Efficacy Of Anti-Helicobacter Pylori Therapy Inadult Immune Thrombocytopenia: A Meta-analysis

Objective:The study was aimed to evaluate comprehensively the clinical efficacy of anti-Helicobacter pylori therapy in adult patients with immune thrombocytopenia by meta-analysis.Methods:We searched The Cochrane libary,Pubmed,Embase,Chinese Journal Full-text Database(CNKI),VIP database and Wanfang database,published at home and abroad to obtain all relevant literature,language not limited,and retrieval time was limited to January 1998 to December 2016.The searched literature was screened in strict accordance with the inclusion and exclusion criteria and included randomized controlled trials of anti-Helicobacter pylori for the treatment of immune thrombocytopenia(ITP).The quality evaluation and bias risk assessment were carried out one by one in accordance with the standard literature.Meta analysis was carried out using RevMan 5.3 software.Observation indicators were the total efficiency,recurrence rate,the incidence of adverse reactions.Results:A total of 17 randomized controlled trials were included in the study,with a total of 956 patients who were similar in baseline to the study.The results showed that:(a)the total efficiency of the comparison: 17 studies were conducted to compare the efficacy of Helicobacter pylori combined with glucocorticoid therapy in the treatment group with glucocorticoid alone.The heterogeneity test results :P = 0.82,I2 = 0%;Meta analysis showed that the total effective rate was significantly improved(88.1% vs 66.9%),RR = 1.32,95% CI [1.23,1.41],the difference was statistically significant(P <0.00001);(b)Recurrence rate comparison: 8 cases were compared with 1 year recurrence rate,heterogeneity test results P = 0.99,I2 = 0%;2 studies compared 2-year recurrence rate,heterogeneity test results P = 0.81,I2 = 0%.The results of meta-analysis showed that the recurrence rate was significantly decreased(9.7% vs 42.5%),RR = 0.27 and 95% CI [0.19,0.39] in the combined treatment group and the glucocorticoid treatment group,the difference was statistically significant(P < 0.00001).The recurrence rate was significantly lower in 2 years(20.3% vs 50.7%),RR = 0.40,95% CI [0.24,0.68],the difference was statistically significant(P = 0.0006).(c)The incidence of side reactions: a total of one study reported the occurrence of adverse reactions,the main adverse reactions were lower extremity edema,nausea,stomach discomfort.The results showed that the incidence of adverse reactions in the combined treatment group was lower than the glucocorticoid alone treatment group(26.7% vs 73.3%),RR = 0.36,95% CI [0.15,0.89],the difference was statistically significant(P = 0.03).Conclusion:For H pylori–positive adult ITP patients,anti-Helicobacter pylori therapy combined with glucocorticoid therapy can improve the effectiveness of treatment,significantly reduced the patient's 1-year recurrence rate,2-year recurrence rate and adverse reaction rate.Anti-Helicobacter pylori therapy can provide a new therapeutic strategy for clinical treatment of ITP.With the quality level is not high literature,and the sample size is not enough,this conclusion requires further expand the sample size to verify.