铝碳酸镁治疗幽门螺杆菌相关性胃溃疡及ESD术后人造溃疡有效性的Meta分析
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摘要
目的系统评价铝碳酸镁联合幽门螺杆菌(H. pylori)根除治疗H. pylori相关性胃溃疡及铝碳酸镁联合质子泵抑制剂(PPI)治疗内镜黏膜下剥离术(ESD)后人造溃疡的有效性。方法计算机检索CBM、CNKI、Wanfang Data、VIP、Pub Med、Embase、Web of Science、Scopus及The Cochrane Library数据库,纳入联用铝碳酸镁治疗H. pylori相关性胃溃疡及联用铝碳酸镁治疗ESD术后人造溃疡的随机对照试验(RCTs),筛选文献、提取数据并评价偏倚风险后,采用Rev Man 5. 3统计软件进行Meta分析。结果①H. pylori相关性胃溃疡:与单独应用H. pylori根除相比,铝碳酸镁联合H. pylori根除治疗能降低溃疡的1年后复发率(ITT分析:RR=0. 48,95%CI:0. 36～0. 65,P <0. 001)。②ESD术后人造溃疡:与单独应用PPI相比,铝碳酸镁联合PPI治疗能提高术后4周的溃疡愈合率(ITT分析,WMD=12. 92,95%CI:10. 15～15. 69,P <0. 001)。结论目前证据表明,在H. pylori根除治疗的基础上联用铝碳酸镁有助于降低H. pylori相关性胃溃疡的1年后复发率;在PPI基础上联用铝碳酸镁有助于加快ESD术后人造溃疡的愈合。
Objective To systematically evaluate the efficacy of Hydrotalcite in the treatment of Helicobacter pylori( H. pylori) associated gastric ulcers and artificial ulcers after ESD. Methods CBM,CNKI,Wanfang Data,VIP,PubMed,Embase,Web of Science,Scopus and The Cochrane Library were retrieved to identify randomized clinical trials about Hydrotalcite plus H. pylori eradication or Hydrotalcite plus PPI for the treatment of H. pylori associated gastric ulcers or artificial ulcers after ESD. Risk of bias of included studies were evaluated according to Cochrane Handbook for Systematic Reviews of Interventions 5. 1. 0. Meta-analysis was performed with Rev Man 5. 3 software. Results ① H. pylori associated gastric ulcers: compared with H. pylori eradication alone,concomitant use of Hydrotalcite decreased one-year recurrence rate( ITT analysis: RR = 0. 48,95% CI: 0. 36-0. 65,P < 0. 001). ② Artificial ulcers after ESD: compared with PPI alone,concomitant use of Hydrotalcite increased ulcer healing rate 4 weeks after ESD( ITT analysis:WMD = 12. 92,95% CI: 10. 15-15. 69,P < 0. 001). Conclusion Concomitant use of Hydrotalcite is superior to H. pylori eradication alone in decreasing one-year recurrence rate of H. pylori associated gastric ulcers; concomitant use of Hydrotalcite with PPI is superior to PPI alone in promoting healing of artificial ulcers after ESD.
Objective To systematically evaluate the efficacy of Hydrotalcite in the treatment of Helicobacter pylori( H. pylori) associated gastric ulcers and artificial ulcers after ESD. Methods CBM,CNKI,Wanfang Data,VIP,PubMed,Embase,Web of Science,Scopus and The Cochrane Library were retrieved to identify randomized clinical trials about Hydrotalcite plus H. pylori eradication or Hydrotalcite plus PPI for the treatment of H. pylori associated gastric ulcers or artificial ulcers after ESD. Risk of bias of included studies were evaluated according to Cochrane Handbook for Systematic Reviews of Interventions 5. 1. 0. Meta-analysis was performed with Rev Man 5. 3 software. Results ① H. pylori associated gastric ulcers: compared with H. pylori eradication alone,concomitant use of Hydrotalcite decreased one-year recurrence rate( ITT analysis: RR = 0. 48,95% CI: 0. 36-0. 65,P < 0. 001). ② Artificial ulcers after ESD: compared with PPI alone,concomitant use of Hydrotalcite increased ulcer healing rate 4 weeks after ESD( ITT analysis:WMD = 12. 92,95% CI: 10. 15-15. 69,P < 0. 001). Conclusion Concomitant use of Hydrotalcite is superior to H. pylori eradication alone in decreasing one-year recurrence rate of H. pylori associated gastric ulcers; concomitant use of Hydrotalcite with PPI is superior to PPI alone in promoting healing of artificial ulcers after ESD.
