| Objective To evaluate the benefits and harms of eradicating helicobacter pylori(Hp) in adult idiopathic thrombocytopenic purpura(ITP).Methods We searched Pubmed, Embase, Cochrane Library, CNKI, Wan Fang and Wei Pu for randomized controlled trials(RCTs) of eradicating Hp in ITP of adults with Hp infection, age ≥ 18 years and both sexes, fulfilling the diagnostic criteria of ITP and Hp infection and excluding secondary thrombocytopenia. The intervention of the experiment group was anti-Hp therapy with different regimens and that of control group was blank or placebo. The major outcomes overall response(defined as platelet >30×109/L), overall remission(defined as platelet >50×103/u L) and recurrence. The minor outcomes included severe bleeding, remission maintenance time, readmission, Cag A protein, GPIIb/IIIa B cells and Th1/Th2 ratio. The safety outcomes included any side effects, drop-out for any reason and withdrawals due to serious side effects. Two reviewers independently identified the trials from the searched records, evaluated the risk bias of the included trials and collected the data for meta-analysis where Cochrane Collaboration’s Rev Man5.0 software was used.Results Ten RCTs(n=633) were included. Nine compared anti-Hp therapy group with blank group and one compared anti-Hp therapy with placebo. All 10 RCTs used random allocation but 2 of them did not introduce the method. None of these trials mentioned allocation concealment and blinding. Only 1 trial repored 2 patients’ lost of follow-up but did not specify the reason. The overall bias risks were high in these included trials. Seven RCTs reported overall response. Six RCT compared anti-Hp therapy with blank control. Anti-Hp regimens were proton pump inhibitor(PPI)+clarithromycin+ amoxicillin for 7d/10 d in 5 of them and it was sequential therapy for 5d+5d in the other RCT. Compared with blank control, analysis showed anti-Hp treatment got higher overall response rate and the pooled RR was 1.23 and 95% CI 1.12 to 1.36. The only RCT compareding anti-Hp therapy group(PPI+clarithromycin+ amoxicillin, 7d) with placebo showed that anti-Hp got a higher overall response rate with the RR 2.30 and 95% CI 1.20 to 4.40. Overall remission was reported in one RCT which compared anti-Hp treatment(PPI + amoxicillin +clarithromycin, 7 d) with blank group and showed higher overall remission rate in anti-Hp treatment group but no statistically(RR=12.07). Recurrence within 1 year was reported in 3 RCTs comparing anti-Hp treatment group with blank group. Anti-Hp regimens were PPI+clarithromycin+ amoxicillin for 7d/10 d in 2 trials and it was sequential therapy for 5d+5d in the other trial. Anti-Hp treatment was found to reduce recurrence. The pooled RR was 0.52 and 95% CI 0.39 to 0.70. None of the included RCTs reported secondary outcomes and side effects.Conclusions Compared with the control group, anti-HP therapy can not only make the adult ITP patients with Helicobacter pylori infection benefit, also can reduce the recurrence rate. Anti-HP therapy can be considered as a way of adults ITP patients with HP infection. Anti-Hp treatment for ITP complicated with Hp infection might get higher overall response rate and overall remission rate and reduce recurrence rate. Because high bias risks exised in the included trials,the benefit of anti-Hp treatment needs confimation. |
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