混合疗法与含铋剂四联疗法根除幽门螺杆菌感染的疗效观察  

Efficacy of Hybrid Therapy and Bismuth Quadruple Therapy in Treatment of Helicobacter pylori Infection

作　　者：何小建[1] 王雯[1] 张志坚[1] 林克荣[1] 李达周[1] 王蓉[1] 刘建强[1] 陈志平[1] 李海涛[1] 

机构地区：[1]南京军区福州总医院消化内科,350025

出　　处：《胃肠病学》2017年第3期168-171,共4页Chinese Journal of Gastroenterology

摘　　要：背景:含铋剂四联疗法是我国共识推荐的根除幽门螺杆菌(Hp)感染的一线治疗方案,然而铋剂潜在的肾毒性导致其临床应用存在局限性。目的:评价混合疗法对初治Hp感染患者的疗效和安全性。方法:纳入2014年1月—2015年12月在南京军区福州总医院确诊Hp感染且未接受过根除治疗的患者152例,随机接受混合疗法[(埃索美拉唑+阿莫西林)×7 d+(埃索美拉唑+阿莫西林+克拉霉素+甲硝唑)×7 d]或含铋剂四联疗法[(埃索美拉唑+阿莫西林+克拉霉素+胶体果胶铋)×14 d]根除Hp治疗。根除治疗结束停药至少4周后复查14C-或13C-尿素呼气试验。结果:两组患者基线资料差异无统计学意义(P>0.05)。149例患者最终完成试验。混合疗法组ITT和PP根除率分别为97.4%(75/77)和98.7%(75/76),含铋剂四联疗法组分别为89.3%(67/75)和91.8%(67/73),两组间差异有统计学意义(P均<0.05)。混合疗法组不良反应发生率显著高于含铋剂四联疗法组(29.9%对16.0%,P<0.05),但无患者因严重不良反应导致停药。结论:混合疗法根除Hp感染的疗效明显优于含铋剂四联疗法,尽管不良反应有所增加,但患者均可耐受。该疗法可用于Hp感染的一线治疗。Background：Bismuth quadruple therapy is recommended as a first-line therapeutic regimen for Helicobacter pylori（Hp）infection in China.However,the renal toxicity induced by bismuth resulted in limitation of its clinical use.Aims：To assess the efficacy and safety of hybrid therapy for initial eradication of Hp infection.Methods：One hundred and fiftytwo patients proved to be positive for Hp infection and treatment-na6ve at the Fuzhou General Hospital of Nanjing Military Command of Chinese PLA from Jan.2014 to Dec.2015 were enrolled and randomized to receive either hybrid therapy（esomeprazole and amoxicillin for 7 days,followed by esomeprazole,amoxicillin,clarithromycin and metronidazole for 7days）or bismuth quadruple therapy（esomeprazole,amoxicillin,clarithromycin and colloidal bismuth pectin for 14 days）.Hp eradication was assessed by14C/13C-urea breath test at a minimum of 4 weeks after the end of treatment.Results：No significant differences were found in general status between the two groups at baseline（P〉0.05）.A total of 149 patients completed the therapy.In hybrid therapy group the eradication rate was 97.4%（75/77）by ITT analysis and 98.7%（75/76）by PP analysis;while in bismuth quadruple therapy group the eradication rates by ITT and PP analyses were 89.3%（67/75）and 91.8%（67/73）,respectively.Hybrid therapy was superior to bismuth quadruple therapy（P all〈0.05）.Although the incidence of adverse events was higher in hybrid therapy group than in bismuth quadruple therapy group（29.9%vs.16.0%,P〈0.05）,none of the patients discontinued the therapy because of severe adverse events.Conclusions：Hybrid therapy showed better efficacy than bismuth quadruple therapy for treatment of Hp infection,and the adverse events were well tolerated.Hybrid therapy might be used as first-line treatment for Hp infection.

关 键 词：幽门螺杆菌 混合疗法 含铋剂四联疗法 根除 安全 

分 类 号：R573.1[医药卫生—消化系统]