阿莫西林二联方案根除幽门螺杆菌疗效与安全性的网状Meta分析OA
Network meta-analysis of the efficacy and safety of dual amoxicillin-based regimens for Helicobacter pylori eradication
目的 评价阿莫西林联用质子泵抑制剂(PPI)或钾离子竞争性酸阻滞剂(P-CAB)根除幽门螺杆菌(Hp)的有效性与安全性.方法 检索PubMed、Embase、the Cochrane Library、Web of Science、中国知网、万方数据、维普网,收集阿莫西林联合PPI或P-CAB根除Hp的随机对照试验(RCT),检索时限为建库起至2025年9月5日.筛选文献、提取资料、评价文献质量后,采用Stata 17.0软件进行网状Meta分析.结果 共纳入12项RCT,共计5 515例患者,涉及8种干预措施,分别为PPI联合高剂量阿莫西林14 d(TR1)、PPI联合低剂量阿莫西林14 d(TR2)、P-CAB联合高剂量阿莫西林7 d(TR3)、P-CAB联合高剂量阿莫西林14 d(TR4)、P-CAB联合高剂量阿莫西林10 d(TR5)、P-CAB联合低剂量阿莫西林7 d(TR6)、P-CAB联合低剂量阿莫西林14 d(TR7)和P-CAB联合低剂量阿莫西林10 d(TR8).网状Meta分析结果显示,在意向性治疗的Hp根除率方面,TR5和TR4的根除率显著高于TR3、TR8、TR6和TR1(P＜0.05);累积排序概率曲线下面积(SUCRA)从高到低依次为:TR4(89.7%)＞TR5(82.3%)＞TR7(71.5%)＞TR2(48.6%)＞TR1(43.9%)＞TR8(28.7%)＞TR3(22.7%)＞TR6(12.6%).在安全性方面,TR3、TR5的不良反应发生率显著低于TR1(P＜0.05);SUCRA 从高到低依次为:TR1(91.3%)＞TR4(79.8%)＞TR5(55.0%)＞TR7(50.9%)＞TR8(41.3%)＞TR2(36.4%)＞TR3(27.6%)＞TR6(17.7%).结论 尽管P-CAB联合高剂量阿莫西林14 d的疗效最佳,但P-CAB联合高剂量阿莫西林10 d在疗效与安全性方面表现更均衡.
OBJECTIVE To evaluate the efficacy and safety of amoxicillin combined with proton pump inhibitor(PPI)or potassium-competitive acid blocker(P-CAB)for Helicobacter pylori(Hp)eradication.METHODS Randomized controlled trial(RCTs)on amoxicillin combined with PPI or P-CAB for Hp eradication were retrieved from PubMed,Embase,the Cochrane Library,Web of Science,CNKI,Wanfang,and VIP data.The search time frame was from database inception to September 5,2025.After literature screening,data extraction,and quality assessment,a network meta-analysis was performed using Stata 17.0 software.RESULTS A total of 12 RCTs involving 5 515 patients were included,encompassing 8 therapeutic regimens:PPI combined with high-dose amoxicillin for 14 days(TR1),PPI combined with low-dose amoxicillin for 14 days(TR2),P-CAB combined with high-dose amoxicillin for 7 days(TR3),P-CAB combined with high-dose amoxicillin for 14 days(TR4),P-CAB combined with high-dose amoxicillin for 10 days(TR5),P-CAB combined with low-dose amoxicillin for 7 days(TR6),P-CAB combined with low-dose amoxicillin for 14 days(TR7),and P-CAB combined with low-dose amoxicillin for 10 days(TR8).The network meta-analysis results showed that,in terms of intention-to-treat Hp eradication rates,the eradication rates of TR5 and TR4 were significantly higher than those of TR3,TR8,TR6 and TR1(P＜0.05).The surface under the cumulative ranking curve(SUCRA)values from highest to lowest were:TR4(89.7%)＞TR5(82.3%)＞TR7(71.5%)＞TR2(48.6%)＞TR1(43.9%)＞TR8(28.7%)＞TR3(22.7%)＞TR6(12.6%).Regarding safety,the incidence of adverse reactions in TR3 and TR5 was significantly lower than that in TR1(P＜0.05).The SUCRA values from highest to lowest were:TR1(91.3%)＞TR4(79.8%)＞TR5(55.0%)＞TR7(50.9%)＞TR8(41.3%)＞TR2(36.4%)＞TR3(27.6%)＞TR6(17.7%).CONCLUSIONS Although the regimen of P-CAB combined with high-dose amoxicillin for 14 days demonstrates the best efficacy,the combination of P-CAB with high-dose amoxicillin for 10 days exhibits a better balanced profile in terms of both efficacy and safety.
宋子文;段飞;原鑫淼;罗俐媛;何雨芳;杨玲淑;黄译续;佘建朋;魏培涵;郭思涵
河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003河南中医药大学第一附属医院脾胃肝胆病科,郑州 450099||河南中医药大学第一临床医学院,郑州 450003
医药卫生
阿莫西林幽门螺杆菌二联方案质子泵抑制剂钾离子竞争性酸阻滞剂网状Meta分析疗效安全性
amoxicillinHelicobacter pyloridual therapyproton pump inhibitorpotassium-competitive acid blockernetwork meta-analysisefficacysafety
《中国药房》 2026 (8)
1074-1079,6
河南省科技发展计划项目(No.232102310410,No.231111312400)河南省卫生健康委国家中医临床研究基地科研专项(No.2022JDZX092)
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