抗幽门螺旋杆菌治疗于成人特发性血小板减少性紫癜的系统评价

发布时间：2018-05-23 23:34

本文选题：幽门螺旋杆菌 + 特发性血小板减少性紫癜　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的评估抗幽门螺旋杆菌(Hp)治疗与成人特发性血小板减少性紫癜(ITP)治疗的疗效和副作用。方法计算机检索Pubmed、Embase、The Cochrane Library、中国知网、万方和维普等数据库中的相关文献,语种不限,收集关于抗Hp治疗与伴Hp感染的成人ITP的RCT文献。受试患者年龄≥18岁,性别不限,符合ITP和Hp诊断标准,排除继发性血小板减少性紫癜。干预措施实验组为各种不同的抗Hp治疗方案,对照组为空白或安慰剂,主要结局指标为总有效(血小板计数30×109/L)、总缓解(血小板计数50×103/u L)和复发,次要结局指标为严重出血、缓解维持时间、再次入院、Cag A蛋白、GPIIb/IIIa抗体B细胞、Th1/Th2比值。安全性结局指标包括试验报告的任何不良反应、因严重不良反应而退出试验的事件和所有退出试验和失访的事件。检索到的文献,由2名评价员独立确定纳入的试验,对其偏倚风险进行评价,提取数据,应用Revman 5.0软件进行Meta分析。结果本次Meta分析纳入10个RCTs(n=633例)。9个RCTs为抗Hp与空白对照,1个RCT为抗Hp与安慰剂对照。10个RCTs均使用随机分配,但其中8个研究未说明随机分配方法。所有研究均未提供分配隐藏方案及盲法。1篇研究失访2名受试患者,未说明原因。总体上方法学质量较低,存在较大的偏倚危险。7个试验报告总有效,6个RCTs比较抗Hp组与空白组,其中5个研究抗Hp治疗为质子泵抑制剂(PPI)+克拉霉素+阿莫西林,疗程7天/10天,1个研究抗Hp治疗为序贯疗法,5天+5天。相对于空白对照,抗Hp治疗有较高的总有效率,汇总的RR值(95%CI)为1.23(1.12-1.36)。1个RCT比较抗Hp(PPI+克拉霉素+阿莫西林,疗程7天)与安慰剂,相对于安慰剂,抗Hp治疗组的总有效率更高,RR值(95%CI)为2.30(1.20-4.40)。1个试验报告总缓解率,比较抗Hp(PPI+克拉霉素+阿莫西林,疗程7天)与空白对照,显示抗Hp治疗组高于空白组,但无统计学意义(RR=12.07)。3个抗Hp与空白对照比较的RCTs报告1年内复发,其中2个研究抗Hp治疗为PPI+克拉霉素+阿莫西林,疗程7天/10天。1个研究抗Hp治疗为序贯疗程,5天+5天。抗Hp治疗组的复发率显著低于空白对照组,RR及其95%CI为0.52(0.39-0.70)。所有研究未报道次要结局指标和不良反应。共有2名患者失访,属于试验组,但文献未交待失访原因。结论抗Hp治疗伴Hp感染的ITP可能获得较高的总有效率和总缓解率,降低1年内的复发率,但由于纳入试验存在较高的偏倚风险,抗Hp治疗ITP的益处有待证实。
[Abstract]:Objective to evaluate the efficacy and side effects of anti-Helicobacter pylori (HP) therapy and adult idiopathic thrombocytopenic purpura (ITP). Methods We searched online the Cochrane Library of Pubmedus Embase, Wannang, Weip and other databases in unlimited languages, and collected RCT literature on ITP in adults with HP infection and anti-HP therapy. The age of the patients was more than 18 years old, sex was not limited, according to the diagnostic criteria of ITP and HP, the secondary thrombocytopenic purpura was excluded. The main outcome indexes were total effective (platelet count 30 脳 10 9 / L), total remission (platelet count 50 脳 10 3 / u L) and recurrence, and the secondary outcome index was severe hemorrhage, while the control group was blank or placebo, and the main outcome indexes were total effective (platelet count 30 脳 10 9 / L), total remission (platelet count 50 脳 103% / L) and recurrence. After remission and maintenance time, the ratio of Th _ 1 / Th2 of GPSIIb / IIIa antibody B cells was re-admitted to hospital. Safety outcome indicators include any adverse reactions reported in the trial, the event of withdrawal from the trial due to severe adverse reactions, and all withdrawal and loss events. The collected literature was independently determined by two evaluators to evaluate the bias risk, extract the data, and use Revman 5.0 software for Meta analysis. Results Ten cases of RCTs(n=633 were included in this Meta analysis. 9 RCTs were used as anti-HP and blank control, 1 RCT as anti-HP and placebo. All 10 RCTs were randomly assigned, but 8 of them did not indicate the method of random distribution. All the studies did not provide allocation and concealment scheme and blind method. 1. 2 subjects were not interviewed without explanation of the reasons. In general, the quality of methodology was low, and there was a significant risk of bias. Seven trials were reported to be effective. Six RCTs groups were compared with those in control group, and 5 of them were treated with clarithromycin Amoxicillin, a proton pump inhibitor, and 5 of them were treated with Clarithromycin Amoxicillin, a proton pump inhibitor. The course of treatment was 7 days / 10 days, and one study of anti-HP therapy was sequential therapy for 5 days and 5 days. The total effective rate of anti-HP therapy was higher than that of the blank control, the total RR value of 95 CI was 1.23v 1.12-1.360.1 RCT compared with Hp(PPI clarithromycin amoxicillin for 7 days) and placebo, as opposed to placebo. The total effective rate of the anti-HP treatment group was higher than that of the control group (95 CI). The total remission rate of one trial report was 2.30v 1.20-4.400.Compared with the control group for 7 days, the total remission rate of the anti-HP treatment group was higher than that of the control group, and that of the anti-HP treatment group was higher than that of the control group. But there was no statistical significance between RCTs and control group. The RCTs of 3 anti-HP groups had recurred within one year. Two of them were treated with PPI clarithromycin amoxicillin for 7 days / 10 days. One study showed that the anti-HP treatment was sequential therapy for 5 days and 5 days. The relapse rate of anti-HP treatment group was significantly lower than that of control group (0.52 ~ 0.39-0.70). No secondary outcome indicators and adverse reactions were reported in all studies. A total of 2 patients, belonging to the trial group, did not explain the reasons for the missing visit. Conclusion the total effective rate and total remission rate of ITP with HP infection may be higher, and the recurrence rate can be reduced within one year. However, the benefit of anti-HP therapy for ITP needs to be proved because of the high risk of bias in the trial.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R554.6

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