITT）分析的结果显示含莫西沙星组Hp根除率为74．8％,含铋剂组为62．3％,差异有显著性（OR1．79,95％CI：1．29～2．49,P=0．0005）。基于按符合方案（PPT）分析的结果显示含莫西沙星组Hp根除率为81．4％,含铋剂组为71．7％,差异有显著性（OR1．61,95％CI：1．10～2．36,P=0．01）。进一步对仅纳入英文或中文研究以及疗程为7天的研究行敏感性分析,基于ITT分析的结果亦显示含莫西沙星组Hp根除率显著高于含铋剂组。结论含莫西沙星的三联补救根除Hp方案明显优于含铋剂的四联方案,应为Hp补救根除的优选方案。     

Allicin as add-on therapy for Helicobacter pylori infection: A systematic review and meta-analysis

BACKGROUND Allicin(2-propene-1-sulfinothioic acid S-2-propenyl ester, diallyl thiosulfinate)extracted from garlic, has proven activity against Helicobacter pylori(H. Pylori)infection. In recent years, clinical trials have explored its utility as an add-on therapy with variable outcomes reported.AIM To perform a systemic review of allicin as an add-on treatment for H. Pylori infection and assess its efficacy in randomized controlled trials(RCTs).METHODS Electronic databases including MEDLINE, EMBASE, the Web of Science, the Cochrane Database, the China National Knowledge Infrastructure Database,Chinese VIP Information Databases, Chinese Medical Databases, and the WanFang Database were searched for keywords including "allicin", "Helicobacter pylori", "randomized clinical trials", and their synonyms. A meta-analysis was performed using the fixed-effects model for low heterogeneity and the randomeffects model for high heterogeneity with sensitivity analysis. Bias was evaluated using Egger's tests. Trial sequential analysis(TSA) was used to evaluate information size and treatment benefits. The Grading of Recommendations Assessment, Development and Evaluation(GRADE) was used to assess the level of quality, and studies were classed as "high quality", "moderate quality", "low quality", and "very low quality".RESULTS A total of eight RCTs consisting of 867 participants(435 from the allicin group and 432 from the control group) were included. Eradication rate in the allicin group(93.33%, 406/435) was significantly higher than that of the control group(83.56%, 361/432) [I~2 = 0%, odds ratio(OR) = 2.75, 95% confidence interval(CI):1.74-4.35, P 0.001]. The healing rate of ulcers following H. pylori therapy in the allicin group(86.17%, 349/405) was significantly higher than that of the control group(75.87%, 305/402) [I~2 = 0%, OR = 2.05, 95%CI: 1.39-3.03, P 0.001]. The total remission rate of peptic ulcers across all allicin groups was 95.99%, which was significantly higher than that of controls [95.99%(359/374) vs 89.25%(332/372), I~2 = 0, heterogeneity P = 0.84, OR = 3.13, 95%CI: 1.51-6.51, P =0.002].No significant differences in side effects were observed. TSA suggested that the trials were of sufficient standard to draw reliable conclusions. The quality of outcomes including eradication rates and side effects was graded as "very low"due to downgrades for "risk of bias" and "indirectness". Other outcomes such as ulcer healing rates and total ulcer remission rates were graded as "low" due to downgrades for "risk of bias".CONCLUSION Allicin as an add-on therapy improves H. pylori eradication, healing of ulcers, and remission of symptoms. These results are suggested to be treated with caution due to limited quality.     

Fourth-generation quinolones in the treatment of Helicobacter pylori infection: a meta-analysis

AIM To assess the efficacy and safety of fourth-generation quinolones for helicobacter pylori(h. pylori) eradication, we conducted this systematic review and metaanalysis of randomized clinical trials. METHODS Major literature databases(Pub Med, EMBASE and the Cochrane Central Register of Controlled Trials) were searched for relevant articles published prior to February 2018. We performed a meta-analysis of all randomized clinical trials that examined the efficacy of h. pylori eradication therapies and included fourthgeneration quinolones in the experimental arm. Subgroup analyses by regions and different types of fourth-generation quinolones were also performed.RESULTS Ten studies including a total of 2198 patients were assessed. A meta-analysis of randomized controlled trials showed that the eradication rate of therapies containing non-fourth-generation quinolones was significantly lower than that of therapies containing fourth-generation quinolones by intention-to-treat(ITT) analysis [75.4% vs 81.8%; odds ratio(OR) = 0.661; 95% confidence interval(CI): 0.447-0.977; P = 0.038]. This analysis also showed that the eradication rate of the therapies containing non-fourth-generation quinolones was inferior to that of therapies containing fourth-generation quinolones by perprotocol analysis(79.1% vs 84.7%; OR = 0.663; 95%CI: 0.433-1.016; P = 0.059). Moreover, the occurrence of side effects was significantly different between the control and experimental groups by ITT analysis(30.6% vs 19.5%; OR = 1.874; 95%CI: 1.120-3.137; P = 0.017). The sub-analyses also showed significant differences in moxifloxacin therapies vs other fourth-generation quinolone therapies(84.3% vs 71.9%) and in Asian vs European groups(76.7% vs 89.1%).CONCLUSION Therapies containing fourth-generation quinolones achieved a poor eradication rate in the treatment of h. pylori infection. Such regimens might be useful as a rescue treatment based on antimicrobial susceptibility testing. Different antibiotics should be chosen in different regions.     

Efficacy of integrated traditional Chinese medicine and Western medicine in the treatment of poststroke insomnia: A protocol for systematic review and meta-analysis of randomized controlled trials

Background:Western medicine has played an essential role in treating poststroke insomnia (PSI) in China, and traditional Chinese medicine therapy based on Chinese characteristics is also effective. Combined with China''s national conditions, we plan to conduct this systematic review and meta-analysis to compare the efficacy of integrated traditional Chinese medicine and Western medicine (INTEGRATED TCM and WM) therapy and Western medicine alone for PSI.Methods:We will search the following 5 electronic databases: PubMed, Wanfang, Chinese biomedical literature database, the Chongqing VIP Chinese Science and Technology Periodical, and China national knowledge infrastructure. Randomized controlled trials that compared the efficacy of INTEGRATED TCM and WM with Western medicine alone in the treatment of PSI will be considered. Primary outcomes have Treatment effectiveness rate, and Pittsburgh sleep quality index. Secondary outcomes include traditional Chinese medicine syndrome score, Athens insomnia scale, the incidence of adverse reactions, and outcome follow-up. Based on the eligibility criteria, we will conduct literature screening and data extraction. The quality of the included literature will be evaluated using the Cochrane risk of bias tools. We will use Review Manager software (Version 5.3) for data synthesis and statistical analyses. If sources of heterogeneity exist, we will perform a subgroup analysis or sensitivity analysis. A funnel plot will be used to analyze publication bias.Results:This study will provide evidence-based medicine evidence for treatment of PSI with INTEGRATED TCM and WM in terms of its efficacy.Conclusion:This systematic review aims to provide new options for INTEGRATED TCM and WM treatment of PSI in terms of its efficacy.