序贯疗法与三联疗法根除幽门螺旋杆菌感染疗效比较的Meta分析

发布时间：2018-04-29 02:31

本文选题：序贯疗法 + 三联疗法　；参考：《福建医科大学》2014年硕士论文

【摘要】：背景：三联疗法(Triple Therapy, TT)的根除率逐年下降，，当前国内外有较多关于序贯疗法(Sequential Therapy, ST)根除幽门螺旋杆菌(Helicobacter pylori,Hp)感染的报道，应用循证医学的方法对ST与TT根除Hp感染的疗效进行比较具有一定的临床意义。目的：运用Meta分析法评价ST与TT根除Hp感染的疗效差异。方法：选用Cochrane系统综述方法，确定恰当的检索词、检索年限及检索的数据库。纳入ST与TT根除Hp感染疗效比较的随机对照试验(RCTs)，对纳入文献进行资料提取及质量评价，对研究结果进行异质性检验，根据异质性分析结果选择适当的效应模型及决定是否采用Meta分析，同时进行亚组分析、敏感性分析、安全性评价及发表偏倚评价。结果：共11篇RCTs研究文献符合纳入标准， Cochrane风险偏倚评估提示低风险偏倚见于选择偏倚、随访偏倚及报告偏倚，高风险偏倚见于实施偏倚、测量偏倚及其他偏倚，Jadad量表结果提示高质量文献、较高质量文献、低质量文献分别为2篇、5篇、4篇。Meta分析结果显示，意向性治疗(ITT)分析ST组与TT组根除率的OR为3.39，95%可信区间(CI)为2.66～4.33，ST组与TT组根除率比较有统计学差异(Z=9.87, p0.00001)。符合方案集(PP)分析ST组与TT组根除率的OR为4.76，95%可信区间(CI)为3.53～6.40，ST组与TT组根除率比较有统计学差异(Z=10.29, p0.00001)。亚组分析成人、儿童及中国的ST与TT疗法，结果均支持ST根除Hp感染疗效优于TT。而ST与TT不良反应无差异。结论： ST根除Hp感染疗效优于TT。因纳入研究的文献数量较少，质量良莠不齐，今后仍需进行多中心、大样本RCTs分析以证实ST根除Hp感染的优越性。
[Abstract]:Background: The eradication rate of Triple Therapy (TT) has been decreasing year by year. There are many reports about Sequential Therapy (ST) for the eradication of Helicobacter pylori (Helicobacter pylori) infection at home and abroad. Evidence-based medicine was used to compare the efficacy of St and TT in the eradication of HP infection. Objective: Meta analysis was used to evaluate the efficacy of St and TT in the eradication of HP infection. Methods: Cochrane system review method is used to determine the appropriate search term, retrieval time and retrieval database. A randomized controlled trial to compare the efficacy of St and TT in the eradication of HP infection was used to extract the data and evaluate the quality of the literature, and to test the heterogeneity of the results. According to the results of heterogeneity analysis, appropriate effect models were selected and Meta analysis was used to determine whether to use Meta analysis, while subgroup analysis, sensitivity analysis, safety evaluation and publication bias evaluation were carried out. Results: A total of 11 RCTs studies met the inclusion criteria. The Cochrane risk bias assessment showed that low risk bias was found in selective bias, follow-up bias and reporting bias, and high risk bias in implementation bias. The results of Jadad scale for measuring bias and other biases suggested that there were 2 articles with high quality, 5 articles with high quality and 4 articles with low quality. The results of meta-analysis showed that: 1. The OR of the eradication rate of St group and TT group was 3.39 卤95% CI). The eradication rate of St group and TT group was 2.664.33 St group and TT group. There was significant difference in eradication rate between St group and TT group (P 0.00001). The OR of eradication rate of St group and TT group was 4.76% 95% CI). The eradication rate of St group and TT group was 3.53 ~ 6.40%. There was significant difference in eradication rate between St group and TT group (P = 10.29, p 0.00001). The subgroup analysis of St and TT therapy in adults, children and China showed that the efficacy of St to eradicate HP infection was better than that of TTT. There was no difference in adverse reactions between St and TT. Conclusion: The efficacy of St in eradicating HP infection was better than that of TT. Due to the small number of literatures and the uneven quality, there are still many centers to be carried out in the future. Large sample RCTs analysis is needed to confirm the superiority of St in eradicating HP infection.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R57

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