Hybrid Therapy Regimen for Helicobacter Pylori Eradication.
Hybrid Therapy Regimen for Helicobacter Pylori Eradication.
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DOI：
10.4103/0366-6999.179803
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发表时间：
2016-04-20
影响因子：
6.1
通讯作者：
Zhou LY
中科院分区：
文献类型：
--
作者：
Song ZQ;Liu J;Zhou LY
随着抗生素耐药性的增加，根除幽门螺杆菌仍然是一个挑战。混合疗法因其良好的疗效和安全性而受到广泛关注。然而，混合疗法的根除效果、安全性、依从性、影响因素、与抗生素耐药性的相关性以及与其他方案的比较等问题仍不清楚。因此，我们对幽门螺杆菌感染的混合治疗证据进行了全面的回顾。本综述使用的数据主要来源于截至2015年9月30日发表的PubMed英文文章，检索词为Helicobacter pylori或H。Pylori”和“hybrid”。临床研究文章的选择主要根据其与本主题的相关程度。12项研究共1871例患者接受了混合治疗。意向治疗的根除率为77.6-97.4%，按方案分析的根除率为82.6-99.1%。依从性为93.3 ~ 100.0%，总不良反应率为14.5 ~ 67.5%，因不良反应停药率为0 ~ 6.7%。只有13.3%的患者进行幽门螺杆菌培养和敏感性试验。合并分析结果显示，对克拉霉素和甲硝唑双敏感、甲硝唑或克拉霉素双耐、克拉霉素双耐和甲硝唑双耐的根除率分别为98.5%、97.6%、92.9%和80.0%。总的来说，混合治疗的疗效、依从性和安全性与顺序或伴随治疗相似。然而，在亚洲，混合疗法可能优于序贯疗法。混合疗法在不同地区的疗效差异很大，但始终具有良好的依从性和安全性。双克拉霉素和甲硝唑耐药是影响疗效的关键因素。混合治疗在疗效、安全性和依从性方面与顺序或伴随治疗相似。
Helicobacter pylori (H. pylori) eradication remains a challenge with increasing antibiotic resistance. Hybrid therapy has attracted widespread attention because of initial report with good efficacy and safety. However, many issues on hybrid therapy are still unclear such as the eradication efficacy, safety, compliance, influencing factors, correlation with antibiotic resistance, and comparison with other regimens. Therefore, a comprehensive review on the evidence of hybrid therapy for H. pylori infection was conducted. The data used in this review were mainly from PubMed articles published in English up to September 30, 2015, searching by the terms of “Helicobacter pylori” or “H. pylori”, and “hybrid”. Clinical research articles were selected mainly according to their level of relevance to this topic. Totally, 1871 patients of 12 studies received hybrid therapy. The eradication rates were 77.6–97.4% in intention-to-treat and 82.6–99.1% in per-protocol analyses. Compliance was 93.3–100.0%, overall adverse effects rate was 14.5–67.5%, and discontinued medication rate due to adverse effects was 0–6.7%. H. pylori culture and sensitivity test were performed only in 13.3% patients. Pooled analysis showed that the eradication rates with dual clarithromycin and metronidazole susceptible, isolated metronidazole or clarithromycin resistance, and dual clarithromycin and metronidazole resistance were 98.5%, 97.6%, 92.9%, and 80.0%, respectively. Overall, the efficacy, compliance, and safety of hybrid therapy were similar with sequential or concomitant therapy. However, hybrid therapy might be superior to sequential therapy in Asians. Hybrid therapy showed wide differences in the efficacy but consistently good compliance and safety across different regions. Dual clarithromycin and metronidazole resistance were the key factor to efficacy. Hybrid therapy was similar to sequential or concomitant therapy in the efficacy, safety, and compliance.