益生菌辅助含左氧氟沙星的补救方案治疗幽门螺杆菌感染疗效的Meta分析
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摘要
目的系统评价益生菌在辅助含左氧氟沙星补救治疗根除幽门螺杆菌(Hp)感染的疗效和安全性。方法计算机检索Pubmed、Embase、Cochrane Library、CNKI、VIP、CBM和Wan Fang Data,收集2017年3月1日前国内外公开发表的关于益生菌辅助含左氧氟沙星的补救方案治疗Hp感染疗效的随机对照试验,所有研究对象给予含左氧氟沙星补救治疗方案抗Hp治疗,试验组在此基础上再给予益生菌制剂辅助治疗,对照组未给予益生菌制剂治疗,随访过程并追踪结局。两名研究者独立完成文献筛选、资料提取、质量评价(采用PEDro量表进行评价)工作后,运用RevMan 5.2进行统计分析。结果最终纳入6个随机对照研究,包括益生菌联合治疗组(试验组) 430例,无益生菌治疗组(对照组)380例。Meta分析结果显示:益生菌组及非益生菌组Hp根除率PP分析结果(OR=2.11, 95%CI=1.47～3.02, P<0.0001);益生菌组及非益生菌组Hp根除率ITT分析结果(OR=2.01,95%CI=1.43～2.81, P<0.0001);益生菌组及对照组治疗过程中出现不良反应情况(OR=0.63, 95%CI=0.40～0.99, P=0.05),均有统计学意义。结论含益生菌能有效提高含左氧氟沙星补救疗法的Hp根除率,改善临床症状且减少药物的副作用。
Objective To assess the efficacy and safety of probiotics supplementation on anti-Helicobacter pylori levofloxacin-based second-line rescue therapy. Methods All relevant controlled trials(RCT) of probiotics reuteri supplementation on anti-Helicobacter pylori levofloxacin-based second-line therapy published before March 1, 2017 were collected by searching Pubmed, Embase, the Cochrane Library, CNKI, VIP, CBM and Wan Fang Data. All subjects were treated with anti-Helicobacter pylori levofloxacin-based rescue therapy. The experimental group was treated with probiotics at the same time, while the control group was treated without probiotics, and the process and the outcome of both groups were followed up. Two researchers used RevMan 5.2 to perform statistical analysis on the basis of literature screening, data extraction and quality evaluation(PEDro). Results Six RCTs included 430 patients with probiotics(experimental group) and 380 patients without probiotics(control group). The results of Metaanalysis: the PP-analysis results about the rate of Hp eradication of the groups with and without probiotics(OR=2.11, 95%CI=1.47～3.02, P<0.0001); the ITT-analysis results about the rate of Hp eradication of the groups with and without probiotics(OR=2.01, 95%CI=1.43～2.81, P<0.0001) and the comparative results of adverse reactions about the two groups(OR=0.63, 95%CI=0.40～0.99, P=0.05) were all statistically significant. Conclusion The probiotics reuteri supplementation on anti-Helicobacter pylori levofloxacin-based second-line therapy can effectively improve the rate of Hp eradication and reduce the side effects of the drugs.
Objective To assess the efficacy and safety of probiotics supplementation on anti-Helicobacter pylori levofloxacin-based second-line rescue therapy. Methods All relevant controlled trials(RCT) of probiotics reuteri supplementation on anti-Helicobacter pylori levofloxacin-based second-line therapy published before March 1, 2017 were collected by searching Pubmed, Embase, the Cochrane Library, CNKI, VIP, CBM and Wan Fang Data. All subjects were treated with anti-Helicobacter pylori levofloxacin-based rescue therapy. The experimental group was treated with probiotics at the same time, while the control group was treated without probiotics, and the process and the outcome of both groups were followed up. Two researchers used RevMan 5.2 to perform statistical analysis on the basis of literature screening, data extraction and quality evaluation(PEDro). Results Six RCTs included 430 patients with probiotics(experimental group) and 380 patients without probiotics(control group). The results of Metaanalysis: the PP-analysis results about the rate of Hp eradication of the groups with and without probiotics(OR=2.11, 95%CI=1.47～3.02, P<0.0001); the ITT-analysis results about the rate of Hp eradication of the groups with and without probiotics(OR=2.01, 95%CI=1.43～2.81, P<0.0001) and the comparative results of adverse reactions about the two groups(OR=0.63, 95%CI=0.40～0.99, P=0.05) were all statistically significant. Conclusion The probiotics reuteri supplementation on anti-Helicobacter pylori levofloxacin-based second-line therapy can effectively improve the rate of Hp eradication and reduce the side effects of the drugs.
