基于基因型耐药性检测的经验对比定制疗法用于杆菌根除:系统性审查和元分析
Meng Li1, Xiaolei Wang1, Wenting Meng1
1Department of Gastroenterology, Peking University First Hospital, Beijing, China.
Therapeutic advances in gastroenterology
|September 5, 2023
概括
基因型耐药性引导的量身定制疗法显示出消除Helicobacter pylori感染的前景,特别是与经验三重疗法相比. 然而,它的优越性比经验四重疗法需要进一步的研究.
科学领域:
- 胃肠病学和传染病学
- 分子诊断和治疗学分子诊断和治疗学
背景情况:
- 由于抗菌素耐药性增加,实证疗法对Helicobacter pylori (H. pylori) 根除的疗效下降.
- 目前的指导方针建议基因型耐药导向治疗,但其有效性的临床证据有限.
研究的目的:
- 以基因型耐药性测试为指导的量身定制治疗的疗效与H. pylori感染的标准实证治疗进行比较.
主要方法:
- 随机对照试验 (RCT) 的系统审查和元分析.
- 搜索了PubMed,Embase和Cochrane图书馆的相关研究.
- 主要结局:H. pylori根除率;次要结局:不良事件 (AE). 使用随机效应模型进行分析.
主要成果:
- 包括12个与3940名患者参与的RCT. 量身定制的治疗比实证疗法显示出更高的根除率,尽管并不总是统计学上显著.
- 三重治疗:量身定制的方法显著改善了根除率 (ITT和PP分析,p < 0.0001).
- 四重治疗:经验方法显示更高的根除率 (p=0.001对于BQT,p=0.009对于非BQT). 量身定制和经验组之间的AE没有显著差异 (p=0.17).
结论:
- 基于基因型耐药性的量身定制疗法可能比实证三重疗法在H. pylori根除方面更有效.
- 量身定制治疗对实证四重疗法的优越性尚未确立.
- 进一步的大规模,个性化的RCT是指导临床实践所必需的.
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