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目的系统评价乳杆菌治疗幽门螺杆菌(H.pylori)感染的有效性。方法计算机检索PubMed、Cochrane Central Register of Controlled Trials、Clinicatrials.gov、中国临床试验注册中心(http://www.chictr.org.cn/)、中国知网(CNKI)、万方数据库。检索时间从建库至2016年6月30日。此外追索已纳入文献和综述的参考文献。经两位研究者独立筛选文献、提取资料和评价质量,交叉核对后,采用Stata 12.0进行Meta分析。结果最终纳入17个RCT,共1 758例患者。Meta分析结果:乳杆菌联合常规三联疗法能提高H.pylori根除率[OR=2.762,95%CI(2.163,3.526),P<0.001],降低不良反应发生率[OR=0.334,95%CI(0.242,0.461),P<0.001],但乳杆菌单独应用对H.pylori根除率结果与对照组比较差异无统计学意义。根据乳杆菌给药疗程的亚组分析结果,0~14(含14)d乳杆菌联合给药方案显著提高了H.pylori根除率[OR=2.893,95%CI(2.187,3.827),P<0.05],14~28(含28)d给药疗程也显著提高了H.pylori根除率[OR=2.619,95%CI(1.652,4.153),P<0.05]。乳杆菌联合三联疗法在欧洲人群及亚洲人群的亚组分析中,均提高了H.pylori根除率。结论乳杆菌联合三联疗法有利于提高H.pylori根除率,并能降低总不良反应的发生,在H.pylori感染相关疾病的治疗中具有一定意义。
Objective To evaluate the effectiveness of Lactobacillus treatment of H. pylori infection. Methods We searched PubMed, Cochrane Central Register of Controlled Trials, Clinicatrials.gov, China Clinical Trial Register (http://www.chictr.org.cn/), CNKI and Wanfang Database. Retrieval time from the building to June 30, 2016. Also recalled references that have been included in the literature and reviews. The two investigators independently screened the literature, extracted data and evaluated the quality of the data. After cross-checking, Stata 12.0 was used for meta-analysis. The results eventually included 17 RCTs, for a total of 1,758 patients. Meta analysis results: Lactobacillus combined with conventional triple therapy can improve H.pylori eradication rate [OR = 2.762,95% CI (2.163,3.526, P <0.001], reduce the incidence of adverse reactions [OR = 0.334, 95% CI 0.242, 0.461), P <0.001]. However, there was no significant difference in the results of H.pylori eradication between Lactobacilli alone and the control group. According to the results of subgroup analysis of Lactobacillus treatment, the combination of 0 ~ 14 (including 14) d Lactobacillus significantly increased the H.pylori eradication rate [OR = 2.893,95% CI 2.187,3.827, P < 0.05], 14-28 (including 28) d treatment also significantly improved the H.pylori eradication rate [OR = 2.619,95% CI (1.652,4.153), P <0.05]. Lactobacillus combined with triple therapy increased the H. pylori eradication rate in both European and Asian subgroup analyzes. Conclusion Lactobacillus combined with triple therapy is helpful to improve H.pylori eradication rate and reduce the incidence of total adverse reactions, which is of certain significance in the treatment of diseases related to H.pylori infection.