Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication: A Meta-Analysis.
Tailored Therapy Versus Empiric Chosen Treatment for Helicobacter pylori Eradication: A Meta-Analysis.
复制标题
根除幽门螺杆菌的定制疗法与经验选择疗法：荟萃分析
DOI：
10.1097/md.0000000000002750
复制
发表时间：
2016-02
期刊：
影响因子：
1.6
通讯作者：
Zhang G
中科院分区：
文献类型：
--
作者：
Chen H;Dang Y;Zhou X;Liu B;Liu S;Zhang G
尽管经验上接受了各种方案用于根除幽门螺杆菌，但疗效可能会受到多种个体因素的影响。个性化根除治疗的必要性仍然存在争议。该研究的目的是比较定制治疗与经验选择方案。检索PUBMED、EMBASE和MEDLINE数据库中截至2015年10月发表的合格研究。纳入了所有相关对照临床试验。应用随机效应模型比较合并相对风险（RR）和相关95%置信区间（CI）。13个对照临床试验纳入3512名参与者进行了评估。总体而言，定制组的汇总根除率高于经验组（意向治疗：RR = 1.16，95%CI 1.10-1.22;方案前：RR = 1.14，95%CI 1.08-1.21）。 在亚组分析中，个体化治疗的根除率上级优于7天标准三联疗法（RR = 1.22，95%CI 1.16-1.29）和铋剂四联疗法（RR = 1.14，95%CI 1.07-1.22）;一线个体化治疗的根除率高于一线经验方案（汇总RR = 1.18，95%CI 1.14-1.22），而个体化补救方案与经验方案无差异（汇总RR = 1.16，95%CI 0.96-1.39）。 此外，在不同的定制设计中，易感性指导的定制治疗获得了比经验组更高的根除率，与CYP 2C 19基因型检测无关（有易感性：RR = 1.16，95%CI 1.09-1.23;无易感性：RR = 1.14，95%CI 1.01-1.28）。 基于分子检测和基于培养的定制组的根除率均优于经验组（分子：RR = 1.23，95%CI 1.11-1.35;培养：RR = 1.13，95%CI 1.06-1.20）。 与经验性选择性治疗相比，个体化治疗是根除H pylori的更好选择。
Although various regimens are empirically accepted for Helicobacter pylori eradication, the efficacy might be declined by multiple individual factors. The necessity of a personalized eradication therapy still remains controversial. The aim of the study was to compare tailored therapy with empiric chosen regimens. Databases of PUBMED, EMBASE, and MEDLINE were searched for eligible studies, published up to October 2015. All relevant controlled clinical trials were included. A random-effect model was applied to compare pooled relative risk (RR) with related 95% confidence intervals (CIs). Thirteen controlled clinical trials integrating 3512 participants were assessed. Overall, the pooled eradication rates of tailored groups were higher than those of empiric ones (intention-to-treat: RR = 1.16, 95% CI 1.10–1.22; preprotocol: RR = 1.14, 95% CI 1.08–1.21). In subgroup analysis, tailored therapy was superior to 7-day standard triple therapy (RR = 1.22, 95% CI 1.16–1.29) and bismuth-quadruple therapy (RR = 1.14, 95% CI 1.07–1.22) on eradication rates; first-line tailored therapy achieved higher eradication rates than first-line empirical regimens (pooled RR = 1.18, 95%CI 1.14–1.22), whereas tailored rescue regimen showed no difference with empirical ones (pooled RR = 1.16, 95% CI 0.96–1.39). Moreover, among different tailored designs, susceptibility-guided tailored therapy obtained higher eradication rates than empiric groups, independent of CYP2C19 genotype detection (with CYP: RR = 1.16, 95% CI 1.09–1.23; without CYP: RR = 1.14, 95% CI 1.01–1.28). Both molecular test-based and culture-based tailored groups were better on eradication rates than empiric groups (molecular: RR = 1.23, 95% CI 1.11–1.35; culture: RR = 1.13, 95% CI 1.06–1.20). Compared with empiric chosen treatments, tailored therapy is a better alternative for H pylori eradication.