天津医药

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序贯疗法根除幽门螺杆菌的疗效观察

张杰   

  1. 河北联合大学附属开滦医院
  • 收稿日期:2011-10-08 修回日期:2011-10-31 出版日期:2012-01-15 发布日期:2012-01-15
  • 通讯作者: 张杰

Jie Zhang   

  • Received:2011-10-08 Revised:2011-10-31 Published:2012-01-15 Online:2012-01-15
  • Contact: Jie Zhang

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摘要： 目的：比较8天序贯疗法与三联、铋剂四联疗法根除幽门螺杆菌（H.pylori）的疗效。 方法：将经胃镜检查确诊为慢性胃炎和消化性溃疡且H.pylori阳性的患者335例随机分为3组，A组方案：前4天，雷贝拉唑+阿莫西林；后4天，雷贝拉唑+克拉霉素+奥硝唑。B组方案：雷贝拉唑+克拉霉素+阿莫西林+胶体果胶铋，疗程10天。C组方案：雷贝拉唑+克拉霉素+阿莫西林，疗程10天。治疗后复查14C-尿素呼气试验。 结果：A、B、C三组H.pylori ITT根除率分别为90.2%、91.1%及80.2%，PP根除率分别为92.7%、93.6%及84.0%，两种分析方法均显示A、B两组H.pylori根除率明显高于C组，差异有统计学意义（P<0.05），而A组与B组间差异无统计学意义（P>0.05），但8天序贯疗法减轻了患者的经济负担。三种方案症状缓解率及不良反应发生率差异均无统计学意义（P>0.05）。 结论：8天序贯疗法可以获得较高的H.pylori根除率且耐受性好、可减轻经济负担，是一种可供选择的一线治疗方案。

关键词: 幽门螺杆菌, 序贯疗法, 三联疗法, 四联疗法, 根除率

Abstract: AIM: To compate the effectiveness of Triple, bismuth pectin quadruple and 8-day sequential therapies for Helicobacter pylori (H.pylori) eradication. METHODS: Three hundred and thirty-five patients with H.pylori infection accompanied with peptic ulcer or chronic gastritis were randomly divided into three groups: group A (n=112) received sequential therapy (rabeprazole 10 mg plus amoxicillin 1000mg for 4 days, and rabeprazole 10 mg plus clarithromycin 500 mg and ornidazole 500 mg for another 4 days); group B (n=112) received a 10-day bismuth pectin quadruple therapy (rabeprazole 10 mg plus clarithromycin 500 mg, amoxicillin 1000mg and colloidal bismuth pectin 300mg); group C (n=111) received 10 days triple therapy (rabeprazole 10 mg plus clarithromycin 500 mg, amoxicillin 1000mg). All drugs were given twice daily. Eradication of H.pylori was determined after treatment. RESULTS: Intention-to-treat and per-protocol eradication rate was respectively 90.2% and 92.7% in group A, 91.1% and 93.6% in group B, 80.2% and 84.0% in the group C.The eradication rates of H.pylori were significantly higher in group A and group B than in group C (P<0. 05).No statistically significant difference between group A and group B (P>0.05).However, 8-day sequential therapy can decrease cost of therapy.There was no difference in incidence of side effects and symptomatic relief among the three groups (P>0.05). CONCLUSION: The 8-day sequential therapy can achieve a high H.pylori eradication rate, and can be used as first-line therapy.

Key words: Helicobacter pylori, Sequential therapy, Triple therapy, Quadruple therapy, Eradication rate