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目的采用累积Meta分析,对以雷贝拉唑(Rab)和奥美拉唑(Ome)为基础的三联疗法根除幽门螺杆菌(Hp)的效果进行系统评价。方法检索1993年1月—2013年1月公开发表的关于比较雷贝拉唑或奥美拉唑三联疗法治疗Hp阳性相关消化系统疾病的随机对照试验,根据标准筛选出31篇中英文文献,运用Revman5.0软件对文献试验数据进行Meta分析,绘制森林图,同时绘制漏斗图检查发表偏倚。并应用stata12.0软件进行累积Meta分析,并与传统Meta分析结果进行比较。结果雷贝拉唑组对Hp的根除率及溃疡愈合率显著优于奥美拉唑组,合并效应量OR值及其95%CI分别为1.64(1.27,2.11)和2.16(1.51,3.09),P<0.001。雷贝拉唑组与奥美拉唑组不良反应发生率差异无统计学意义,合并效应量OR值及其95%CI为0.81(0.61,1.08)(P>0.05)。累积Meta分析显示,按年代先后顺序累积后,三种结局指标OR值及95%可信区间趋于稳定且有较好的变化趋势。可确定根除率和愈合率疗效最初被证实具有统计学意义的时间。结论与奥美拉唑相比,雷贝拉唑三联疗法具有Hp根除率、溃疡愈合率高优点,用其根除Hp感染是有效的和安全的。按年代先后顺序累积后,根除率、愈合率、不良反应发生率的OR值趋于稳定,OR95%CI范围变窄,根除率、愈合率疗效最初被证实具有统计学意义的时间为2008年。
Objective To evaluate the efficacy of triple therapy based on rabeprazole and omeprazole (Ome) in the eradication of Helicobacter pylori (Hp) using a cumulative meta-analysis. METHODS: A randomized controlled trial published January 1993-January 2013 on the comparison of rabeprazole or omeprazole triple therapy in the treatment of Hp-positive digestive diseases was screened, based on which 31 articles in both English and Chinese were searched. Revman5.0 software Meta analysis of the literature test data, draw the forest map, while drawing the funnel chart to check publication bias. The stata12.0 software was used to do the cumulative meta-analysis and compared with the traditional meta-analysis results. Results The rate of eradication and ulcer healing in rabeprazole group was significantly better than that in omeprazole group. The OR value and 95% CI of combined effect were 1.64 (1.27, 2.11) and 2.16 (1.51, 3.09), respectively P <0.001. There were no significant differences in the incidence of adverse reactions between rabeprazole and omeprazole groups. The OR of combined effects and its 95% CI were 0.81 (0.61, 1.08) (P> 0.05). Cumulative meta-analysis showed that the odds ratios (OR) and 95% confidence intervals (TRs) of the three outcome measures tended to be stable and had a good trend after accumulating in chronological order. Eradication and healing rates were initially determined to be statistically significant. Conclusion Compared with omeprazole, rabeprazole triple therapy has the advantages of Hp eradication rate and ulcer healing rate. It is effective and safe to eradicate Hp infection. According to the chronological order of accumulation, the OR of eradication rate, healing rate and incidence of adverse reactions tended to be stable, and the range of OR95% CI narrowed. The eradication rate and healing rate were initially confirmed to be statistically significant in 2008.