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目的 评价布拉氏酵母菌(Saccharomyces boulardii,S.boulardii)联合铋剂四联疗法(bismuth quadruple therapy, BQT)在根除幽门螺杆菌(Helicobacter pylori,H.pylori)治疗中的有效性和安全性。方法 检索中国知网、万方、维普、PubMed、EmBase、Cochrane Library等数据库，收集自建库至2024年2月22日公开发表的对比S.boulardii&BQT与BQT治疗H.pylori感染的随机对照试验(randomized controlled trial, RCT)。采用RevMan 5.4软件进行Meta分析。结果 共纳入22篇文献，3 923例患者。Meta分析结果：试验组S.boulardii&BQT的H.pylori根除率显著高于对照组BQT(93.7%vs 86.2%,OR=2.42,95%CI:1.92～3.04,P<0.001),且总体不良反应发生率(12.7%vs 25.6%,OR=0.40,95%CI:0.32～0.49,P<0.001)及腹泻发生率(3.8%vs 13.6%,OR=0.24,95%CI:0.19～0.32,P<0.001)明显低于对照组。进一步的亚组分析表明，在H.pylori感染的初次治疗中S.boulardii&BQT的根除率仍显著高于BQT(94.3%vs 87.5%,OR=2.41,95%CI:1.84～3.14,P<0.001),而在补救治疗中两者的根除率差异却无统计学意义(90.0%vs 83.1%,OR=1.82,95%CI:0.93～3.55,P=0.08);此外，无论是低剂量S.boulardii(250 mg bid)或高剂量S.boulardii(500 mg bid)均能显著提高BQT的H.pylori根除率。结论 基于现有RCT的Meta分析表明，S.boulardii可显著提高BQT的疗效，并能减少不良事件尤其是腹泻的发生，值得在临床上推广应用。
Abstract：Objective To evaluate the efficacy and safety of Saccharomyces boulardii(S.boulardii) combined with Bismuth quadruple therapy(BQT) in eradicating Helicobacter pylori(H.pylori). Methods Retrieve databases such as CNKI, WanFang, VIP, PubMed, EmBase, Cochrane Library, and collect randomized controlled trials(RCTs) comparing S.boulardii & BQT with BQT for the treatment of H.pylori infection, from inception to Feb. 22nd, 2024. Meta-analysis was conducted by RevMan 5.4 software. Results A total of 22 literatures and 3 923 patients were included. Meta-analysis results: the H.pylori eradication rate of experimental group, S.boulardii & BQT, was significantly higher than that of control group, BQT(93.7% vs 86.2%, OR=2.42, 95% CI: 1.92-3.04, P<0.001), and the overall incidence of adverse reactions(12.7% vs 25.6%, OR=0.40, 95% CI: 0.32-0.49, P<0.001), as well as the incidence of diarrhea(3.8% vs 13.6%, OR=0.24, 95% CI: 0.19-0.32, P<0.001), were significantly lower than those of control group. Further subgroup analysis indicated that the eradication rate of S.boulardii & BQT was still significantly higher than that of BQT(94.3% vs 87.5%, OR=2.41, 95% CI: 1.84-3.14, P<0.001) in the first treatment of H.pylori infection, but their eradication rates were not statistically significant different in the rescue treatment of H.pylori infection(90.0% vs 83.1%, OR=1.82, 95% CI: 0.93-3.55, P=0.08). In addition, both low-dose S.boulardii(250 mg bid) and high-dose S.boulardii(500 mg bid) could significantly improve the H.pylori eradication rate of BQT. Conclusion The Meta-analysis based on existing RCTs indicates that S.boulardii can significantly improve the efficacy of BQT and reduce the occurrence of adverse events, especially diarrhea, which is worth promoting and applying in clinical practice.
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基本信息:
DOI：
中图分类号:R573
引用信息:
[1]张淼霞,张聚,宋书杰,等.布拉氏酵母菌联合铋剂四联疗法根除幽门螺杆菌安全性和有效性的Meta分析[J].胃肠病学和肝病学杂志,2025,34(09):1282-1289.
基金信息:
陕西省重点研发计划(2023-ZDLSF-35); 陕西省卫生健康科研创新团队(2024YD-06)