引文
[1]Yuan X Z,Chang C.Helicobacter pylori and its related clinical diseases[J].Chin J Clin Gastroenterol,2003,15(1):44.
[2]Fallone C A,Chiba N,van Zanten S V,et al.The Toronto consensus for the treatment of Helicobacter pylori infection in adults[J].Gastroenterology,2016,151(1):51-69.e14
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[4]张艳梅,胡玢婕,赵付菊,等.幽门螺杆菌的耐药性及其相关耐药基因的分析[J].检验医学,2016,31(5):412-418.
[5]郑鹏远,刘志强,张展.幽门螺杆菌多重耐药性与其外排泵抑制剂研究进展[J].现代消化及介入诊疗,2010,15(5):307-311.
[6]Boyanova L,Gergova G,Nikolov R,et al.Prevalence and evolution of Helicobacter pylori resistance to 6 antibacterial agents over 12 years and correlation between susceptibility testing methods[J].Diagn Microbiol Infect Dis,2008,60(4):409-415.
[7]Brzozowski T,Konturek P C,Mierzwa M,et al.Effect of probiotics and triple eradication therapy on the cyclooxygenase(COX)-2 expression,apoptosis,and functional gastric mucosal impairment in Helicobacter pylori-infected Mongolian gerbils[J].Helicobacter,2006,11(1):10-20.
[8]Szajewska H,Horvath A,Piwowarczyk A.Meta-analysis:The effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment[J].Aliment Pharmacol Ther,2010,32(9):1069-1079.
[9]Centre for Evidence-Based Physiotherapy at The George Institute for Global Health.Physiotherapy Evidence Database(PEDro)[CP/OL].(1999-06-21)[2012-03-30].
[10]吴志芳,赵晖,钟卫一.益生菌辅助含左氧氟沙星补救疗法根除幽门螺杆菌[J].航空航天医学杂志,2016,27(3):276-277.
[11]彭卫斌,容海鹰,沙卫红,等.含左氧氟沙星三联疗法联合益生菌根除幽门螺杆菌的补救治疗[J].胃肠病学,2016,21(4):211-214.
[12]刘霞,何永红,刘海林,等.益生菌制剂在根除幽门螺杆菌初治失败者的临床疗效观察[J].贵州医药,2015,39(1):32-34.
[13]许亮,许学新.益生菌在治疗难治性幽门螺杆菌感染中的价值[J].临床消化病杂志,2012,24(4):218-219.
[14]Ojetti V,Bruno G,Ainora M E,et al.Impact of lactobacillus reuteri supplementation on Anti-Helicobacter pylori levofloxacin-based second-line therapy[J].Gastroenterol Res Pract,2012(12):175-180.
[15]胡桂梅,王伯军.含益生菌序贯疗法作为根除幽门螺杆菌二线疗法的临床观察[J].浙江医学,2011,33(2):186-189.
[16]杜坤庭,葛勤利,杨伟捷,等.左氧氟沙星对Hp感染治疗作用探讨[J].山东医药,2007,47(19):140-141.
[17]Davis R,Bryson H M.Levofloxacin a review of its antibacterial activity,pharmacokinetics and the rapetic efficacy[J].Drugs,1994,47(4):677-700.
[18]邹军,李欣欣,杨昭徐,等.左氧氟沙星对幽门螺杆菌体外抗菌活性的评价[J].中国抗生素杂志,2003,28(5):292-294.
[19]Dicaro S,Zocco M A,Cremonini F,et al.Levofloxacin basedregimens for the eradication of Helicobacter pylori[J].Eur J Gastroenterrol Hepatol,2002,14(12):1309-1312.
[20]Watanabe Y,Aoyama N,Shirasaka D,et al.Levofloxacin basedtriple therapy asasecond-line treatment after failure of Helicobacter pylori eradication with standard triple therapy[J].Dig Liver Dis,2003,35(10):711-715.
[21]孙雯娟,张波,李大魁,等.益生菌制剂的发展现状与临床应用进展[J].中国医院药学杂志,2015,35(9):850-857.
[22]王学红,汪春莲,卢放根,等.乳酸杆菌cL22菌株治疗BaIb/c小鼠Hp感染性胃炎模型的有效性研究[J].中南大学学报(医学版),2007,32:341-346.
[23]Lee J S,Paek N S,Kwon O S.Anti-inflammatory actions of probiotics through activating suppressor of cytokine signaling(SOCS)expression and signaling in Helicobacter pylori infection:A novel mechanism[J].Gastroenterol Hepatol,2010,25(1):194-202.
[24]Canducci F,Cremonini F,Armuzzi A,et al.Probiotics and Helicobacter pylori eradic ation[J].Dig Liver Dis,2002,34(suppl 2):81-83.