引文
[1]中华消化杂志编委会.消化性溃疡诊断与治疗规范(2016年,西安)[J].中华消化杂志,2016,36(8):508-513. DOI:10. 3760/cma. j. issn. 0254-1432. 2016. 08. 003.
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[4]铝碳酸镁研究协作组.铝碳酸镁联合奥美拉唑治疗活动期胃溃疡的随机、平行对照、多中心临床研究[J].中华消化杂志,2005,25(12):740-743. DOI:10. 3760/j. issn:0254-1432. 2005. 12. 011.Talcid Research Group. Evaluation of hydrotalcite combined with ome-prazole in treatment of gastric ulcer:a multi-center,randomized,con-trolled clinical trial[J]. Chin J Dig,2005,25(12):740-743. DOI:10. 3760/j. issn:0254-1432. 2005. 12. 011.
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[6]张敏.铝碳酸镁对幽门螺杆菌感染活动性胃溃疡患者组织学溃疡愈合质量影响研究[D].长沙:中南大学,2009.
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[8]周爱华.胃黏膜保护剂铝碳酸镁治疗活动性胃溃疡的观察[J].中国处方药,2014,12(2):13-15.ZHOU A H. Efficacy observation on active gastric ulcer treated withgastric mucosa protectant hydrotalcid[J]. Journal of China Prescrip-tion Drug,2014,12(2):13-15.
[9]马可可,王洪涛,刘义宾.铝碳酸镁对幽门螺杆菌感染性胃溃疡溃疡愈合质量的影响[J].安徽医药,2016,20(6):1197-1199.DOI:10. 3969/j. issn. 1009-6469. 2016. 06. 052.
[10]杨瑞琦.铝碳酸镁联合埃索美拉唑治疗胃溃疡黏膜愈合质量的临床研究[D].广州:南方医科大学,2016.
[11]路国涛,严志刚,吴大成,等.铝碳酸镁联合质子泵抑制剂治疗内镜黏膜下剥离术后人造溃疡的随机对照研究[J].中华消化内镜杂志,2012,29(8):433-436. DOI:10. 3760/cma. j. issn. 1007-5232. 2012. 08. 005.LU G T,YAN Z G,WU D C,et al. Hydrotalcite combined with pro-ton pump inhibitor in treatment of post endoscopic submucosal dissec-tion ulcer:a randomized,controlled clinical trial[J]. Chin J DigEndosc,2012,29(8):433-436. DOI:10. 3760/cma. j. issn. 1007-5232. 2012. 08. 005.
[12]王建新,李锐. 32例内镜黏膜下剥离术后人造溃疡的临床治疗与分析[J].中国医药导报,2013,10(24):65-67,70. DOI:10.3969/j. issn. 1673-7210. 2013. 24. 021.WANG J X,Li R. Clinical treatment and analysis of artificial ulcersof 32 cases after endoscopic submucosal dissection[J]. China Medi-cal Herald,2013,10(24):65-67,70. DOI:10. 3969/j. issn.1673-7210. 2013. 24. 021.
[13]汪培欢.铝碳酸镁联合奥美拉唑治疗内镜黏膜下剥离术后人造溃疡的疗效及其安全性观察[J].中国中西医结合消化杂志,2015,23(8):578-580. DOI:10. 3969/j. issn. 1671-038X. 2015.08. 18.
[14]刘瑞珏.铝碳酸镁联合奥美拉唑治疗内镜黏膜下剥离术后人造溃疡的疗效观察[J].临床合理用药,2016,9(14):36-37. DOI:10. 15887/j. cnki. 13-1389/r. 2016. 14. 020.
[15] LAINE L,TAKEUCHI K,TARNAWSKI A. Gastric mucosal defenseand cytoprotection:bench to bedside[J]. Gastroenterology,2008,135(1):41-60. DOI:10. 1053/j. gastro. 2008. 05. 030.
[16] SATOH K,YOSHINO J,AKAMATSU T,et al. Evidence-based clinicalpractice guidelines for peptic ulcer disease 2015[J]. J Gastroenterol,2016,51(3):177-194. DOI:10. 1007/s00535-016-1166-4.
[17] ASAKA M,KATO M,SUGIYAMA T,et al. Follow-up survey of alarge-scale multicenter,double-blind study of triple therapy with lan-soprazole,amoxicillin,and clarithromycin for eradication of Helico-bacter pylori in Japanese peptic ulcer patients[J]. J Gastroenterol,2003,38(4):339-347. DOI:10. 1007/s005350300061.
