微生态制剂在儿童幽门螺杆菌根除治疗中 应用效果的Meta分析

目的系统评价微生态制剂联合标准三联疗法或贯序疗法在儿童幽门螺杆菌(H.pylori)治疗中应用的临床疗效及其对治疗中抗生素相关不良反应发生的改善情况。方法计算机检索CNKI、VIP、Wan Fang Data、Pub Med、Web of science和The Cochrane Library数据库,搜集国内外公开发表的关于微生态制剂在治疗儿童H.pylori感染中应用的随机对照试验(RCT),检索时限均为从建库至2017年10月,同时人工检索相关文献的参考文献,以补充获取研究文献。由2位研究员独立筛选文献、提取数据并对纳入研究进行质量评价,采用RevMan 5.3软件进行Meta分析。结果共纳入17个RCT,共2 033例H.pylori阳性的儿童患者。Meta分析结果显示,微生态制剂+标准三联或贯序疗法vs标准三联或贯序疗法:微生态制剂+标准三联或贯序疗法在儿童H.pylori根除率方面优于对照组OR=2.66,95%CI(2.09,3.40),P0.00001];总不良反应发生率明显低于对照组OR=0.28,95%CI(0.21,0.37),P0.00001],差异均有统计学意义。微生态制剂+标准三联或贯序疗法组的恶心呕吐(P0.001)、腹痛(P=0.015)、腹泻(P0.001)、便秘(P=0.023)、纳差(P0.001)、味觉障碍或口腔炎(P0.001)发生率明显低于对照组,差异有统计学意义。结论与标准三联或贯序疗法相比,微生态制剂+标准三联或贯序疗法安全、有效,能提高儿童H.pylori的根除率,降低H.pylori治疗中抗生素相关不良反应的发生。受纳入研究质量的限制,上述结论尚需开展高质量的RCT进一步验证。

Effect of microecological agents for eradication of Helicobacter pylori in children: A Meta analysis

Abstract: Objective To systematically evaluate the clinical efficacy of probiotics in combination with standard triple therapy or sequential therapy in the treatment of Helicobacter pylori infection and related adverse reactions by antibiotics in children. Methods The CNKI, VIP, Wan Fang Data, Pub Med, Web of science and The Cochrane Library database were retrieved for randomized controlled trials (RCTs) on microecological agents in the treatment of Helicobacter pylori infection in children at home and abroad published from the establishment of database to October 2017. The related reference literatures were retrieved manually. Two researchers independently screened the literatures and evaluated the quality of the trials. RevMan 5.3 software was used for Meta analysis. Results A total of 2,033 Helicobacter pylori positive children were included in 17 RCTs. Meta analysis showed that microecological preparations combined with standard triple or sequential therapy were superior to standard triple or sequential therapies alone for eradication of Helicobacter pylori in childrenOR=2.66, 95%CI (2.09, 3.40), P<0.00001]. The total incidence of adverse reactions was significantly lower in the trial group than in the control groupOR=0.28, 95%CI (0.21, 0.37), P<0.00001] with significant difference. In the trial group, the incidence rate of nausea (P<0.001), vomiting (P=0.015), diarrhea (P=0.023), constipation (P=0.023), anorexia (P<0.001), taste disorder or oral inflammation (P<0.001) was significantly lower than in the control group. Conclusion Compared with standard triple or sequential therapy, the combination of probiotics is safe and effective in children, which can raise the eradication rate of Helicobacter pylori, and reduce the occurrence of adverse reactions caused by antibiotics. Due to the limitation of the quality of the included researches, the above conclusion is subject to further verification with higher-quality RCTs.