幽门螺旋杆菌药敏试验指导的治疗方案和新一线四联方案:网状Meta分析

目的 比较细菌培养药敏试验指导的幽门螺旋杆菌治疗方案和新一线4种方案（伴同疗法、混合治疗、序贯治疗、铋剂四联治疗）的疗效和不良反应,并进行概率排序为临床治疗提供科学依据。方法 系统检索电子数据库,筛选截至2015年6月比较细菌培养药敏试验指导治疗和新一线4种方案,包括基于细菌培养药敏试验指导治疗、伴同疗法、混合治疗、序贯治疗、铋剂四联治疗方案的随机对照试验。通过网状Meta分析和单组率的Meta分析,定量综合这些方案的相对和绝对疗效及不良反应。采用Jadad评分量表评价随机对照试验的方法学质量,构建漏斗图定性测量发表偏倚,其中不对称性检验使用Egger线性回归法或者Begg秩相关法。结果 共纳入20个初治幽门螺旋杆菌感染的随机对照试验,涉及6 753例患者。网状Meta分析表明,细菌培养药敏试验指导治疗的方案显著优于其他方案,根除率最高,不良反应发生率最低;伴同疗法虽然高效但最有可能出现不良反应事件;混合治疗和铋剂四联治疗方案具有较高的疗效、较低的不良反应发生率。结论 对于成年人幽门螺旋杆菌感染,细菌培养药敏试验指导的治疗方案显著优于伴同疗法、混合治疗、铋剂四联治疗和序贯治疗方案;医疗条件匮乏地区可选择混合治疗和铋剂四联治疗方案。

Drug susceptibility test guided therapy and novel empirical quadruple therapy for Helicobacter pylori infection: a network Meta-analysis

Objective To compare the efficacy and the risk of adverse effect of drug susceptibility test guided therapy and novel empirical quadruple therapy for Helicobacter (H.) pylori infection. Methods Literature retrieval was conducted by using major databases. Related papers published up to June 2015 were considered eligible if they were randomized control trials comparing different pharmacological formulations for H. pylori infection and used in a network Meta-analysis and a single rate Meta-analysis to evaluate the relative and absolute rates of H. pylori eradication and the risk of adverse effect. The Jadad score was used to evaluate the methodological quality. Funnel plot was constructed to evaluate the risk of publication bias. Begg''s rank correlation test or Egger''s regression intercept test was done for the asymmetry of funnel plot. Results Twenty randomized control trials for the treatment of 6 753 initial treated patients with H. pylori infection were included. Drug susceptibility test guided therapy was significantly superior to concomitant therapy, hybrid therapy, sequential therapy and bismuth quadruple therapy. The culture-based therapy had the highest likelihood of improving clinical efficacy, with lowest risk of adverse effect. Concomitant therapy had the highest probability of causing adverse effect despite its effectiveness. Hybrid therapy and bismuth quadruple therapy were associated with lower risk of adverse effect and higher effectiveness. Conclusion Drug susceptibility test guided therapy showed superiority to other 4 interventions for H. pylori eradication mentioned above. Hybrid therapy and bismuth quadruple therapy might be applied in the settings where the culture-based strategy is not available.