10d序贯治疗根除幽门螺杆菌的疗效评价  

Efficacy of a 10-day sequential therapy for elimination of Helicobacter pylori infection

作　　者：黄一沁[1] 张赣生[1] 胡晓娜[1] 尹曙明[1] 保志军[1] 王一倩[1] 

机构地区：[1]复旦大学附属华东医院消化内科,上海200040

出　　处：《国际病理科学与临床杂志》2012年第3期205-210,共6页Journal of International Pathology and Clinical Medicine

基　　金：上海申康医院发展中心市级医院适宜技术推广和应用项目(SHDC12010213)~~

摘　　要：目的：探索根除率较高、价格较低、安全实用的幽门螺杆菌（Helicobacterpylori,H.pylori）根除方案。方法：289例经胃镜证实伴H.pylori感染的消化不良患者,随机分为三组：1）10d序贯组。92例,以奥美拉唑20mg＋阿莫西林1g,每日2次,疗程5d,然后以奥美拉唑20mg＋克拉霉素500mg＋甲硝唑400mg,每日2次,疗程5d的序贯治疗;2）1周奥美拉唑、阿莫西林、克拉霉素（omeprazole,amoxicillin,clarithromycin,OAC）组。97例,以奥美拉唑20mg＋阿莫西林1000mg＋克拉霉素500mg,每日2次,疗程7d;3）2周OAC组。100例,以奥美拉唑20mg＋阿莫西林1000mg＋克拉霉素500mg,每日2次,疗程14d。抗H.pylori治疗结束并停药4~8周后复查13C-尿素酶呼气试验。结果：按意向性治疗（intention-to-treat,ITT）分析,10d序贯组、2周OAC及1周OAC组的H.pylori根除率分别为80.43%,69.00%,63.92%;按方案（per-protocol,PP）分析,三组H.pylori根除率分别为87.06%,74.19%,69.66%;与OAC1周及2周组比较,序贯组疗效显著（PH.pylori所需费用分别为287.8,550.9和287.1元。结论：10d序贯治疗方案具有根除率较高、疗程短、安全、依从性良好等特点,对于根除H.pylori具有较好的成本效果。Objective： To develop a practical regimen for the elimination of Helicobacter pylori （H. pylori） infection which is rapid, safe, and cost-effective. Methods： The 289 patients with H. pylori infection, diagnosed by gastroscopy, were randomized into 1） a sequential group （n=92）; 2） a 1- week OAC group （n = 97） treated for one week with a combination of omeprazole, amoxicillin, and clarithromycin （OAC）; and 3） a 2- week OAC group （n=100） treated for two weeks with OAC. The sequential group was treated with omeprazole （Ome） 20 mg and amoxicillin （Amo） 1000 mg bid for 5 days, then with Ome 20 mg, clarithromycin （Cla） 500 mg, and metronidazole 400 mg bid for another five days. The 1-week OAC group was treated with triple therapy of Ome 20 mg, Amo1000 mg, and Cla 500 mg bid for 1 week. The 2-week OAC group was treated likewise, but for two weeks. A 13C-urea breath test was used to monitor H. pylori for four to eight weeks following therapy. Results： In the intention-to-treat analysis, elimination of infection was 80.4%, 69.0%, and 63.9%, respectively, in the sequential group, the 1-week OAC group, and the 2-week OAC group. In the per-protocol analysis, the eradication rates in the three groups were 87.1%, 74.2%, 69.7%, respectively. Compared with the 1-week and 2-week OAC groups, the efficacy of treatment in the sequential group is significantly better （PH. pylori therapy （per patient） in the three groups was 287.8, 550.9, and 287.1 RMB,respectively. Conclusion： A ten days sequential therapy regimen yields a higher rate of elimination of H. pylori, over an intermediate time course, safely and with good compliance, and at lower cost.

关 键 词：幽门螺杆菌 根除治疗 序贯疗法 按意向性治疗分析 按方案分析 

分 类 号：R57[医药卫生—消化系统]