本文選題：幽門螺旋桿菌 + 特發(fā)性血小板減少性紫癜��； 參考：《福建醫(yī)科大學》2015年碩士論文

【摘要】：目的評估抗幽門螺旋桿菌(Hp)治療與成人特發(fā)性血小板減少性紫癜(ITP)治療的療效和副作用。方法計算機檢索Pubmed、Embase、The Cochrane Library、中國知網(wǎng)、萬方和維普等數(shù)據(jù)庫中的相關文獻,語種不限,收集關于抗Hp治療與伴Hp感染的成人ITP的RCT文獻。受試患者年齡≥18歲,性別不限,符合ITP和Hp診斷標準,排除繼發(fā)性血小板減少性紫癜。干預措施實驗組為各種不同的抗Hp治療方案,對照組為空白或安慰劑,主要結局指標為總有效(血小板計數(shù)30×109/L)、總緩解(血小板計數(shù)50×103/u L)和復發(fā),次要結局指標為嚴重出血、緩解維持時間、再次入院、Cag A蛋白、GPIIb/IIIa抗體B細胞、Th1/Th2比值。安全性結局指標包括試驗報告的任何不良反應、因嚴重不良反應而退出試驗的事件和所有退出試驗和失訪的事件。檢索到的文獻,由2名評價員獨立確定納入的試驗,對其偏倚風險進行評價,提取數(shù)據(jù),應用Revman 5.0軟件進行Meta分析。結果本次Meta分析納入10個RCTs(n=633例)。9個RCTs為抗Hp與空白對照,1個RCT為抗Hp與安慰劑對照。10個RCTs均使用隨機分配,但其中8個研究未說明隨機分配方法。所有研究均未提供分配隱藏方案及盲法。1篇研究失訪2名受試患者,未說明原因�？傮w上方法學質量較低,存在較大的偏倚危險。7個試驗報告總有效,6個RCTs比較抗Hp組與空白組,其中5個研究抗Hp治療為質子泵抑制劑(PPI)+克拉霉素+阿莫西林,療程7天/10天,1個研究抗Hp治療為序貫療法,5天+5天。相對于空白對照,抗Hp治療有較高的總有效率,匯總的RR值(95%CI)為1.23(1.12-1.36)。1個RCT比較抗Hp(PPI+克拉霉素+阿莫西林,療程7天)與安慰劑,相對于安慰劑,抗Hp治療組的總有效率更高,RR值(95%CI)為2.30(1.20-4.40)。1個試驗報告總緩解率,比較抗Hp(PPI+克拉霉素+阿莫西林,療程7天)與空白對照,顯示抗Hp治療組高于空白組,但無統(tǒng)計學意義(RR=12.07)。3個抗Hp與空白對照比較的RCTs報告1年內復發(fā),其中2個研究抗Hp治療為PPI+克拉霉素+阿莫西林,療程7天/10天。1個研究抗Hp治療為序貫療程,5天+5天�？笻p治療組的復發(fā)率顯著低于空白對照組,RR及其95%CI為0.52(0.39-0.70)。所有研究未報道次要結局指標和不良反應。共有2名患者失訪,屬于試驗組,但文獻未交待失訪原因。結論抗Hp治療伴Hp感染的ITP可能獲得較高的總有效率和總緩解率,降低1年內的復發(fā)率,但由于納入試驗存在較高的偏倚風險,抗Hp治療ITP的益處有待證實。
[Abstract]:Objective to evaluate the efficacy and side effects of anti-Helicobacter pylori (HP) therapy and adult idiopathic thrombocytopenic purpura (ITP). Methods We searched online the Cochrane Library of Pubmedus Embase, Wannang, Weip and other databases in unlimited languages, and collected RCT literature on ITP in adults with HP infection and anti-HP therapy. The age of the patients was more than 18 years old, sex was not limited, according to the diagnostic criteria of ITP and HP, the secondary thrombocytopenic purpura was excluded. The main outcome indexes were total effective (platelet count 30 脳 10 9 / L), total remission (platelet count 50 脳 10 3 / u L) and recurrence, and the secondary outcome index was severe hemorrhage, while the control group was blank or placebo, and the main outcome indexes were total effective (platelet count 30 脳 10 9 / L), total remission (platelet count 50 脳 103% / L) and recurrence. After remission and maintenance time, the ratio of Th _ 1 / Th2 of GPSIIb / IIIa antibody B cells was re-admitted to hospital. Safety outcome indicators include any adverse reactions reported in the trial, the event of withdrawal from the trial due to severe adverse reactions, and all withdrawal and loss events. The collected literature was independently determined by two evaluators to evaluate the bias risk, extract the data, and use Revman 5.0 software for Meta analysis. Results Ten cases of RCTs(n=633 were included in this Meta analysis. 9 RCTs were used as anti-HP and blank control, 1 RCT as anti-HP and placebo. All 10 RCTs were randomly assigned, but 8 of them did not indicate the method of random distribution. All the studies did not provide allocation and concealment scheme and blind method. 1. 2 subjects were not interviewed without explanation of the reasons. In general, the quality of methodology was low, and there was a significant risk of bias. Seven trials were reported to be effective. Six RCTs groups were compared with those in control group, and 5 of them were treated with clarithromycin Amoxicillin, a proton pump inhibitor, and 5 of them were treated with Clarithromycin Amoxicillin, a proton pump inhibitor. The course of treatment was 7 days / 10 days, and one study of anti-HP therapy was sequential therapy for 5 days and 5 days. The total effective rate of anti-HP therapy was higher than that of the blank control, the total RR value of 95 CI was 1.23v 1.12-1.360.1 RCT compared with Hp(PPI clarithromycin amoxicillin for 7 days) and placebo, as opposed to placebo. The total effective rate of the anti-HP treatment group was higher than that of the control group (95 CI). The total remission rate of one trial report was 2.30v 1.20-4.400.Compared with the control group for 7 days, the total remission rate of the anti-HP treatment group was higher than that of the control group, and that of the anti-HP treatment group was higher than that of the control group. But there was no statistical significance between RCTs and control group. The RCTs of 3 anti-HP groups had recurred within one year. Two of them were treated with PPI clarithromycin amoxicillin for 7 days / 10 days. One study showed that the anti-HP treatment was sequential therapy for 5 days and 5 days. The relapse rate of anti-HP treatment group was significantly lower than that of control group (0.52 ~ 0.39-0.70). No secondary outcome indicators and adverse reactions were reported in all studies. A total of 2 patients, belonging to the trial group, did not explain the reasons for the missing visit. Conclusion the total effective rate and total remission rate of ITP with HP infection may be higher, and the recurrence rate can be reduced within one year. However, the benefit of anti-HP therapy for ITP needs to be proved because of the high risk of bias in the trial.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R554.6

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