关于铋剂与质子泵抑制剂联用的思考  

Combination of bismuth and proton pump inhibitor in Helicobacter pylori eradication therapy

作　　者：唐莉[1] 蔡燕峰[1] 杨勤[1] 金小晶[1] TANG Li;CAI Yanfeng;YANG Qin;JIN Xiaojin(Department of Spleen-Stomach Diseases,Nanjing Hospital of Traditional Chinese Medicine,Nanjing University of Traditional Chinese Medicine,Nanjing 210001,China)

机构地区：[1]南京中医药大学附属南京中医院脾胃病科

出　　处：《医学争鸣》2020年第1期53-57,共5页Negative

基　　金：南京市科技发展计划项目(201605037)

摘　　要：我国幽门螺杆菌(H.pylori)感染共识报告推荐铋剂四联疗法作为一线根除方案,但是铋剂与质子泵抑制剂联用是否安全合理、有无违规、如何联用仍有许多疑惑。现通过整理分析铋剂与质子泵抑制剂联用的相关文献发现,抑制胃酸可能影响铋剂药效,质子泵抑制剂可增加铋剂吸收与蓄积,可致血铋浓度升高,脏器中铋蓄积量增加。此外,各国指南或共识中铋剂四联疗法的证据级别均较低,缺乏高质量随机对照研究或药效/药代动力学研究的支持。不同国家或地区对于铋剂四联方案推荐级别不同,并非均作为一线根除方案,欧美日等一些国家尚未批准常规使用铋剂治疗H.pylori相关的胃病,并且铋剂与质子泵抑制剂联用有违铋剂的药品说明书。本文就铋剂与质子泵抑制剂联用的若干问题作一初步探讨,旨在引起同道对H.pylori根除方案中联合用药的合理性、安全性的进一步思考和研究。The Chinese consensus report on helicobacter pylori infection recommended bismuth quadruple therapy as the first-line eradication therapy.However,there are many doubts regarding whether the combination of bismuth and proton pump inhibitor is safe and reasonable,and how to use it probably.After searching for the related literatures,we found that the inhibition of gastric acid might affect the efficacy of bismuth.Proton pump inhibitors can increase bismuth absorption and accumulation,lead to the increase of bismuth concentration in blood and bismuth accumulation in viscera.In addition,the level of evidence for bismuth quadruple therapy in national guidelines or consensus is relatively low due to a lack of the support from high-quality randomized controlled trials or pharmacodynamics/pharmacokinetic studies.Different countries or regions have different recommendation levels for bismuth quadruple therapy,which is not always as first-line eradication therapy.Some countries,such as Europe,America and Japan,have not allowed the routine use of bismuth for the treatment of Helicobacter pylori-related gastric diseases.And the bismuth combined with proton pump inhibitor goes against the instructions of the bismuth.In this paper,some questions about the combination of bismuth and proton-pump inhibitors are discussed,in order to spur further consideration and research on the rationality and safety of the drug combination in the Helicobacter pylori eradication therapy.

关 键 词：铋剂 幽门螺杆菌 质子泵抑制剂 

分 类 号：R573[医药卫生—消化系统]