针对Helicobacter pylori根除的非石四倍同时治疗:系统性审查和元分析
Pablo Parra1, Olga P Nyssen1, Javier P Gisbert1
1Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
Helicobacter
|January 7, 2026
概括
非比斯穆特同时进行的四重疗法提供了高的Helicobacter pylori根除率,证明对单药耐药菌株有效. 虽然通常是安全的,但其有效性在双抗性H. pylori下降,这表明在这种情况下,替代治疗可能更好.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 针对 Helicobacter pylori (H. pylori) 根除的标准三重疗法在超过 20% 的病例中失败,主要是由于抗生素耐药性增加.
- 非比斯穆特同时使用的四重疗法已成为首选的替代治疗方案.
研究的目的:
- 通过元分析来评估同时治疗 (质子抑制剂,清素,阿莫西西林,尼特罗伊米达) 对H. pylori根除的疗效和安全性.
- 为了将同时治疗与其他H. pylori根除方案进行比较,包括标准的三重,序列,混合和基于木的四重疗法.
主要方法:
- 在PubMed,EMBASE和会议摘要中进行了系统的文献搜索,截至2025年11月.
- 分析包括随机临床试验和观察性研究,评估同时治疗的疗效和安全性.
- 汇集的根除率和风险差异被计算为不同治疗方案之间的比较.
主要成果:
- 分析包括了144项涉及26467名患者的研究,这些研究显示,合并治疗的H. pylori根除率为86% (治疗意向) 和91% (每种方案).
- 同时治疗的疗效明显高于三重疗法和顺序疗法.
- 疗效与混合疗法和石四重疗法相比,在克拉里素或甲尼达抗性菌株 (87%和95%) 中表现良好,但在双抗性菌株 (67%) 中疗效降低. 有38%的不良事件发生,但通常是轻微的.
结论:
- 同时治疗是对H. pylori根除的高效一线治疗方法,特别是在单一克拉里菌素或胺醇耐药的菌株中.
- 在双重耐药性病例中,疗效降低,在这种情况下,替代疗法可能更合适.
- 同时治疗的整体耐受性是可以接受的,其疗效与混合和木四重疗法相比较.
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