不同疗程布拉氏酵母菌散联合四联疗法根除幽门螺杆菌的疗效分析  

Influence of Saccharomyces boulardii Sachets combined with bismuth quadruple therapy for initial Helicobacter pylori eradication

作　　者：朱新影[1] 杜娟[1] 吴婧[1] 赵丽伟[1] 孟霞[1] 刘改芳[1] Zhu Xinying Du Juan Wu Jing Zhao Liwei Meng Xia Liu Gaifang(Department of Gastroenterology, the Third Hospital of Hebei Medical University, Shijiazhuang 050050, Chin)

机构地区：[1]河北医科大学第三医院消化内科,石家庄050050

出　　处：《中华医学杂志》2017年第30期2353-2356,共4页National Medical Journal of China

摘　　要：目的 评价布拉氏酵母菌散联合含铋剂四联疗法根除幽门螺杆菌（H.pylori）的有效性和安全性.方法 选取2014年3月至2015年3月于河北医科大学附属第三医院就诊的H.pylori阳性患者240例,按随机数字表法随机分为3组.四联组：枸橼酸铋钾 220 mg＋雷贝拉唑钠肠溶片 10 mg＋阿莫西林1 000 mg＋呋喃唑酮 100 mg,2次/d口服,共10 d;短疗程益生菌组：在上述四联组基础上,自服药第1天始口服布拉氏酵母菌散500 mg,2次/d,共14 d;长疗程益生菌组：在四联组基础上,自服药第1天始口服布拉氏酵母菌散500 mg,2次/d,共28 d;所有用药停药至少4周后行13C尿素呼气试验（13C-UBT）或14C-UBT,结果阴性者视为H.pylori根除成功,观察并记录治疗过程中的不良反应.结果 四联组、短疗程益生菌组和长疗程益生菌组意向性（ITT）分析的根除率分别为80.0%（64/80）、87.5%（70/80）、87.5%（70/80）,差异无统计学意义（P=0.321）;3组符合方案（PP）分析的根除率分别为92.8%（64/69）、94.6%（70/74）、95.9%（70/73） ,差异无统计学意义（P=0.717）;短疗程益生菌组不良反应的总体发生率以及腹泻、腹胀的发生率均低于四联组,差异有统计学意义（P=0.007、0.003、0.004）,长疗程益生菌组不良反应的总体发生率以及腹泻、腹胀的发生率均低于四联组,差异有统计学意义（P=0.005、0.001、0.010）,而两益生菌组不良反应发生率比较差异无统计学意义.结论 2周或4周布拉氏酵母菌散加入含铋剂四联根除H.pylori方案,均可降低不良反应的总体发生率和腹泻、腹胀的发生率.Objective To evaluate the efficacy and safety of Saccharomyces boulardii Sachets combined with bismuth quadruple therapy for initial Helicobacter pylori（H.pylori） eradication.MethodsFrom March 2014 to March 2015, 240 participants from the third hospital of Hebei medical university with H.pylori infection were recruited and randomized into three groups： Quadruple therapy group received bismuth potassium citrate 220 mg bid ＋ Rabeprazole 10 mg bid ＋ amoxicillin 1 000 mg bid＋ furazolidone 100 mg bid for 10 days. Short-term group and long-term group received the same quadruple therapy for 10 days as above, as well as Saccharomyces boulardii Sachets 500 mg bid for 14 days and 28 days, respectively. H.pylori eradication was confirmed by 13C/14C-UBT at least 4 weeks after completion of therapy. And side effects were investigated during the therapy.Results The H.pylori eradication rates in quadruple therapy, short-term and long-term group were 80%, 87.5% and 87.5% by ITT analysis （P=0.321） and 92.8%, 94.6% and 95.9% by PP analysis （P=0.717）, respectively. The overall side effect rate and occurrence of diarrhea and abdominal distension were significantly lower in short-term or long-term group as compared with quadruple therapy group（P=0.007, 0.003, 0.004）, but there was no significant difference between the two probiotics groups.Conclusions Both short and long-term Saccharomyces boulardii Sachets reduced the overall side effect rate and occurrence of diarrhea or abdominal distension when combined with bismuth quadruple therapy for initial H.pylori eradication and no difference was observed in efficacy or safety between the two groups.

关 键 词：螺杆菌 幽门 布拉氏酵母菌 铋 

分 类 号：R573.3[医药卫生—消化系统]