抗幽门螺杆菌治疗在成人原发免疫性血小板减少症中疗效的meta分析

发布时间：2018-05-25 04:09

本文选题：原发免疫性血小板减少症 + 幽门螺杆菌　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:应用meta分析方法全面评估抗幽门螺杆菌治疗对成人原发免疫性血小板减少症的临床疗效。方法:计算机检索The Cochrane Libary、Pubmed、Embase、相关期刊论文(CNKI)、中文科技期刊数据库(VIP)和万方数据库,检索时间限定为1998年1月至2016年12月,获取所有国内外公开发表的相关文献,语种不限制。所搜索到的文献严格按照纳入和排除标准进行筛选,纳入关于抗幽门螺杆菌治疗原发免疫性血小板减少症(ITP)的随机对照研究,对符合标准的各个文献都实施文献质量评价;采用RevMan5.3软件对观察指标进行meta分析。主要观察指标为总有效率、复发率,次要指标为不良反应发生率。结果:共纳入17篇符合标准的国内外随机对照研究,有956例患者,纳入研究的患者基线情况相似。本项meta分析结果显示,(一)总有效率:对17篇研究进行抗幽门螺杆菌联合激素治疗与单用激素治疗组的有效率的meta分析,异质性检验结果P=0.82,I2=0%,可合并统计量;meta分析结果:总有效率明显提高(88.1%vs 66.9%),RR=1.32,95%CI[1.23,1.41],差异有统计学意义(P0.00001);(二)复发率比较:纳入的总研究中有8篇研究进行了1年内复发率的比较,异质性检验结果P=0.99,I2=0%;共有2篇研究比较2年内复发率,异质性检验结果P=0.81,I2=0%。Meta分析结果显示:联合治疗组与单用激素治疗组比较,1年内复发率明显下降(9.7%vs42.5%),RR=0.27,95%CI[0.19,0.39],差异具有统计学意义(P0.00001)。2年内复发率也明显下降(20.3%vs 50.7%),RR=0.40,95%CI[0.24,0.68],差异具有统计学意义(P=0.0006)。(三)不良反应发生率比较:共有1篇研究报道了不良反应发生情况,主要不良反应表现为下肢水肿、恶心、胃部不适,结果提示联合治疗组不良反应的发生率较单用激素治疗组明显降低(26.7%vs 73.3%),RR=0.36,95%CI[0.15,0.89],差异具有统计学意义(P=0.03)。结论:对于合并幽门螺杆菌感染的成人原发免疫性血小板减少症的患者,抗幽门螺杆菌联合激素治疗可以提高治疗有效率,且1年复发率、2年复发率和不良反应发生率得到明显下降。通过检测幽门螺杆菌感染并行抗幽门螺杆菌治疗可为临床治疗ITP提供一种新的治疗策略。由于纳入的样本量和部分文献质量有限,此结论仍需进一步扩充样本量、选取高质量的研究验证,提高论证强度。
[Abstract]:Objective: to evaluate the clinical efficacy of anti-Helicobacter pylori therapy in adult primary immune thrombocytopenia by meta analysis. Methods: The Cochrane library was searched by computer, Chinese periodical full-text database (CNKI) and Wanfang database were searched by computer. The retrieval time was limited from January 1998 to December 2016. Languages are not restricted. The literature was screened strictly according to the inclusion and exclusion criteria and included in a randomized controlled study on the treatment of primary immune thrombocytopenia with Helicobacter pylori. The observation index was analyzed by meta with RevMan5.3 software. The main indicators were the total effective rate, recurrence rate and the incidence of adverse reactions. Results: a total of 17 domestic and foreign randomized controlled trials were conducted. 956 patients were included in the study. The baseline status of the patients involved in the study was similar. The results of this meta analysis showed (1) the total effective rate: 17 studies were performed with meta analysis of the efficacy of anti-Helicobacter pylori combined hormone therapy and single hormone therapy. The results of heterogeneity test P0. 82 / I ~ 2 / 0, can be combined with statistics and meta-analysis: the total effective rate was significantly increased by 88. 1% vs 66. 9% RRX 1.32 ~ 95 CI [1. 2323 ~ 1. 41]. The difference was statistically significant (P 0. 0001 / 1). The recurrence rate was compared in 8 of the total studies included within one year. The results of heterogeneity test were as follows: P0. 9% I2 + 0. There were 2 studies comparing the recurrence rate within 2 years. The results of heterogeneity test showed that the recurrence rate of the combined treatment group was significantly lower than that of the single hormone treatment group within one year. The difference was statistically significant (P0.00001.The recurrence rate was also significantly decreased within 2 years (P < 0.05), and the difference was statistically significant (P < 0.01). The recurrence rate was also significantly lower than that in the control group (P = 0.4095 CI [0.240.68]), and the difference was statistically significant (P = 0.00060.68), and the recurrence rate was significantly lower than that in the control group (P < 0.05), and the recurrence rate was significantly lower than that in the control group (P < 0.01), and the recurrence rate was significantly lower than that in the control group (P < 0.05). (3) comparison of the incidence of adverse reactions: a total of 1 study reported the occurrence of adverse reactions. The main adverse reactions were edema of lower extremities, nausea and stomach discomfort. The results suggested that the incidence of adverse reactions in the combined treatment group was significantly lower than that in the steroid group alone (26.7 vs 73.3%), and the difference was statistically significant (P < 0.05). Conclusion: for adult patients with primary immune thrombocytopenia complicated with Helicobacter pylori infection, anti-Helicobacter pylori combined with hormone therapy can improve the effective rate of treatment. The recurrence rate of 1 year, the recurrence rate of 2 years and the incidence of adverse reactions were significantly decreased. Detection of Helicobacter pylori infection and anti-Helicobacter pylori therapy may provide a new strategy for clinical treatment of ITP. Due to the limited sample size and the limited quality of some documents, this conclusion still needs to further expand the sample size, select high quality research and verification, and improve the intensity of demonstration.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R558.2

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