含呋喃唑酮四联一线方案初治幽门螺杆菌的临床观察  

Furazolidone-based quadruple therapy as f irst-line treatment for Helicobacter pylori infection

作　　者：陈伟[1] 曾亚[1] 张桂英[2] 李乾[2] 徐美华[2] 刘霆[2] 

机构地区：[1]湖南省长沙市中心医院消化内科,湖南省长沙市410004 [2]中南大学湘雅医院消化内科,湖南省长沙市410008

出　　处：《世界华人消化杂志》2013年第14期1366-1371,共6页World Chinese Journal of Digestology

摘　　要：目的:观察含呋喃唑酮的四联7d及10d疗法,一线治疗幽门螺杆菌(Helicobacter pylori,H.pylori)阳性的慢性胃炎及十二指肠球部溃疡,旨在寻求H.pylori根除治疗的理想方案,为临床提供一个H.pylori根除率较高且费用较低的治疗方案.方法:(1)152例H.pylori阳性的慢性胃炎或十二指肠球部溃疡患者,随机分成对照组(埃索美拉唑+丽珠得乐+阿莫西林+克拉霉素缓释片)、含呋喃唑酮四联7d组(埃索美拉唑+丽珠得乐+阿莫西林+呋喃唑酮)及10d组(埃索美拉唑+丽珠得乐+阿莫西林+呋喃唑酮);(2)随诊并记录患者症状缓解情况和药物不良反应,了解患者依从性及耐受性,H.pylori根除治疗结束后至少4wk,停用PPI至少2wk后进行尿素呼气试验;(3)根除率采用ITT分析和PP分析,计算成本-效果比值和增量成本-效果比值评价比较3种方案.结果:H.pylori根除率按PP分析及ITT分析:对照组为87.50%及79.25%,四联7d组为88.89%及83.33%,四联10d组为93.62%及86.27%;3组间根除率无显著差异.3组间症状缓解情况比较无显著差异.3组间不良反应发生率比较无显著差异.对照组、四联7d组和四联10d组的成本-效果比分别为3.69、2.48和3.37,四联7d组与四联10d组相对于对照组的增量成本-效果比值分别为-73.2和-1.17.结论:含呋喃唑酮的四联7d及10d方案均具有较高的H.pylori根除率,不良反应少而轻微,降低了四联方案的成本,两种方案均为安全、有效、经济的一线治疗方案,符合我国国情,值得临床推广.AIM： To observe the rates of symptom remis- sion, adverse reactions, and Helicobacter pylori （H. pylori） eradication of furazolid0ne-based quadruple therapy as first-line treatment for pa- tients with H. pylori infection. METHODS： One hundred and fifty-two patients who were diagnosed with H. pylori-positive chronic gastritis or duodenal ulcer were ran- domly divided into three groups： control group （esomeprazole ＋ bismuth potassium critrate ＋ amoxicillin ＋ clarithromycin）, 7-day furazoli- done-based quadruple therapy group （esome- prazole ＋ bismuth potassium critrate ＋ amoxicil- lin ＋ furazolidone）, and 10-day furazolidone-based quadruple therapy group （esomeprazole ＋ bismuth potassium critrate ＋ amoxicillin ＋ furazolidone）. Patients were followed to observe symptom remission and adverse reactions. After at least 4 wk of treatment and 2 wk of non-use of PPIs, H. pylori status was assessed using the urea breath test. H. pylori eradication rate was assessed by PP and ITT analysis. Cost-effective- ness ratio and incremental cost-effectiveness ratio were used to evaluate the three treatments. RESULTS： On PP analysis, the rates of H. pylori eradication in the three groups were 87.50%, 88.89% and 93.62%. On ITT analysis, the rates of H. pylori eradication in the three groups were 79.25%, 83.33% and 86.27%. There were no significant differences in the rates of H. pylori eradication among the three groups either on PP analysis or on ITT analysis. The rates of symp- tom remission and adverse reactions in the three groups also showed no significant difference （all P 〉 0.05）. The cost-effectiveness ratios of the three groups were 3.69, 2.48 and 3.37. The incre- mental cost-effectiveness ratios of the 7-day and 10-day furazolidone-based quadruple therapy groups relative to the control group were -73.22 and -1.17. CONCLUSION： Furazolidone-based quadruple therapy is associated with a high rate of H. pylori eradication and few slight side effects and can reduce the costs of quad

关 键 词：幽门螺杆菌 四联 根除率 呋喃唑酮 

分 类 号：R57[医药卫生—消化系统]