[A meta-analysis of randomized controlled trials of bismuth-containing quadruple therapy combined with probiotic supplement for eradication of Helicobacter pylori].

Objective: The bismuth containing quadruple therapy (BCQT) acts as first-line therapy in China. Probiotics supplement also shows Helicobacter pylori eradication effects. Adding probiotics along with BCQT may improve eradication rate of Helicobacter pylori. Methods: Electronic databases including Medline, Embase, Wanfang Database, etc. were searched by the established searching strategy. After that, a funnel plot was adopted to evaluate publication bias. The meta-analysis was supplemented in fixed effect model for low heterogeneity and randomized effect model for high heterogeneity conversely. Results: A total of 16 RCTs with 2 466 subjects finally met the inclusion criteria. There was no significant heterogeneity among the trials. Compared with control group (BCQT only), the probiotic group (combined supplement of probiotics and BCQT) underwent higher eradication rate[90.76%(1 130/1 245) vs 80.43%(982/1 221)]with statistical significance (P=0.000). The probiotics might improve the eradication rate in patients not receiving previous eradication therapy [89.00%(445/500) vs 84.73%(416/491), P=0.04]. Probiotics might also improve the eradication rate[91.06%(326/358) vs 73.83%(268/363)]in patients relapsed from triple therapy (P=0.000). The patients who underwent the combination of BCQT and single Lactobacillus genus showed higher eradiation rate than those with two or more genera. Moreover, fewer adverse reactions were reported in probiotics group than that in control group[13.59%(104/765) vs 28.90%(213/737), P=0.000]. Conclusions: The combination of BCQT and probiotics may improve the eradication rate of Helicobacter pylori especially in patients receiving front-line eradication regimen or failed from triple therapy. Probiotics may reduce the adverse reactions when combined with other eradication agents.目的： 采用Meta分析方法探讨含铋剂四联方案联合微生态制剂是否可提高幽门螺杆菌(Hp)根除率、减少不良反应发生率。 方法： 依据既定检索策略分别在Medline、Embase、中国知网(CNKI)、万方数据库等国内外数据库检索文献。通过绘制漏斗图评估有无发表偏倚。依据异质性检验评估纳入文献异质性情况，若异质性较低(I(2)<40%)，采用固定效应模型分析；反之则采用随机效应模型进行合并分析。 结果： 本研究共纳入16项随机对照试验，包含患者2 466例，异性检验显示异质性较低(I(2)＝32%)。Meta分析显示，含铋剂四联方案联合微生态制剂组的根除率优于单用含铋剂四联方案(对照组)[90.76%(1 130/1 245)比80.43%(982/1 221)，P＝0.000]。对于首次Hp根除治疗的患者，联用微生态制剂组根除成功率优于对照组[89.00%(445/500)比84.73%(416/491)，P＝0.040]。经"三联方案"根除失败的患者，再次予以含铋剂四联方案根除治疗，联用微生态制剂组的根除率优于对照组[91.06%(326/358)比73.83%(268/363)，P＝0.000]。亚组分析显示，联用单一菌(乳酸菌属)制剂的根除率高于对照组[94.49%(257/272)比86.62%(233/269)，P＝0.002]，且优于联用2种、3种菌制剂的根除率。此外，联用微生态制剂组的不良反应发生率显著少于对照组[13.59%(104/765)比28.90%(213/737)，P＝0.000]。 结论： 联合使用含铋剂四联方案及微生态制剂可提高Hp根除率，这一作用不仅适用于根除Hp初始治疗的患者，而且适用于经"三联方案"根除失败后补救治疗的患者，并可显著降低药物不良反应发生率。.