我国幽门螺杆菌感染处理共识推荐的铋剂四联方案根除率分析

背景:随着幽门螺杆菌(Hp)耐药率的上升及其所导致的标准三联疗法根除率的下降,铋剂四联方案成为我国最新共识推荐的Hp感染根除治疗方案。目的:评价各共识推荐铋剂四联方案的根除治疗效果,为高效、价廉的根除治疗方案的选择提供参考。方法:检索CNKI、万方、维普数据库,纳入我国2011-2013年间公开发表,采用共识推荐的铋剂四联方案根除Hp感染的临床试验类文献。提取文献资料,根据Graham等提出的Hp根除率分级系统,对根除率进行分析。结果:共166篇文献入选,包括Hp感染根除试验192项。在全国范围内,含阿莫西林方案的根除率大部分可以接受,其中PAFB(PPI+阿莫西林+呋喃唑酮+铋剂)方案取得优异根除率(≥95%)的可能性最高。在华东和中南地区,相应的适宜根除治疗方案分别为PACB(PPI+阿莫西林+克拉霉素+铋剂)和PAFB方案。适宜疗程为14 d。结论:在各共识推荐铋剂四联方案中,PAFB方案具有明显的效益和成本优势。在全国范围内,非阿莫西林过敏个体行Hp感染根除治疗宜优先选用PAFB方案,建议疗程为14 d。

Eradication Rate of Bismuth-containing Quadruple Regimens Recommended by the Chinese Consensus Report on Management of Helicobacter pylori Infection

Background：With the increasing of antibiotic resistance and decreasing of eradication rate of standard triple therapy, bismuth-containing quadruple regimens were recommended by the update Chinese consensus report for eradication of Helicobacter pylori（ Hp ） infection. Aims：To evaluate the eradication rate of the recommended bismuth-containing quadruple regimens for guiding the choice of low cost and high efficiency eradication regimens. Methods：A search of online database（ CNKI,Wanfang and VIP）was carried out. Clinical trials published in Chinese from 2011 to 2013 that evaluated the eradication rate of the recommended bismuth-containing quadruple regimens were retrieved. Data were extracted by standardized data forms. According to the categories raised by Dr. Graham,the eradication rates were graded and analyzed. Results：A total of 166 eligible articles including 192 clinical trials for eradication of Hp infection were obtained. Nationwidely,the eradication rates of amoxicillin-containing regimens were acceptable,among which PAFB（ PPI＋amoxicillin＋furazolidone＋bismuth）regimen was more prone to achieve excellent eradication rate（≥95%）. PACB （ PPI＋amoxicillin＋clarithromycin＋bismuth）regimen was optimal for Hp eradication in East China,and PAFB regimen was optimal in Central South China. A 14-day treatment course was appropriate. Conclusions：In the recommended bismuth-containing quadruple regimens,PAFB regimen might be the first choice nationwidely for eradication of Hp infection in individuals without amoxicillin-hypersensitivity because of its low cost and high efficiency. The recommended treatment course is 14-day.