含氟喹诺酮类药物的四联方案对根除幽门螺杆菌的治疗价值  

Therapeutic Value of Fluoroquinolone-Based Quadruple Therapy to Eradicate Helicobacter Pylori Infection

作　　者：陈婧[1] 张杰[1] 郭子皓[1] 高茹[1] 庞桂梅[1] 史辛冬[1] 郝建宇[1] 

机构地区：[1]首都医科大学附属北京朝阳医院消化内科,北京100020

出　　处：《中国医药导刊》2011年第10期1729-1730,共2页Chinese Journal of Medicinal Guide

摘　　要：目的:探讨含氟喹诺酮类药物的四联方案对根除幽门螺杆菌的治疗价值。方法:随机将118例病例分成两组,A组(左氧氟沙星组):左氧氟沙星0.2g bid,克拉霉素0.5g bid,埃索美拉唑20mg bid,胶体次枸橼酸铋240mg bid;B组(莫西沙星组):莫西沙星0.4g qd替换左氧氟沙星,余同A组,疗程均为7d,治疗停药4周后采用^(13)C呼气试验或胃镜检查对治疗效果随访,同时观察药物的不良反应和患者的依从性。A组方案治疗失败的病例,再使用B组方案治疗1周,并对疗效进行随访。结果:118例中有115例完成全疗程治疗和随访,3例因药物反应,中途停止治疗治疗的依从性为97.4%(115/118)。主要不良反应:口苦、口干,排便次数增多,腹痛,恶心呕吐,失眠。A组和B组对幽门螺杆菌的根除率分别为78.3%和81.8%(χ~2=0.218,P>0.05)。A组治疗失败的13例病例用B组方案治疗1周,幽门螺杆菌根除率可达84.6%。结论:含氟喹诺酮类药物(左氧氟沙星和莫西沙星)的四联方案对根除幽门螺杆菌有显著疗效,依从性高,均可作为一线用药。对含左氧氟沙星的四联方案治疗失败的病例,含莫西沙星的四联方案仍可作为补救治疗方案选择。Objective： To evaluate the therapeutic value of fluoroquinolone-based quadruple therapy to eradicate Helicobacter pylori （H.pylori）.Methods： The regimens of 118 patients were randomly divided into two groups： Levofloxacin 200mg, Clarithromycin 500mg. Esomeprazole 20mg, Colloidal and Bismuth subcitrate 240mg, given twice daily for 7 days （Group A）.Moxifloxacin 400mg, Ctarithromycin 500mg, Esomeprazole 20mg, Colloidal and Bismuth subcitrate 240mg, given twice daily for 7 days（Group B）.After withdrawing drugs, patients were followed up 4 weeks later to observe adverse reaction and compliance.Eradication rate was confirmed by 13（ breath test or gastroscopy.For failure in Group A, the retreatment regimen of Group B was substituted.Results： Although discontinued procedure was occurred in 3 patients （3/118） because of severely vomitting or insomnia, 115 cases successfully accepted the whole treatment.Compliance rate was 97.4%（115/118）.Adverse reaction of the therapy concentrated on bitter taste of mouth 72.0%（85/118）, defaccation with increasing frequency 26.3%（31/118）, abdominal pain 20.3%（24/118）, nausea and w）mitting 18.6%（22/118）, insomnia 6.8%（8/118）.The eradication rates of Group A and Group B were 78.3% and 81.8% respectively （ x 2=0.218,P〉0.05）.For failure in Group A, eradication rate was achieved 84.6% with the retreatment regimen of Group B.Conclusion： Ftuoroquiuolone-based （Lcvofloxacin and Moxifloxacin） quadcuple therapy is a effective regimen for eradication of H.pylori with good compliance,which can be used as first line therapy.For failure in Levofloxacin-based regimen, Moxifloxacin-bascd regimen can provide an optimal eradication rate as considerable choice of rescuc treatment.

关 键 词：幽门螺杆菌 药物疗法 联合 左氧氟沙星 莫西沙星 

分 类 号：R57[医药卫生—消化系统]