基于胃镜的个体化诊断在幽门螺杆菌根除中应用研究  

Application of Endoscopy-based Tailored Therapy in the Eradication of Helicobacter pylori

作　　者：张灵云[1] 宋志强[2] 周丽雅[2] 张建中[3] 丁钰[2] 

机构地区：[1]北京大学第四临床医学院,北京100096 [2]北京大学第三医院消化科,北京100191 [3]中国疾病预防控制中心传染病预防控制所,北京102206

出　　处：《中国微创外科杂志》2015年第6期497-501,共5页Chinese Journal of Minimally Invasive Surgery

基　　金："十二五"国家支撑计划课题(2012BAI06B02);首都卫生发展科研专项(2011-4032-02)

摘　　要：目的：探讨基于胃镜的个体化根除治疗在幽门螺杆菌感染初治和复治患者中的疗效、安全性和依从性。方法2013年3月～2014年6月于我院行胃镜检查并明确幽门螺杆菌感染的患者，胃镜下取胃黏膜标本进行幽门螺杆菌菌株培养、药物敏感性试验和细胞色素P450同工酶2 C19基因型检测。根据克拉霉素是否敏感选用克拉霉素或替硝唑，基因型为快、慢及中间代谢型分别选用雷贝拉唑或埃索美拉唑，联合阿莫西林组成三联方案，疗程10天，治疗结束后4～12周复查尿素呼气试验，确定幽门螺杆菌感染是否被成功根除。结果共318例初治和62例复治患者幽门螺杆菌培养成功，接受个体化治疗，培养成功率分别为90．9％（318／350）和91．2％（62／68），纳入意向性分析；最终298例初治和59例复治患者完成治疗和随访，纳入遵循方案分析。幽门螺杆菌感染初治及复治患者的根除率，意向性分析分别为88．7％（95％可信区间为85．2％～92．1％）和75．8％（65．1％～86．5％），遵循方案分析分别为93．3％（89．9％～96．0％）和79．7％（69．7％～89．7％）。2组不良反应发生率分别为22．0％（70／318）和33．9％（21／62），依从性分别为94．3％（300／318）和95．2％（59／62）。结论基于胃镜的个体化治疗在幽门螺杆菌感染初治患者中根除率较为理想，而在复治患者中疗效欠佳。Objective To determine the eradication efficacy , safety, and compliance of endoscopy-based tailored therapy in the initial and retreated patients with Helicobacter pylori infection. Methods Between May 2013 and June 2014, patients with dyspepsia （18-70 years old） diagnosed as having infection of Helicobacter pylori under gastroscopy in our hospital were recruited into the study.Gastric mucosa specimens taken with the gastroscopy were cultured for Helicobacter pylori and then antibiotics sensitivity and cytochrome P450 isoenzyme 2C19 genotype were detected .Medications for tailored therapy included amoxicillin and were adjusted based on clarithromycin sensitivity （ clarithromycin or tinidazole ） and cytochrome P450 isoenzyme 2C19 genotype （ rabeprazole or esomeprazole ） .Eradication status was assessed 4-12 weeks after treatment with urea breath test . Results A total of 318 initially-treated and 62 retreated cases of infection of Helicobacter pylori had successful culture of Helicobacter pylori and the culture success rates were 90.9% （318/350） and 91.2% （62/68）, respectively.These cases were included in the intention-to-treat analyses. Finally 298 initially-treated and 59 retreated cases completed the treatment and follow-up and were included in the per-protocol analyses.The eradication rates of endoscopy-based tailored therapy in the initially-treated and the retreated cases were 88.7%（95%confidence interval, 85.2%-92.1%） and 75.8% （95% confidence interval,65.1%-86.5%） in intention-to-treat analyses, and 93.3%（95%confidence interval ,89.9%-96.0%） and 79.7%（95%confidence interval ,69.7%-89.7%） in per-protocol analyses . The rates of adverse effects were 22.0% （70/318） and 33.9% （21/62） in the two groups.The compliance of the two groups was 94.3%（300/318） and 95.2%（59/62）, respectively. Conclusion Endoscopy-based tailored therapy has a satisfactory eradication efficacy in initially-treated patients with Helicobacter pylori infection, but a poor eradication effi

关 键 词：幽门螺杆菌 根除率 个体化方案 抗生素耐药 胃镜 

分 类 号：R573[医药卫生—消化系统]