本文選題：原發(fā)免疫性血小板減少癥 + 幽門螺桿菌��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:應(yīng)用meta分析方法全面評(píng)估抗幽門螺桿菌治療對(duì)成人原發(fā)免疫性血小板減少癥的臨床療效。方法:計(jì)算機(jī)檢索The Cochrane Libary、Pubmed、Embase、相關(guān)期刊論文(CNKI)、中文科技期刊數(shù)據(jù)庫(VIP)和萬方數(shù)據(jù)庫,檢索時(shí)間限定為1998年1月至2016年12月,獲取所有國內(nèi)外公開發(fā)表的相關(guān)文獻(xiàn),語種不限制。所搜索到的文獻(xiàn)嚴(yán)格按照納入和排除標(biāo)準(zhǔn)進(jìn)行篩選,納入關(guān)于抗幽門螺桿菌治療原發(fā)免疫性血小板減少癥(ITP)的隨機(jī)對(duì)照研究,對(duì)符合標(biāo)準(zhǔn)的各個(gè)文獻(xiàn)都實(shí)施文獻(xiàn)質(zhì)量評(píng)價(jià);采用RevMan5.3軟件對(duì)觀察指標(biāo)進(jìn)行meta分析。主要觀察指標(biāo)為總有效率、復(fù)發(fā)率,次要指標(biāo)為不良反應(yīng)發(fā)生率。結(jié)果:共納入17篇符合標(biāo)準(zhǔn)的國內(nèi)外隨機(jī)對(duì)照研究,有956例患者,納入研究的患者基線情況相似。本項(xiàng)meta分析結(jié)果顯示,(一)總有效率:對(duì)17篇研究進(jìn)行抗幽門螺桿菌聯(lián)合激素治療與單用激素治療組的有效率的meta分析,異質(zhì)性檢驗(yàn)結(jié)果P=0.82,I2=0%,可合并統(tǒng)計(jì)量;meta分析結(jié)果:總有效率明顯提高(88.1%vs 66.9%),RR=1.32,95%CI[1.23,1.41],差異有統(tǒng)計(jì)學(xué)意義(P0.00001);(二)復(fù)發(fā)率比較:納入的總研究中有8篇研究進(jìn)行了1年內(nèi)復(fù)發(fā)率的比較,異質(zhì)性檢驗(yàn)結(jié)果P=0.99,I2=0%;共有2篇研究比較2年內(nèi)復(fù)發(fā)率,異質(zhì)性檢驗(yàn)結(jié)果P=0.81,I2=0%。Meta分析結(jié)果顯示:聯(lián)合治療組與單用激素治療組比較,1年內(nèi)復(fù)發(fā)率明顯下降(9.7%vs42.5%),RR=0.27,95%CI[0.19,0.39],差異具有統(tǒng)計(jì)學(xué)意義(P0.00001)。2年內(nèi)復(fù)發(fā)率也明顯下降(20.3%vs 50.7%),RR=0.40,95%CI[0.24,0.68],差異具有統(tǒng)計(jì)學(xué)意義(P=0.0006)。(三)不良反應(yīng)發(fā)生率比較:共有1篇研究報(bào)道了不良反應(yīng)發(fā)生情況,主要不良反應(yīng)表現(xiàn)為下肢水腫、惡心、胃部不適,結(jié)果提示聯(lián)合治療組不良反應(yīng)的發(fā)生率較單用激素治療組明顯降低(26.7%vs 73.3%),RR=0.36,95%CI[0.15,0.89],差異具有統(tǒng)計(jì)學(xué)意義(P=0.03)。結(jié)論:對(duì)于合并幽門螺桿菌感染的成人原發(fā)免疫性血小板減少癥的患者,抗幽門螺桿菌聯(lián)合激素治療可以提高治療有效率,且1年復(fù)發(fā)率、2年復(fù)發(fā)率和不良反應(yīng)發(fā)生率得到明顯下降。通過檢測幽門螺桿菌感染并行抗幽門螺桿菌治療可為臨床治療ITP提供一種新的治療策略。由于納入的樣本量和部分文獻(xiàn)質(zhì)量有限,此結(jié)論仍需進(jìn)一步擴(kuò)充樣本量、選取高質(zhì)量的研究驗(yàn)證,提高論證強(qiáng)度。
[Abstract]:Objective: to evaluate the clinical efficacy of anti-Helicobacter pylori therapy in adult primary immune thrombocytopenia by meta analysis. Methods: The Cochrane library was searched by computer, Chinese periodical full-text database (CNKI) and Wanfang database were searched by computer. The retrieval time was limited from January 1998 to December 2016. Languages are not restricted. The literature was screened strictly according to the inclusion and exclusion criteria and included in a randomized controlled study on the treatment of primary immune thrombocytopenia with Helicobacter pylori. The observation index was analyzed by meta with RevMan5.3 software. The main indicators were the total effective rate, recurrence rate and the incidence of adverse reactions. Results: a total of 17 domestic and foreign randomized controlled trials were conducted. 956 patients were included in the study. The baseline status of the patients involved in the study was similar. The results of this meta analysis showed (1) the total effective rate: 17 studies were performed with meta analysis of the efficacy of anti-Helicobacter pylori combined hormone therapy and single hormone therapy. The results of heterogeneity test P0. 82 / I ~ 2 / 0, can be combined with statistics and meta-analysis: the total effective rate was significantly increased by 88. 1% vs 66. 9% RRX 1.32 ~ 95 CI [1. 2323 ~ 1. 41]. The difference was statistically significant (P 0. 0001 / 1). The recurrence rate was compared in 8 of the total studies included within one year. The results of heterogeneity test were as follows: P0. 9% I2 + 0. There were 2 studies comparing the recurrence rate within 2 years. The results of heterogeneity test showed that the recurrence rate of the combined treatment group was significantly lower than that of the single hormone treatment group within one year. The difference was statistically significant (P0.00001.The recurrence rate was also significantly decreased within 2 years (P < 0.05), and the difference was statistically significant (P < 0.01). The recurrence rate was also significantly lower than that in the control group (P = 0.4095 CI [0.240.68]), and the difference was statistically significant (P = 0.00060.68), and the recurrence rate was significantly lower than that in the control group (P < 0.05), and the recurrence rate was significantly lower than that in the control group (P < 0.01), and the recurrence rate was significantly lower than that in the control group (P < 0.05). (3) comparison of the incidence of adverse reactions: a total of 1 study reported the occurrence of adverse reactions. The main adverse reactions were edema of lower extremities, nausea and stomach discomfort. The results suggested that the incidence of adverse reactions in the combined treatment group was significantly lower than that in the steroid group alone (26.7 vs 73.3%), and the difference was statistically significant (P < 0.05). Conclusion: for adult patients with primary immune thrombocytopenia complicated with Helicobacter pylori infection, anti-Helicobacter pylori combined with hormone therapy can improve the effective rate of treatment. The recurrence rate of 1 year, the recurrence rate of 2 years and the incidence of adverse reactions were significantly decreased. Detection of Helicobacter pylori infection and anti-Helicobacter pylori therapy may provide a new strategy for clinical treatment of ITP. Due to the limited sample size and the limited quality of some documents, this conclusion still needs to further expand the sample size, select high quality research and verification, and improve the intensity of demonstration.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R558.2

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