[18] MIWA H,SAKAKI N,SUGANO K,et al. Recurrent peptic ulcers inpatients following successful Helicobacter pylori eradication:a multi-center study of 4940 patients[J]. Helicobacter,2004,9(1):9-16.
[19] ARAKAWA T,WATANABE T,TANIGAWA T,et al. Quality of ul-cer healing in gastrointestinal tract:its pathophysiology and clinicalrelevance[J]. World J Gastroenterol,2012,18(35):4811-4822.DOI:10. 3748/wjg. v18. i35. 4811.
[20] KAKUSHIMA N,YAHAGI N,FUJISHIRO M,et al. The healingprocess of gastric artificial ulcers after endoscopic submucosal dissec-tion[J]. Dig Endosc,2004,16(4):327-331. DOI:10. 1111/j.1443-1661. 2004. 00413. x.
[21] MENDELSOHN D,MENDELSOHN L. Hydrogen ion,pepsin andbile acid binding properties of hydrotalcite[J]. S Afr Med J,1975,49(25):1011-1014.
[22] TARNAWSKI A,AHLUWALIA A,JONES M K. Gastric cytoprotec-tion beyond prostaglandins:cellular and molecular mechanisms of gas-troprotective and ulcer healing actions of antacids[J]. Curr PharmDes,2013,19(1):126-132.
[23] SCHMASSMANN A, TARNAWSKI A, GERBER H A, et al.Antacid provides better restoration of glandular structures within thegastric ulcer scar than omeprazole[J]. Gut, 1994, 35(7):896-904.
[24] KATO T,ARAKI H,ONOGI F,et al. Clinical trial:rebamipide pro-motes gastric ulcer healing by proton pump inhibitor after endoscopic sub-mucosal dissection--a randomized controlled study[J]. J Gastroenterol,2010,45(3):285-290. DOI:10. 1007/s00535-009-0157-0.
[2]胡伏莲.消化性溃疡发病机理和治疗新理念[J].医学与哲学(临床决策论坛版),2010,31(5):13-15.HU F L. The update of pathogenesis and treatment for peptic ulcer[J].Medicine and Philosophy(Clinical Decision Making Forum Edition),2010,31(5):13-15.
[3] HIGGINS J,GREEN S. Cochrane Handbook for Systematic Reviews ofInterventions Version 5. 1. 0[updated March 2011][EB/OL].http://handbook. cochrane. org.
[4]铝碳酸镁研究协作组.铝碳酸镁联合奥美拉唑治疗活动期胃溃疡的随机、平行对照、多中心临床研究[J].中华消化杂志,2005,25(12):740-743. DOI:10. 3760/j. issn:0254-1432. 2005. 12. 011.Talcid Research Group. Evaluation of hydrotalcite combined with ome-prazole in treatment of gastric ulcer:a multi-center,randomized,con-trolled clinical trial[J]. Chin J Dig,2005,25(12):740-743. DOI:10. 3760/j. issn:0254-1432. 2005. 12. 011.
[5]李家文.铝碳酸镁联合Hp根治法治疗胃溃疡疗效与复发探讨[J].安徽医药,2006,10(9):659-660. DOI:10. 3969/j. issn. 1009-6469. 2006.09. 009.
[6]张敏.铝碳酸镁对幽门螺杆菌感染活动性胃溃疡患者组织学溃疡愈合质量影响研究[D].长沙:中南大学,2009.
[7]何洪波.铝碳酸镁对HP活动性胃溃疡临床疗效的影响[J].中国医药指南,2010,8(23):126-127.
[8]周爱华.胃黏膜保护剂铝碳酸镁治疗活动性胃溃疡的观察[J].中国处方药,2014,12(2):13-15.ZHOU A H. Efficacy observation on active gastric ulcer treated withgastric mucosa protectant hydrotalcid[J]. Journal of China Prescrip-tion Drug,2014,12(2):13-15.
[9]马可可,王洪涛,刘义宾.铝碳酸镁对幽门螺杆菌感染性胃溃疡溃疡愈合质量的影响[J].安徽医药,2016,20(6):1197-1199.DOI:10. 3969/j. issn. 1009-6469. 2016. 06. 052.
[10]杨瑞琦.铝碳酸镁联合埃索美拉唑治疗胃溃疡黏膜愈合质量的临床研究[D].广州:南方医科大学,2016.
