标准三联、新四联及10天序贯疗法对幽门螺杆菌感染的疗效观察  

Standard triple,Bismuth pectin quadruple and sequential therapies for H. pylori eradication:a randomized,double-blinded,comparative clinical trial

作　　者：宋文冲[1] 乔秀丽[1] 王晓丰[1] 高孝忠[1] 

机构地区：[1]威海市立医院消化内科,山东威海264200

出　　处：《胃肠病学和肝病学杂志》2010年第6期551-554,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的观察标准三联、新四联及10天序贯疗法对幽门螺杆菌(H.pylori)感染的疗效。方法 215例H.pylori阳性的患者随机分为3组。A组72例,用新四联疗法(雷贝拉唑+可乐必妥+阿莫西林+果胶铋治疗7天);B组72例,用10天序贯疗法(奥美拉唑+阿莫西林治疗5天,继之以奥美拉唑+克拉霉素+替硝唑再治疗5天);C组71例,用标准三联疗法(奥美拉唑+阿莫西林+克拉霉素治疗7天)。治疗后,3组均继续服用3周奥美拉唑。停药4周后复查胃镜、快速尿素酶实验与14C尿素呼气试验,评估H.pylori根除率及溃疡愈合率。结果 215例均完成抗H.pylori治疗周期及随访。A、B、C三组的H.pylori根除率分别为83.33%、88.89%和81.69%;溃疡愈合率分别为86.44%、90.16%和84.91%。B组H.pylori根除率及溃疡愈合率比A、C组稍高,H.pylori根除率与A、C组比较差异亦有统计学意义(P<0.05),但A、C组间H.pylori根除率比较差异无统计学意义(P>0.05);三组溃疡愈合率比较差异无统计学意义(P>0.05),不良反应发生率组间比较差异无统计学意义(P>0.05),普遍均能耐受。结论标准三联、新四联及10天序贯疗法均能有效根除H.pylori感染,无明显不良反应,但10天序贯疗法更为理想。Objective To compare the effectiveness of standard triple,bismuth pectin quadruple and sequential therapies for H.pylori eradication in a randomized,double-blinded,comparative clinical trial in China.Methods Total of 215 H.pylori-positive patients were enrolled in the study and randomly allocated into the following three groups：group A（n=72）received a 10-day bismuth pectin quadruple therapy（20 mg rabeprazole bid,1 000 mg amoxicillin bid,100 mg bismuth pectin qid,and 500 mg levofloxacin qd）;group B（n=72）received the sequential therapy（20 mg omeprazole bid,1 000 mg amoxicillin bid,for the first 5 days;followed by 20 mg omeprazole bid,500 mg tinidazole bid,500 mg clarithromycin bid,for the remaining 5 days）;group C（n=71）received a standard 1-week triple therapy（20 mg omeprazole bid,1 000 mg amoxicillin bid,500 mg clarithromycin bid）.After this initial period of therapy followed by 20 mg omeprazole bid for a further 3 weeks,Helicobacter pylori status was assessed by histology,14C-urea breath test and rapid urease test at baseline at 4 weeks after completion of treatment.Ulcer cicatrization was assessed by gastroscope.Results The eradication rate was 83.33%（60/72）in group A,88.89%（64/72）in group B,and 81.69%（58/71）in group C.The ulcer healing rate was 86.44% in group A（51/59）,90.16% in group B（55/61）,and 84.91% in group C（45/53）.The eradication rate of group B was statistically higher than that of group A and C（P0.05）,but the ulcer healing rate and adverse reaction rate were not difference among three groups（P0.05）.The three treatment protocols were generally well tolerated.Conclusion Sequential therapies achieved significantly higher eradication rates in comparison with standard triple and bismuth pectin quadruple therapies.

关 键 词：幽门螺杆菌 标准三联疗法 新四联疗法 10天序贯疗法 

分 类 号：R573[医药卫生—消化系统]