本文選題：序貫療法 + 三聯(lián)療法��； 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：背景： 三聯(lián)療法(Triple Therapy, TT)的根除率逐年下降，，當(dāng)前國(guó)內(nèi)外有較多關(guān)于序貫療法(Sequential Therapy, ST)根除幽門螺旋桿菌(Helicobacter pylori,Hp)感染的報(bào)道，應(yīng)用循證醫(yī)學(xué)的方法對(duì)ST與TT根除Hp感染的療效進(jìn)行比較具有一定的臨床意義。 目的： 運(yùn)用Meta分析法評(píng)價(jià)ST與TT根除Hp感染的療效差異。方法： 選用Cochrane系統(tǒng)綜述方法，確定恰當(dāng)?shù)臋z索詞、檢索年限及檢索的數(shù)據(jù)庫(kù)。納入ST與TT根除Hp感染療效比較的隨機(jī)對(duì)照試驗(yàn)(RCTs)，對(duì)納入文獻(xiàn)進(jìn)行資料提取及質(zhì)量評(píng)價(jià)，對(duì)研究結(jié)果進(jìn)行異質(zhì)性檢驗(yàn)，根據(jù)異質(zhì)性分析結(jié)果選擇適當(dāng)?shù)男?yīng)模型及決定是否采用Meta分析，同時(shí)進(jìn)行亞組分析、敏感性分析、安全性評(píng)價(jià)及發(fā)表偏倚評(píng)價(jià)。 結(jié)果： 共11篇RCTs研究文獻(xiàn)符合納入標(biāo)準(zhǔn)， Cochrane風(fēng)險(xiǎn)偏倚評(píng)估提示低風(fēng)險(xiǎn)偏倚見(jiàn)于選擇偏倚、隨訪偏倚及報(bào)告偏倚，高風(fēng)險(xiǎn)偏倚見(jiàn)于實(shí)施偏倚、測(cè)量偏倚及其他偏倚，Jadad量表結(jié)果提示高質(zhì)量文獻(xiàn)、較高質(zhì)量文獻(xiàn)、低質(zhì)量文獻(xiàn)分別為2篇、5篇、4篇。Meta分析結(jié)果顯示，意向性治療(ITT)分析ST組與TT組根除率的OR為3.39，95%可信區(qū)間(CI)為2.66～4.33，ST組與TT組根除率比較有統(tǒng)計(jì)學(xué)差異(Z=9.87, p0.00001)。符合方案集(PP)分析ST組與TT組根除率的OR為4.76，95%可信區(qū)間(CI)為3.53～6.40，ST組與TT組根除率比較有統(tǒng)計(jì)學(xué)差異(Z=10.29, p0.00001)。亞組分析成人、兒童及中國(guó)的ST與TT療法，結(jié)果均支持ST根除Hp感染療效優(yōu)于TT。而ST與TT不良反應(yīng)無(wú)差異。 結(jié)論： ST根除Hp感染療效優(yōu)于TT。因納入研究的文獻(xiàn)數(shù)量較少，質(zhì)量良莠不齊，今后仍需進(jìn)行多中心、大樣本RCTs分析以證實(shí)ST根除Hp感染的優(yōu)越性。
[Abstract]:Background: The eradication rate of Triple Therapy (TT) has been decreasing year by year. There are many reports about Sequential Therapy (ST) for the eradication of Helicobacter pylori (Helicobacter pylori) infection at home and abroad. Evidence-based medicine was used to compare the efficacy of St and TT in the eradication of HP infection. Objective: Meta analysis was used to evaluate the efficacy of St and TT in the eradication of HP infection. Methods: Cochrane system review method is used to determine the appropriate search term, retrieval time and retrieval database. A randomized controlled trial to compare the efficacy of St and TT in the eradication of HP infection was used to extract the data and evaluate the quality of the literature, and to test the heterogeneity of the results. According to the results of heterogeneity analysis, appropriate effect models were selected and Meta analysis was used to determine whether to use Meta analysis, while subgroup analysis, sensitivity analysis, safety evaluation and publication bias evaluation were carried out. Results: A total of 11 RCTs studies met the inclusion criteria. The Cochrane risk bias assessment showed that low risk bias was found in selective bias, follow-up bias and reporting bias, and high risk bias in implementation bias. The results of Jadad scale for measuring bias and other biases suggested that there were 2 articles with high quality, 5 articles with high quality and 4 articles with low quality. The results of meta-analysis showed that: 1. The OR of the eradication rate of St group and TT group was 3.39 鹵95% CI). The eradication rate of St group and TT group was 2.664.33 St group and TT group. There was significant difference in eradication rate between St group and TT group (P 0.00001). The OR of eradication rate of St group and TT group was 4.76% 95% CI). The eradication rate of St group and TT group was 3.53 ~ 6.40%. There was significant difference in eradication rate between St group and TT group (P = 10.29, p 0.00001). The subgroup analysis of St and TT therapy in adults, children and China showed that the efficacy of St to eradicate HP infection was better than that of TTT. There was no difference in adverse reactions between St and TT. Conclusion: The efficacy of St in eradicating HP infection was better than that of TT. Due to the small number of literatures and the uneven quality, there are still many centers to be carried out in the future. Large sample RCTs analysis is needed to confirm the superiority of St in eradicating HP infection.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R57

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