[2]Fallone C A,Chiba N,van Zanten S V,et al.The Toronto consensus for the treatment of Helicobacter pylori infection in adults[J].Gastroenterology,2016,151(1):51-69.e14
[3]Cianci R,Montalto M,Pandolfi F,et al.Third-line rescue therapy for Helicobacter pylori infection[J].World JGastroenterol,2006,12(15):2313-2319.
[4]张艳梅,胡玢婕,赵付菊,等.幽门螺杆菌的耐药性及其相关耐药基因的分析[J].检验医学,2016,31(5):412-418.
[5]郑鹏远,刘志强,张展.幽门螺杆菌多重耐药性与其外排泵抑制剂研究进展[J].现代消化及介入诊疗,2010,15(5):307-311.
[6]Boyanova L,Gergova G,Nikolov R,et al.Prevalence and evolution of Helicobacter pylori resistance to 6 antibacterial agents over 12 years and correlation between susceptibility testing methods[J].Diagn Microbiol Infect Dis,2008,60(4):409-415.
[7]Brzozowski T,Konturek P C,Mierzwa M,et al.Effect of probiotics and triple eradication therapy on the cyclooxygenase(COX)-2 expression,apoptosis,and functional gastric mucosal impairment in Helicobacter pylori-infected Mongolian gerbils[J].Helicobacter,2006,11(1):10-20.
[8]Szajewska H,Horvath A,Piwowarczyk A.Meta-analysis:The effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment[J].Aliment Pharmacol Ther,2010,32(9):1069-1079.
[9]Centre for Evidence-Based Physiotherapy at The George Institute for Global Health.Physiotherapy Evidence Database(PEDro)[CP/OL].(1999-06-21)[2012-03-30].
[10]吴志芳,赵晖,钟卫一.益生菌辅助含左氧氟沙星补救疗法根除幽门螺杆菌[J].航空航天医学杂志,2016,27(3):276-277.
[11]彭卫斌,容海鹰,沙卫红,等.含左氧氟沙星三联疗法联合益生菌根除幽门螺杆菌的补救治疗[J].胃肠病学,2016,21(4):211-214.
[12]刘霞,何永红,刘海林,等.益生菌制剂在根除幽门螺杆菌初治失败者的临床疗效观察[J].贵州医药,2015,39(1):32-34.
[13]许亮,许学新.益生菌在治疗难治性幽门螺杆菌感染中的价值[J].临床消化病杂志,2012,24(4):218-219.
[14]Ojetti V,Bruno G,Ainora M E,et al.Impact of lactobacillus reuteri supplementation on Anti-Helicobacter pylori levofloxacin-based second-line therapy[J].Gastroenterol Res Pract,2012(12):175-180.
[15]胡桂梅,王伯军.含益生菌序贯疗法作为根除幽门螺杆菌二线疗法的临床观察[J].浙江医学,2011,33(2):186-189.
[16]杜坤庭,葛勤利,杨伟捷,等.左氧氟沙星对Hp感染治疗作用探讨[J].山东医药,2007,47(19):140-141.
[17]Davis R,Bryson H M.Levofloxacin a review of its antibacterial activity,pharmacokinetics and the rapetic efficacy[J].Drugs,1994,47(4):677-700.
[18]邹军,李欣欣,杨昭徐,等.左氧氟沙星对幽门螺杆菌体外抗菌活性的评价[J].中国抗生素杂志,2003,28(5):292-294.
[19]Dicaro S,Zocco M A,Cremonini F,et al.Levofloxacin basedregimens for the eradication of Helicobacter pylori[J].Eur J Gastroenterrol Hepatol,2002,14(12):1309-1312.
[20]Watanabe Y,Aoyama N,Shirasaka D,et al.Levofloxacin basedtriple therapy asasecond-line treatment after failure of Helicobacter pylori eradication with standard triple therapy[J].Dig Liver Dis,2003,35(10):711-715.
[21]孙雯娟,张波,李大魁,等.益生菌制剂的发展现状与临床应用进展[J].中国医院药学杂志,2015,35(9):850-857.
[22]王学红,汪春莲,卢放根,等.乳酸杆菌cL22菌株治疗BaIb/c小鼠Hp感染性胃炎模型的有效性研究[J].中南大学学报(医学版),2007,32:341-346.
[23]Lee J S,Paek N S,Kwon O S.Anti-inflammatory actions of probiotics through activating suppressor of cytokine signaling(SOCS)expression and signaling in Helicobacter pylori infection:A novel mechanism[J].Gastroenterol Hepatol,2010,25(1):194-202.
[24]Canducci F,Cremonini F,Armuzzi A,et al.Probiotics and Helicobacter pylori eradic ation[J].Dig Liver Dis,2002,34(suppl 2):81-83.
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