埃索美拉唑与第1代质子泵抑制剂对幽门螺旋杆菌感染疗效比较Meta分析

Esomeprazole vs First-generation Pump Inhibitors in the Treatment of Helicobacter Pylori Infection: A Meta-analysis

关键词:  埃索美拉唑  第1代质子泵抑制剂  幽门螺旋杆菌  CYP2C19  Meta分析

Key words:  esomeprazole  first-generation pump inhibitors  Helicobacter pylori  CYP2C19  Meta-analysis

摘要:

目的 系统比较评价埃索美拉唑与第1代质子泵抑制剂治疗幽门螺旋杆菌感染的效果。方法 计算机检索Cochrane图书馆临床对照试验资料库、PubMed、EMBase、万方电子期刊、中国知网、中国科技期刊数据库、中国生物医学文献数据库，对纳入的文献进行质量评价与数据提取后，用RevMan 5.1软件对数据进行分析。结果 共纳入15 篇文献，包括3 032例患者，文献质量较高。Meta分析结果显示，埃索美拉唑与第1代质子泵抑制剂相比在治疗效果上有显著性差异[WMD=1.32，95％CI(1.09，1.59)，P=0.004]，证明埃索美拉唑疗效更好，但在20 mg bid的用法用量下与第1代质子泵抑制剂没有显著性差异[WMD=1.17，95％CI(0.93，1.48)，P=0.18]，而在40 mg bid的用法用量下与第1代质子泵抑制剂有显著性差异[WMD=2.27，95％CI(1.07，4.82)，P=0.03]；在CYP2C19快代谢人群中两组没有显著性差异[WMD=1.19，95％CI(0.22，6.53)，P=0.84]，慢代谢人群中两组存在显著性差异[WMD=1.84，95％CI(1.13，2.98)，P=0.01]。结论 与埃索美拉唑相比第1代质子泵抑制剂抗幽门螺旋杆菌感染疗效更好，但在20 mg bid的用法用量下并不明显，在40 mg bid的用法用量下效果显著，且不受CYP2C19 基因多态性的影响，快代谢人群更适宜选用埃索美拉唑。

Abstract:

OBJECTIVE To conduct a Meta-analysis of study comparing esomeprazole with first-generation pump inhibitors in the treatment of Helicobacter pylori infection. METHODS Retrieved from Clinical Controlled Trials Database of Cochrane Library, PubMed, EMBase, Wanfang Database, CNKI, VIP and CBM, randomized controlled trials were screened according to predefined inclusion and exclusion criteria. Then the quality of the included studies was evaluated and Meta-analyses was performed by RevMan 5.1 software. RESULTS A total of 15 articles involving 3 032 patients were included. All these articles were regarded as high quality according to Jadad evaluation criteria. The result of meta-analysis showed that the risk ratio was significantly different when esomeprazole compared with first-generation pump inhibitors [WMD=1.32, 95％CI(1.09, 1.59), P=0.004]. There were no significant differences in the risk ratio between two groups when the dosage of esomeprazole was 20 mg bid [WMD=1.17, 95％CI(0.93, 1.48), P=0.18]. But the risk ratio was significantly different when the dosage of esomeprazole was 40 mg bid [WMD=2.27, 95％CI(1.07, 4.82), P=0.03]. In PM patients, no differences were found between esomeprazole and first-generation PPIs [WMD=1.19, 95％CI(0.22, 6.53), P=0.84]. In EM patients, however, the eradication rates in esomeprazole group were significantly better than first-generation PPIs group[WMD=1.84, 95％CI(1.13, 2.98), P=0.01]. CONCLUSION Esomeprazole shows better overall H. pylori eradication rates than first-generation pump inhibitors. This clinical benefit is more pronounced in esomeprazole 40 mg bid regimens. In EM patients, the eradication rates are significantly better with esomeprazole.