抗幽门螺杆菌治疗防治消化道肿瘤化疗致吐临床研究  

Significance of helicobacter pylori eradication in the prevention and treatment of vomiting induced by gastrointestinal cancer chemotherapy

作　　者：姚艺玮 胡冰[1] 何义富[1] 罗会芹[1] 季楚舒[1] 

机构地区：[1]安徽省立医院肿瘤科,安徽合肥230001

出　　处：《中华肿瘤防治杂志》2017年第21期1539-1543,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的幽门螺旋杆菌(helicobacter pylori,HP)感染与多种消化道疾病密切相关,临床发现合并HP感染的消化道肿瘤患者化疗引起的恶心、呕吐发生率高。本研究探讨抗HP治疗在防治消化道肿瘤化疗导致恶心、呕吐中的意义。方法选取2015-12-01-2016-12-01安徽省立医院进行化疗的消化道恶性肿瘤患者88例,经14C-尿素呼气试验检查后筛选的88例患者均为HP阳性,采用随机数字表法分为试验组(n=45)和对照组(n=43)。在化疗间期试验组予以正规四联抗HP治疗(泮托拉唑20mg+克拉霉素0.5g+阿莫西林1.0g+枸橼酸铋钾220mg),2次/d,连续服用2周。试验组抗HP治疗结束后4周复查14C-尿素呼气试验,获得HP根治的患者纳入统计学分析。通过MASCC止吐工具(MASCC antiemesis tool,MAT)、呕吐生活功能指数量表(functional living index-emesis,FLIE)记录化疗0~120h患者恶心呕吐发生情况及对患者生活功能的影响,对比试验组与观察组化疗期间恶心、呕吐情况。在化疗期间两组均予以5-羟色胺3(5-HT3)受体的拮抗剂托烷司琼6mg、胃复安20mg和地塞米松10mg进行预防性止吐治疗。结果试验组共有40例患者获得HP根治并纳入统计学分析,根治率为88.9%。化疗期间试验组和对照组恶心缓解率急性期分别为85.0%和53.5%(P=0.002),延迟期分别为65.0%和37.2%(P=0.011),总体分别为67.5%和39.5%(P=0.010)。试验组和对照组呕吐缓解率急性期分别为87.5%和62.8%(P=0.009),延迟期分别为72.5%和48.8%(P=0.028),总体分别为72.5%和51.2%(P=0.046)。采用FLIE问卷评估患者化疗5d内CINV对生活功能的影响。试验组和对照组在恶心部分中生活质量影响甚微(no impact to daily life,NIDL)患者比例分别为72.5%和48.8%(P=0.028)。呕吐部分中NIDL患者比例分别为77.5%和53.5%(P=0.022)。FLIE问卷总分显示,试验组和对照组NIDL患者所占比例分别为75.0%和48.8%(P=0.014)。结论抗HP治疗可以改善消化道肿瘤患者化疗所致的恶�OBJECTIVE Helicobacter pylori （HP） infection is closely related to many digestive diseases. The pa- tient of gastrointestinal cancer complicated with HP infection had high incidence of nausea and vomiting induced by chem- otherapy. This study is to discuss the significance of HP eradication in the prevention and treatment of nausea and vomi ting,induced by chemotherapy. METHODS In total, patients with malignant tumors of the gastrointestinal tract, who were admitted to Anhui Provincial Hospital Oncology Department and Anhui Provincial Cancer Hospital Medical Oncology Department between December 1,2015 and December 1,2016 ,were selected. Based on the 14C-urea breath test results,88 patients with HP positive were selected,then randomly divided into experimental group （n= 45） and control group （n= 43）. During the interval of chemotherapy, the experimental group was administered the standard anti-HP quadruple thera py （pantoprazole 20 mg @ clarithromycin 0.5 gq-amoxicillin 1.0 gq-bismuth potassium citrate 220 mg） twice a day,for 2 weeks. The 14C-urea breath test was repeated 4 weeks after the end of the anti-HP treatment. Patients with HP eradi- cation were included in the statistical analysis. The incidence of nausea and vomiting and their effects on patients＇ life functions were recorded using the MASCC Antiemetic Tool （MAT） and the Vomiting Living Function Index （FLIE） from 0 to 120 hours after chemotherapy. Information on nausea and vomiting of the experimental group and control group were obtained after HP eradication to identify any significance of HP eradication in the prevention and treatment of nausea and vomiting induced by chemotherapy. RESULTS Totally 40 patients in the experimental group had HP eradication and were included in the statistical analysis, the HP eradication rate was 88.9 ~. The remission rate of nausea in experimental group was better than that in control group. In the acute phase the remission rates of nausea were 85.0% vs 53.5% （P=0. 002）;in the lag phase the

关 键 词：幽门螺杆菌 消化道肿瘤 恶心 呕吐 

分 类 号：R735[医药卫生—肿瘤]