幽门螺杆菌感染患儿三联疗法治疗后继发难辨梭菌感染分析  

Analysis of Clostridium difficile Infection Secondary to Triple Therapy in Pediatric Patients with Helicobacter pylori Infection

作　　者：胡鸿伟 程国平[1] 汪在华[2] 蔡萍[2] 张振[2] 

机构地区：[1]湖北省咸宁市通城县人民医院儿科,437400 [2]武汉市妇女儿童医疗保健中心儿科

出　　处：《胃肠病学》2015年第9期542-545,共4页Chinese Journal of Gastroenterology

基　　金：武汉市卫计委临床医学科研项目(WX13A12)

摘　　要：背景:近年来,难辨梭菌(CD)感染在儿童中的发病率及其严重程度有不断上升的趋势。根除幽门螺杆菌(Hp)感染标准三联疗法中的抗菌药物和质子泵抑制剂(PPIs)均与CD感染有关。甲硝唑既是三联疗法中的常用抗菌药物组分,又是治疗CD感染的重要药物。目的:探讨含甲硝唑三联疗法降低Hp感染患儿根除治疗后继发CD感染的作用。方法:187例经胃镜和活检病理检查确诊的慢性胃炎或胃溃疡伴Hp感染患儿纳入研究,随机接受OAM(奥美拉唑+阿莫西林+甲硝唑)或OAC(奥美拉唑+阿莫西林+克拉霉素)方案根除治疗。三联疗法治疗结束后4周复查胃镜并检测Hp,以酶联荧光免疫法对粪便标本中的CD毒素A/B进行定性检测。83名健康儿童作为正常对照组。结果:OAM组与OAC组间Hp根除率(86.5%对84.6%)、临床症状缓解率(92.7%对95.6%)和溃疡愈合有效率(81.6%对82.8%)差异均无统计学意义(P>0.05)。OAC组CD感染率显著高于OAM组和正常对照组(37.4%对10.4%和7.2%,P均<0.01),OAM组与正常对照组间差异无统计学意义(P>0.05)。结论:含甲硝唑三联疗法能有效减少Hp感染患儿根除治疗后的继发CD感染,且不影响根除治疗的疗效。Background： The incidence and severity of Clostridium difficile（ CD） infection are increasing in pediatric patients.Antibiotics and proton pump inhibitors（ PPIs）,as the components of standard triple therapy for eradication of Helicobacter pylori（ Hp） infection,are associated with CD infection. Metronidazole is the commonly used antibiotics in triple therapy regimen,and is also an important initial treatment for CD infection. Aims： To investigate the effect of metronidazolecontaining triple therapy in reducing CD infection secondary to eradication of Hp infection in pediatric patients. Methods：A total of 187 pediatric patients with chronic gastritis or gastric ulcer and Hp infection were enrolled,the diagnosis was proved by endoscopy and histopathology. Patients were randomly divided into two groups and received OAM regimen（ omeprazole ＋ amoxicillin ＋ metronidazole） and OAC regimen（ omeprazole ＋ amoxicillin ＋ clarithromycin）,respectively,for eradication of Hp infection. Four weeks after triple eradication therapy,endoscopy was re-performed and the efficacy of Hp eradication was tested. Meanwhile,the fecal specimens were obtained for qualitative detection of CD toxin A and B by using enzyme-linked immunofluorescence assay. Eighty-three healthy children were served as normal controls. Results： There were no significant differences in Hp eradication（ 86. 5% vs. 84. 6%）,clinical symptoms relieving（ 92. 7% vs. 95. 6%） and ulcer healing（ 81. 6% vs. 82. 8%） between OAM group and OAC group（ P〈0. 05）.But for CD infection rate,OAC group was significantly higher than OAM group and normal control group（ 37. 4% vs.10. 4% and 7. 2%,P all 〈0. 01）,while the CD infection rate in OAM group was similar to that in normal control group（ P〈0. 05）. Conclusions： Metronidazole-containing triple therapy may reduce the CD infection secondary to eradication of Hp infection in pediatric patients,and has no negative impact on efficacy of Hp eradication.

关 键 词：幽门螺杆菌 三联疗法 甲硝唑 难辨梭菌 儿童 

分 类 号：R725.1[医药卫生—儿科]