[11]路国涛,严志刚,吴大成,等.铝碳酸镁联合质子泵抑制剂治疗内镜黏膜下剥离术后人造溃疡的随机对照研究[J].中华消化内镜杂志,2012,29(8):433-436. DOI:10. 3760/cma. j. issn. 1007-5232. 2012. 08. 005.LU G T,YAN Z G,WU D C,et al. Hydrotalcite combined with pro-ton pump inhibitor in treatment of post endoscopic submucosal dissec-tion ulcer:a randomized,controlled clinical trial[J]. Chin J DigEndosc,2012,29(8):433-436. DOI:10. 3760/cma. j. issn. 1007-5232. 2012. 08. 005.
[12]王建新,李锐. 32例内镜黏膜下剥离术后人造溃疡的临床治疗与分析[J].中国医药导报,2013,10(24):65-67,70. DOI:10.3969/j. issn. 1673-7210. 2013. 24. 021.WANG J X,Li R. Clinical treatment and analysis of artificial ulcersof 32 cases after endoscopic submucosal dissection[J]. China Medi-cal Herald,2013,10(24):65-67,70. DOI:10. 3969/j. issn.1673-7210. 2013. 24. 021.
[13]汪培欢.铝碳酸镁联合奥美拉唑治疗内镜黏膜下剥离术后人造溃疡的疗效及其安全性观察[J].中国中西医结合消化杂志,2015,23(8):578-580. DOI:10. 3969/j. issn. 1671-038X. 2015.08. 18.
[14]刘瑞珏.铝碳酸镁联合奥美拉唑治疗内镜黏膜下剥离术后人造溃疡的疗效观察[J].临床合理用药,2016,9(14):36-37. DOI:10. 15887/j. cnki. 13-1389/r. 2016. 14. 020.
[15] LAINE L,TAKEUCHI K,TARNAWSKI A. Gastric mucosal defenseand cytoprotection:bench to bedside[J]. Gastroenterology,2008,135(1):41-60. DOI:10. 1053/j. gastro. 2008. 05. 030.
[16] SATOH K,YOSHINO J,AKAMATSU T,et al. Evidence-based clinicalpractice guidelines for peptic ulcer disease 2015[J]. J Gastroenterol,2016,51(3):177-194. DOI:10. 1007/s00535-016-1166-4.
[17] ASAKA M,KATO M,SUGIYAMA T,et al. Follow-up survey of alarge-scale multicenter,double-blind study of triple therapy with lan-soprazole,amoxicillin,and clarithromycin for eradication of Helico-bacter pylori in Japanese peptic ulcer patients[J]. J Gastroenterol,2003,38(4):339-347. DOI:10. 1007/s005350300061.
[18] MIWA H,SAKAKI N,SUGANO K,et al. Recurrent peptic ulcers inpatients following successful Helicobacter pylori eradication:a multi-center study of 4940 patients[J]. Helicobacter,2004,9(1):9-16.
[19] ARAKAWA T,WATANABE T,TANIGAWA T,et al. Quality of ul-cer healing in gastrointestinal tract:its pathophysiology and clinicalrelevance[J]. World J Gastroenterol,2012,18(35):4811-4822.DOI:10. 3748/wjg. v18. i35. 4811.
[20] KAKUSHIMA N,YAHAGI N,FUJISHIRO M,et al. The healingprocess of gastric artificial ulcers after endoscopic submucosal dissec-tion[J]. Dig Endosc,2004,16(4):327-331. DOI:10. 1111/j.1443-1661. 2004. 00413. x.
[21] MENDELSOHN D,MENDELSOHN L. Hydrogen ion,pepsin andbile acid binding properties of hydrotalcite[J]. S Afr Med J,1975,49(25):1011-1014.
[22] TARNAWSKI A,AHLUWALIA A,JONES M K. Gastric cytoprotec-tion beyond prostaglandins:cellular and molecular mechanisms of gas-troprotective and ulcer healing actions of antacids[J]. Curr PharmDes,2013,19(1):126-132.
[23] SCHMASSMANN A, TARNAWSKI A, GERBER H A, et al.Antacid provides better restoration of glandular structures within thegastric ulcer scar than omeprazole[J]. Gut, 1994, 35(7):896-904.
[24] KATO T,ARAKI H,ONOGI F,et al. Clinical trial:rebamipide pro-motes gastric ulcer healing by proton pump inhibitor after endoscopic sub-mucosal dissection--a randomized controlled study[J]. J Gastroenterol,2010,45(3):285-290. DOI:10. 1007/s00535-009-0157-0.