新四联根除幽门螺旋杆菌的临床对比研究  

Clinical evaluation of new quadruplet therapy for Helicobacter pylori eradication

作　　者：顾勇[1] 杨艳[2] 王兰[1] 李娜[1] 惠增骞[1] 段炜[1] 

机构地区：[1]武警陕西总队医院消化内科,西安710054 [2]第四军医大学西京消化病医院四科,西安710032

出　　处：《武警医学》2016年第5期493-496,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的比较3种不同用药方法治疗幽门螺旋杆菌感染(helicobacter pylori,Hp)的临床效果及其不良反应发生情况。方法选取420例Hp阳性患者,随机分成3组。A组标准四联组(埃索美拉唑+胶体果胶铋+阿莫西林+克拉霉素),B组新四联组(埃索美拉唑+胶体果胶铋+阿莫西林+环丙沙星),A、B两组用药疗程14d。C组序贯治疗组(埃索美拉唑+阿莫西林治疗5 d,随后埃索美拉唑+环丙沙星+替硝唑再治疗5 d)。比较3组患者Hp根除率,随访3、6个月的Hp再感染率及不良反应发生率。结果 B组、C组Hp根除率分别为92.9%、95.7%,优于A组的85.0%(P<0.05),随访3个月A、B、C组再感染率分别为10.1%、6.2%、7.5%,3组比较差异无统计学意义。6个月A组Hp再感染率为26.9%,显著高于B、C两组的13.8%、11.9%(P<0.05)。不良反应发生率组间比较差异无统计学意义。结论以环丙沙星为基础的新四联及10d序贯疗法高效、复发率低、安全、患者依从性好,可推荐作为抗Hp治疗的一线标准治疗方案。Objective To compare the clinical efficacy and adverse events of three different therapies for Helicobacter pylori（ H. pylori） eradication. Methods Four hundred and twenty H. pylori positive patients were randomly assigned into three groups in this open-label,prospective,controlled study. Group A patients received 14-day standard quadruplet therapy（ esomeprazole plus colloidal bismuth pectin,amoxicillin and clarithromycin）. Group B received 14-day new quadruplet therapy（ esomeprazole plus colloidal bismuth pectin,amoxicillin and ring ciprofloxacin）. Group C received 10-day sequential therapy（ esomeprazole plus amoxicillin for 5days,followed by esomeprazole plus ciprofloxacin and tinidazole for 5 days）. H. pylori eradication rate,reinfection rates and adverse events were assessed at three months and six months after treatment. Results H. pylori eradication rates in group B,group C were significantly higher than in the group A（ 92. 9%,95. 7% vs 85. 0%,P〈0. 05）. H. pylori reinfection rates were 10. 1%,6. 2%,7. 5%,respectively,with no significant difference between the three groups,at three months after treatment. Six months after treatment,H. pylori reinfection rate in group A was 26. 9%,which was significantly higher than in groups B,and C,with a 13. 8% and11. 9%,respectively（ P〈0. 05）. The incidence rate of adverse events between the three groups was not significantly different.Conclusions Ciprofloxacin-based new quadruple therapy and 10-day sequential therapy are both efficient and safe,with a low reinfection rate and high patient compliance,and can be recommended as first-line anti-H. pylori therapy.

关 键 词：幽门螺旋杆菌 标准四联疗法 新四联疗法 序贯疗法 

分 类 号：R573[医药卫生—消化系统]